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Provenzano R, De Caro C, Vitiello A, Izzo L, Ritieni A, Ungaro F, Quaglia F, Russo E, Miro A, d'Angelo I. Enhancing transmucosal delivery of CBD through nanoemulsion: in vitro and in vivo studies. Drug Deliv Transl Res 2024; 14:1648-1659. [PMID: 38064145 DOI: 10.1007/s13346-023-01481-x] [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] [Accepted: 11/09/2023] [Indexed: 04/28/2024]
Abstract
Cannabidiol (CBD) has gained significant attention as a complementary and alternative medicine due to its promising therapeutic properties. However, CBD faces obstacles when administered orally due to its poor solubility in water, leading to limited absorption into the bloodstream and low and variable bioavailability. Therefore, the development of innovative delivery approaches that can enhance CBD's bioavailability, facilitate administration, and promote patient adherence is crucial. We propose a new approach for buccal delivery of CBD based on a self-assembling nanoemulsion (NE) made of a mixture of surfactants (Tween 80 and Labrasol) and medium chain triglycerides (MCTs). The NE formulation showed properties suitable for buccal administration, including appropriate size, CBD content, and surface properties, and, if compared to a CBD-MCT solution, it exhibited better control of administered doses, faster dissolution in buccal medium, and enhanced stability. The CBD-NE effectively released its active load within 5 h, remained stable even when diluted in simulated buccal fluids, and could be easily administered through a commercially available spray, providing consistent and reproducible doses of NE with optimized properties. In vitro permeation studies demonstrated that the CBD-NE facilitated swift and consistent permeation through the buccal mucosa, resulting in a higher concentration in the acceptor compartment compared to CBD-MCT. Furthermore, the in vivo study in mice showed that a single buccal administration of CBD-NE led to a quicker onset of action than a CBD solution in MCT, while maintaining the same plasma levels over time and leading to typically higher plasma concentrations compared to those usually achieved through oral administration. In conclusion, our CBD-NE represents a promising alternative formulation strategy for buccal CBD administration, overcoming the challenges associated with conventional formulations such as variable bioavailability and low control of administered doses.
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Affiliation(s)
- Romina Provenzano
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Carmen De Caro
- Department of Science of Health, Magna Græcia University, Catanzaro, Italy
| | - Antonella Vitiello
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Luana Izzo
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Alberto Ritieni
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Francesca Ungaro
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Fabiana Quaglia
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy
| | - Emilio Russo
- Department of Science of Health, Magna Græcia University, Catanzaro, Italy
| | - Agnese Miro
- Department of Pharmacy, University of Naples Federico II, Via D. Montesano 49, 80131, Naples, Italy.
| | - Ivana d'Angelo
- DiSTABiF, University of Campania "Luigi Vanvitelli", Via A. Vivaldi, 43, 81100, Caserta, Italy
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D'Onofrio G, Roberti R, Riva A, Russo E, Verrotti A, Striano P, Belcastro V. Pharmacodynamic rationale for the choice of antiseizure medications in the paediatric population. Neurotherapeutics 2024:e00344. [PMID: 38521667 DOI: 10.1016/j.neurot.2024.e00344] [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: 11/27/2023] [Revised: 02/28/2024] [Accepted: 03/01/2024] [Indexed: 03/25/2024] Open
Abstract
In the landscape of paediatric epilepsy treatment, over 20 anti-seizure medications (ASMs) have gained approval from Drug Regulatory Agencies, each delineating clear indications. However, the complexity of managing drug-resistant epilepsy often necessitates the concurrent use of multiple medications. This therapeutic challenge highlights a notable gap: the absence of standardized guidelines, compelling clinicians to rely on empirical clinical experience when selecting combination therapies. This comprehensive review aims to explore current evidence elucidating the preferential utilization of specific ASMs or their combinations, with a primary emphasis on pharmacodynamic considerations. The fundamental objective underlying rational polytherapy is the strategic combination of medications, harnessing diverse mechanisms of action to optimize efficacy while mitigating shared side effects. Moreover, the intricate interplay between epilepsy and comorbidities partly may influence the treatment selection process. Despite advancements, unresolved queries persist, notably concerning the mechanisms underpinning drug resistance and the paradoxical exacerbation of seizures. By synthesizing existing evidence and addressing pertinent unresolved issues, this review aims to contribute to the evolving landscape of paediatric epilepsy treatment strategies, paving the way for more informed and efficacious therapeutic interventions.
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Affiliation(s)
- Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Roberta Roberti
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | - Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy
| | - Emilio Russo
- Science of Health Department, Magna Græcia University, Catanzaro, Italy
| | | | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Via Gerolamo Gaslini 5, 16147 Genoa, Italy; Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini", Via Gerolamo Gaslini 5, 16147 Genoa, Italy
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Roberti R, Riva A, D'Onofrio G, Giacheri E, Amadori E, Vari MS, La Neve A, Vigevano F, Verrotti A, Cordelli DM, Romeo A, Palmieri A, Mancardi MM, Caglieris S, Varone A, Minetti C, Russo E, Buratti S, Striano P. A proposal for a shared therapeutic algorithm in children with prolonged convulsive seizures and status epilepticus. Expert Rev Neurother 2024; 24:133-138. [PMID: 38230547 DOI: 10.1080/14737175.2024.2305813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 01/11/2024] [Indexed: 01/18/2024]
Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Gianluca D'Onofrio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Emanuele Giacheri
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Maria Stella Vari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Federico Vigevano
- Neurology Unit, Department of Neuroscience, Bambino Gesù, IRCCS Children's Hospital, Full member of European Reference Network EpiCARE, Rome, Italy
| | - Alberto Verrotti
- Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio"of Chieti-Pescara, Chieti, Italy
| | - Duccio Maria Cordelli
- UOC Neuropsychiatry of the Pediatric Age, IRCCS Institute of Neurological Sciences of Bologna, Bologna, Italy
| | - Antonino Romeo
- Pediatric Neurology Unit and Epilepsy Center, Department of Neuroscience, "Fatebenefratelli e Oftalmico" Hospital, Milano, Italy
| | - Antonella Palmieri
- Emergency Medicine Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Maria Margherita Mancardi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Child Neuropsychiatry Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Sergio Caglieris
- Health System of Liguria, Territorial Emergency Liguria, Genoa, Italy
| | - Antonio Varone
- Department of Neuroscience, Pediatric Neurology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Carlo Minetti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Silvia Buratti
- Neonatal and Pediatric Intensive Care Unit, Emergency Department, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
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Juffs B, Russo E. Things We Do for No Reason™: Using lactate as our resuscitation guide in sepsis. J Hosp Med 2024; 19:133-135. [PMID: 37455371 DOI: 10.1002/jhm.13168] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 05/12/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Affiliation(s)
| | - Emilio Russo
- LSU Rural Family Medicine, New Orleans, Louisiana, USA
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Roberti R, Di Gennaro G, Anzellotti F, Arnaldi D, Belcastro V, Beretta S, Boero G, Bonanni P, Canafoglia L, D'Aniello A, Dainese F, De Caro C, Di Gennaro G, Di Giacomo R, DiFrancesco JC, Dono F, Falcicchio G, Ferlazzo E, Foschi N, Franciotta S, Gambardella A, Giordano A, Iannone LF, Labate A, La Neve A, Lattanzi S, Leggio U, Liguori C, Maschio M, Nilo A, Operto FF, Pascarella A, Pauletto G, Renna R, Strigaro G, Russo E. A real-world comparison among third-generation antiseizure medications: Results from the COMPARE study. Epilepsia 2024; 65:456-472. [PMID: 38052481 DOI: 10.1111/epi.17843] [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: 07/31/2023] [Revised: 11/22/2023] [Accepted: 11/30/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE There are few comparative data on the third-generation antiseizure medications (ASMs). We aimed to assess and compare the effectiveness of brivaracetam (BRV), eslicarbazepine acetate (ESL), lacosamide (LCM), and perampanel (PER) in people with epilepsy (PWE). Efficacy and tolerability were compared as secondary objectives. METHODS This multicenter, retrospective study collected data from 22 Italian neurology/epilepsy centers. All adult PWE who started add-on treatment with one of the studied ASMs between January 2018 and October 2021 were included. Retention rate was established as effectiveness measure and described using Kaplan-Meier curves and the best fitting survival model. The responder status and the occurrence of adverse events (AEs) were used to evaluate efficacy and safety, respectively. The odds of AEs and drug efficacy were estimated by two multilevel logistic models. RESULTS A total of 960 patients (52.92% females, median age = 43 years) met the inclusion criteria. They mainly suffered from structural epilepsy (52.29%) with monthly (46.2%) focal seizures (69.58%). Compared with LCM, all the studied ASMs had a higher dropout risk, statistically significant in the BRV levetiracetam (LEV)-naïve (hazard ratio [HR] = 1.97, 95% confidence interval [CI] = 1.17-3.29) and PER groups (HR = 1.64, 95% CI = 1.06-2.55). Women were at higher risk of discontinuing ESL (HR = 5.33, 95% CI = 1.71-16.61), as well as PER-treated patients with unknown epilepsy etiology versus those with structural etiology (HR = 1.74, 95% CI = 1.05-2.88). BRV with prior LEV therapy showed lower odds of efficacy (odds ratio [OR] = .08, 95% CI = .01-.48) versus LCM, whereas a higher efficacy was observed in women treated with BRV and LEV-naïve (OR = 10.32, 95% CI = 1.55-68.78) versus men. PER (OR = 6.93, 95% CI = 3.32-14.44) and BRV in LEV-naïve patients (OR = 6.80, 95% CI = 2.64-17.52) had a higher chance of AEs than LCM. SIGNIFICANCE Comparative evidence from real-world studies may help clinicians to tailor treatments according to patients' demographic and clinical characteristics.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Gianfranco Di Gennaro
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Dario Arnaldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Clinical Neurology, University of Genoa, Genoa, Italy
- IRCSS Ospedale Policlinico San Martino, Genoa, Italy
| | | | - Simone Beretta
- Department of Neurology, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS Annunziata Hospital, Taranto, Italy
| | - Paolo Bonanni
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Laura Canafoglia
- Integrated Diagnostics for Epilepsy, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy
| | | | - Filippo Dainese
- Clinical Neurophysiology Unit, Clinical Neurology, DIDAS Department, Padua, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | | | - Roberta Di Giacomo
- Epilepsy Unit, Fondazione IRCCS Istituto Neurologico Besta, Milan, Italy
| | | | - Fedele Dono
- Department of Neurology, Epilepsy Center, SS Annunziata Hospital, Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Science, D'Annunzio University of Chieti-Pescara, Chieti, Italy
| | | | - Edoardo Ferlazzo
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, Bianchi-Melacrino-Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Nicoletta Foschi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Silvia Franciotta
- Clinical Neurophysiology Unit, Clinical Neurology, DIDAS Department, Padua, Italy
| | - Antonio Gambardella
- Department of Medical and Surgical Sciences, Institute of Neurology, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Alfonso Giordano
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Luigi Francesco Iannone
- Section of Clinical Pharmacology and Oncology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Angelo Labate
- Neurophysiopathology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angela La Neve
- DiBraiN Department, University of Bari Aldo Moro, Bari, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Ugo Leggio
- Unit of Neurophysiopathology, ASST Spedali Civili, Brescia, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Neurology Unit, Epilepsy Center, University Hospital Tor Vergata, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Annacarmen Nilo
- Clinical Neurology Unit, Department of Head, Neck, and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Angelo Pascarella
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
- Regional Epilepsy Center, Bianchi-Melacrino-Morelli Great Metropolitan Hospital, Reggio Calabria, Italy
| | - Giada Pauletto
- Neurology Unit, Department of Head, Neck, and Neurosciences, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Rosaria Renna
- Neurology and Stroke Unit, Department of Emergency and Acceptance, AORN Antonio Cardarelli Hospital, Naples, Italy
| | - Gionata Strigaro
- Neurology Unit, Department of Translational Medicine, Epilepsy Center, University of Piemonte Orientale, Novara, Italy
- Maggiore della Carità University Hospital, Novara, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Ranzato F, Roberti R, Deluca C, Carta M, Peretti A, Polo D, Perini F, Russo E, Di Gennaro G. Pilot study on the probability of drug-drug interactions among direct oral anticoagulants (DOACs) and antiseizure medications (ASMs): a clinical perspective. Neurol Sci 2024; 45:277-288. [PMID: 37548755 PMCID: PMC10761387 DOI: 10.1007/s10072-023-06992-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/29/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND There is little and controversial information about changes in plasma concentrations (PCs) or clinical events during coadministration of antiseizure medications (ASMs) and direct oral anticoagulants (DOACs). We aimed to explore possible determinants of dosage class among DOACs trough PCs when ASMs are co-administered and the relative risks. We also provided some clinical examples of patients' management. METHODS Data on adult patients concomitantly treated with ASMs (grouped in enzyme-inducing [I-ASMs], non-inducing [nI-ASMs], and levetiracetam [LEV]) and DOACs with at least one measurement of DOACs' PC were retrospectively collected. The role of DOAC-ASM combinations in predicting PC class (ranging from I at ischemic/thromboembolic risk to IV at increased bleeding risk) was investigated by an ordered logit model, and the marginal probabilities of belonging to the four dosage classes were calculated. RESULTS We collected 46 DOACs' PCs out of 31 patients. There were 5 (10.9%) determinations in class I (4 out of 5 with concomitant I-ASMs) and 5 (10.9%) in class IV. The rivaroxaban/I-ASM combination was associated with lower DOAC dosages than rivaroxaban/LEV (OR: 0.00; 95% CI: 0.00-0.62). Furthermore, patient's probability of being in class I was approximately 50% with the rivaroxaban/I-ASM combination, while apixaban, dabigatran, and edoxaban had the highest cumulative probability of being in class II or III despite the ASM used. CONCLUSION These preliminary results confirm the reduction of DOAC's PC by I-ASMs and suggest a better manageability of apixaban, dabigatran, and edoxaban independently from the concomitant ASM, whereas rivaroxaban seems the most liable to PC alterations with I-ASMs.
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Affiliation(s)
- Federica Ranzato
- Regional Epilepsy Center, Neurology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Roberta Roberti
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Via T. Campanella, 115, 88100, Catanzaro, Italy
| | - Cristina Deluca
- Stroke Unit, Neurology, San Bortolo Hospital, Vicenza, Italy
| | | | - Alessia Peretti
- Regional Epilepsy Center, Neurology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Diana Polo
- Regional Epilepsy Center, Neurology Unit, San Bortolo Hospital, Vicenza, Italy
| | - Francesco Perini
- Regional Epilepsy Center, Neurology Unit, San Bortolo Hospital, Vicenza, Italy
- Stroke Unit, Neurology, San Bortolo Hospital, Vicenza, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Via T. Campanella, 115, 88100, Catanzaro, Italy.
| | - Gianfranco Di Gennaro
- Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Via T. Campanella, 115, 88100, Catanzaro, Italy
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Brigo F, Zelano J, Abraira L, Bentes C, Ekdahl CT, Lattanzi S, Ingvar Lossius M, Redfors P, Rouhl RPW, Russo E, Sander JW, Vogrig A, Wickström R. Proceedings of the "International Congress on Structural Epilepsy & Symptomatic Seizures" (STESS, Gothenburg, Sweden, 29-31 March 2023). Epilepsy Behav 2024; 150:109538. [PMID: 38039602 DOI: 10.1016/j.yebeh.2023.109538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/09/2023] [Accepted: 11/09/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Francesco Brigo
- Innovation, Research and Teaching Service (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical Private University (PMU), Bolzano, Italy.
| | - Johan Zelano
- Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Neuroscience and Physiology, Department of Clinical Neuroscience, Sahlgrenska Academy, Gothenburg University, Sweden; Wallenberg Center of Molecular and Translational Medicine, Gothenburg University, Sweden
| | - Laura Abraira
- Neurology Department, Epilepsy Unit, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; Epilepsy Unit, Neurology Department, Vall d'Hebron University Hospital, Barcelona, Spain; Epilepsy Research Group, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Carla Bentes
- Neurophysiological Monitoring Unit - EEG/Sleep Laboratory, Refractory Epilepsy Reference Centre (member of EpiCARE), Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Centro de Estudos Egas Moniz, Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - Christine T Ekdahl
- Division of Clinical Neurophysiology and Department of Clinical Sciences, Lund University, Sweden; Lund Epilepsy Center, Department of Clinical Sciences, Lund University, Sweden
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Morten Ingvar Lossius
- National Centre for Epilepsy, Division of Clinical Neuroscience, Oslo University Hospital, Member of the ERN EpiCARE, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Petra Redfors
- Department of Neurology, Member of the ERN EpiCARE, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Rob P W Rouhl
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, The Netherlands; Academic Centre for Epileptology Kempenhaeghe/MUMC+ Heeze and Maastricht, The Netherlands; School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Italy
| | - Josemir W Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK; Centre for Epilepsy, Chalfont St Peter, Bucks., SL9 0RJ, United Kingdom; Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, The Netherlands; Neurology Department, West of China Hospital, Sichuan University, Chengdu 610041, China
| | - Alberto Vogrig
- Department of Medicine (DAME), University of Udine, Udine, Italy; Clinical Neurology, Department of Head-Neck and Neuroscience, Azienda Sanitaria Universitaria Friuli Centrale (ASU FC), Udine, Italy
| | - Ronny Wickström
- Neuropediatric Unit, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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Pietrafusa N, Falcicchio G, Russo E, Lattanzi S, Goffredo B, Simeoli R, Cairoli S, Corsetti T, Roberti R, De Tommaso M, Vigevano F, La Neve A, Specchio N. Cenobamate as add-on therapy for drug resistant epilepsies: effectiveness, drug to drug interactions and neuropsychological impact. What have we learned from real word evidence? Front Pharmacol 2023; 14:1239152. [PMID: 38186643 PMCID: PMC10768012 DOI: 10.3389/fphar.2023.1239152] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background: Cenobamate (CNB) is an anti-seizure medication (ASM) approved in 2021 in Europe for adjunctive treatment of focal-onset seizures in adults who were not adequately controlled with at least two previous ASMs. Methods: seizure outcome, treatment-emergent adverse events, neuropsychological profile, and blood levels of CNB and concomitant ASM were analyzed in a real world setting in two different Italian epilepsy centers in the context of CNB early access program. All patients performed a general cognitive evaluation, while 32 patients underwent the administration of a battery of neuropsychological tests at baseline and 6 months after CNB treatment. We performed CNB quantification in plasma in 31 patients at different doses in the range of 100-400 mg/day (65 measures). Results: we enrolled 54 patients with a median age of 27.9 years. The mean follow-up was 10.7 months. Most (91%) completed the efficacy analysis. At last follow-up visit, a 69.5% median seizure reduction was registered. Thirty-two patients (59.2%) had a ≥50% reduction of seizures that was ≥75% in 20 (42.0%) cases, whilst 10 (20.2%) patients were seizure-free. The most common adverse events were somnolence (53.1%), dizziness (28.1%) and diplopia (12.5%). The correlation between CNB dose and plasma concentration, revealed a significant linear correlation (r = 0.86, p < 0.0001), and there was a significant difference in mean plasma concentration/dose administered ratio (C/D ratio) between patients taking or not at least one inducer (0.10 ± 0.04 [(μg/mL)/(mg/day)]; n = 47 vs. 0.13 ± 0.05 [(μg/mL)/(mg/day)]; n = 18, p = 0.04). CNB dose was inversely correlated (r = -0.31, p = 0.02) to the C/D ratio of Carbamazepine blood levels. and positively correlated (r = 0.74, p < 0.0001) with an increased plasma concentration of the active Clobazam metabolite N-desmethylclobazam. General Anxiety Disorder-7 showed a significant improvement of score from baseline evaluation of 6.82 to follow-up 6 months evaluation of 4.53 (p = 0.03). Conclusion: In this real-world study, we registered a clinically meaningful reduction in seizure frequency after CNB administration in most patients along with a good tolerability profile. CNB treatment is correlate to a reduction in symptom severity of anxiety score. Plasma levels measurements confirm that CNB acts both as "victim" and as "perpetrator" of drug-drug interactions.
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Affiliation(s)
- Nicola Pietrafusa
- Clinical and Experimental Neurology, Full Member of European Reference Network EpiCARE, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Giovanni Falcicchio
- Department of Translational Biomedicine and Neurosciences, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Bianca Goffredo
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Raffaele Simeoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Sara Cairoli
- Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Tiziana Corsetti
- Hospital Pharmacy Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Roberta Roberti
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Marina De Tommaso
- Department of Translational Biomedicine and Neurosciences, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Federico Vigevano
- Head of Neurological Sciences and Rehabilitation Medicine Scientific Area, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Angela La Neve
- Department of Translational Biomedicine and Neurosciences, University of Bari ‘Aldo Moro’, Bari, Italy
| | - Nicola Specchio
- Clinical and Experimental Neurology, Full Member of European Reference Network EpiCARE, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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De Virgilio A, Costantino A, Russo E, Festa BM, Pirola F, Spriano G. Comparison between the high-definition 3D exoscope and the operating microscope in head and neck reconstruction. Int J Oral Maxillofac Surg 2023:S0901-5027(23)00879-2. [PMID: 38052704 DOI: 10.1016/j.ijom.2023.11.004] [Citation(s) in RCA: 1] [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: 01/24/2023] [Revised: 10/16/2023] [Accepted: 11/17/2023] [Indexed: 12/07/2023]
Abstract
The purpose of this study was to compare the three-dimensional (3D) operating exoscope (OE) with the conventional operating microscope (OM) in head and neck reconstruction. A retrospective cohort study was performed including 50 consecutive patients with no history of previous surgery or irradiation (32 male, 18 female; mean age 59.2 ± 13.3 years), who underwent free flap head and neck reconstruction using a 3D OE (n = 25; OE group) or conventional OM (n = 25; OM group). The mean total operative time was 8.0 ± 1.53 h in the OE group and 7.6 ± 1.52 h in the OM group (P = 0.86). The median (interquartile range) anastomosis time was 78.0 (63.0-91.5) minutes in the OE group and 90.0 (75.5-115.0) minutes in the OM group (P = 0.06). The final free flap survival rate was 100%. Only seven patients experienced a free flap reconstruction-related complication, and they were similarly distributed between the two groups (four in the OE group, three in the OM group; P = 0.68). Secondary outcomes (length of hospital stay, tracheostomy dependence, feeding tube dependence) were comparable in the two groups (P > 0.05). The 3D OE is a viable alternative to the conventional OM for performing standard head and neck free flap reconstructive procedures.
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Affiliation(s)
- A De Virgilio
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A Costantino
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - E Russo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
| | - B M Festa
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Pirola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Spriano
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy; Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
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10
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Paoletti G, Casini M, Malvezzi L, Pirola F, Russo E, Nappi E, Muci GQ, Montagna C, Messina MR, Ferri S, Racca F, Lamacchia D, Cataldo G, Puggioni F, De Virgilio A, Ferreli F, Mercante G, Spriano G, Canonica GW, Heffler E. Very Rapid Improvement in Extended Nitric Oxide Parameters Is Associated With Clinical and Functional Improvement in Patients With Chronic Rhinosinusitis With Nasal Polyps Treated With Dupilumab. J Investig Allergol Clin Immunol 2023; 33:457-463. [PMID: 38095494 DOI: 10.18176/jiaci.0851] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Dupilumab, an anti-IL-4 receptor a monoclonal antibody, was recently approved for the treatment of chronic rhinosinusitis with nasal polyps (CRSwNP) and moderate-to-severe asthma. Onset of its clinical effects is rapid. CRSwNP is characterized by extended type 2 inflammatory involvement that can be assessed using extended nitric oxide analysis. We investigated whether dupilumab was associated with a rapid improvement in extended nitric oxide parameters, lung function, and clinical outcomes in patients with CRSwNP. METHODS Consecutive patients with CRSwNP and an indication for dupilumab were evaluated for extended nitric oxide analysis (exhaled, FeNO; bronchial, JawNO; alveolar, CalvNO; nasal, nNO) and lung function 15 and 30 days after initiation of treatment and for clinical outcomes (nasal polyps score [NPS], quality of life questionnaires, visual analog scale [VAS] for the main symptoms, and the Asthma Control Test [ACT]) 30 days after initiation of treatment. RESULTS We enrolled 33 patients. All extended nitric oxide and lung function parameters improved significantly after 15 days of treatment, remaining stable at 30 days. Scores on the NPS, VAS for the main RSwNP symptoms, quality of life questionnaires, and the ACT improved significantly 30 days after initiation of treatment. CONCLUSION Dupilumab is associated with very rapid improvement in type 2 inflammation in all airway areas. This is associated with improved lung function and clinical parameters in patients with CRSwNP.
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Affiliation(s)
- G Paoletti
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M Casini
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - L Malvezzi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Pirola
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - E Russo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - E Nappi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - G Q Muci
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - C Montagna
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - M R Messina
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - S Ferri
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Racca
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - D Lamacchia
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - G Cataldo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - F Puggioni
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - A De Virgilio
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - F Ferreli
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - G Mercante
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - G Spriano
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - G W Canonica
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - E Heffler
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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11
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Martellino C, Laganà A, Atanasio G, Lamanna F, Attardo S, Cascino S, De Luca M, Pardeo O, Giacobbe G, Tripepi G, Roberti R, Granata F, Morace C, Russo E, Labate A. The real-world effectiveness of intravenous brivaracetam as a second-line treatment in status epilepticus. Epilepsy Behav 2023; 148:109464. [PMID: 37839249 DOI: 10.1016/j.yebeh.2023.109464] [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: 08/08/2023] [Revised: 09/21/2023] [Accepted: 09/26/2023] [Indexed: 10/17/2023]
Abstract
PURPOSE Status epilepticus (SE) is defined by abnormally prolonged seizures that may lead to brain damage and death. Our aim was to evaluate the efficacy and tolerability (effectiveness) of intravenous brivaracetam (BRV) as a second-line treatment. METHODS Twenty-one patients (median age 68 years ± 17.28) were prospectively recruited between June 2019 and December 2022. Patients were treated with BRV (50-200 mg) as a second-line add-on therapy for SE. We evaluated the response of SE to the administration of BRV in terms of SE termination and recurrence of epileptic seizures at 6, 12, and 24 h, also monitoring safety. The first-line therapy was represented by intravenous benzodiazepines (mainly diazepam). RESULTS Almost a quarter of patients had generalized seizures, whereas the vast majority (76.2%) presented focal seizures. In 52.4% of patients, the underlying cause was cerebrovascular. Fourteen (66.7%) patients displayed a good early response in the subsequent 6 h. At 12 and 24 h, 8 (38%) and 11 (52.4%) patients, respectively, did not present seizures. CONCLUSION The present study highlights the potential of BRV when used as an early add-on therapy in SE, further confirming its good safety profile.
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Affiliation(s)
- Chiara Martellino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Angelina Laganà
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy
| | - Giorgia Atanasio
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Fabio Lamanna
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Silvia Attardo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Cascino
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Marcella De Luca
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Orazio Pardeo
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giuseppa Giacobbe
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Giovanni Tripepi
- National Research Council (CNR), Institute of Clinical Physiology (IFC), Clinical Epidemiology of Renal Diseases and Hypertension, Ospedali Riuniti, Reggio Calabria, Italy
| | - Roberta Roberti
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | | | - Carmela Morace
- Internal Medicine Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy; Regional Epilepsy Center, University of Messina, Messina, Italy.
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12
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Oliva EN, Riva M, Niscola P, Santini V, Breccia M, Giai V, Poloni A, Patriarca A, Crisà E, Capodanno I, Salutari P, Reda G, Cascavilla N, Ferrero D, Guarini A, Tripepi G, Iannì G, Russo E, Castelli A, Fattizzo B, Beltrami G, Bocchia M, Molteni A, Fenaux P, Germing U, Ricco A, Palumbo GA, Impera S, Di Renzo N, Rivellini F, Buccisano F, Stamatoullas-Bastard A, Liberati AM, Candoni A, Delfino IM, Arcadi MT, Cufari P, Rizzo L, Bova I, D'Errigo MG, Zini G, Latagliata R. Eltrombopag for Low-Risk Myelodysplastic Syndromes With Thrombocytopenia: Interim Results of a Phase II, Randomized, Placebo-Controlled Clinical Trial (EQOL-MDS). J Clin Oncol 2023; 41:4486-4496. [PMID: 37294914 PMCID: PMC10552995 DOI: 10.1200/jco.22.02699] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/16/2023] [Accepted: 05/01/2023] [Indexed: 06/11/2023] Open
Abstract
PURPOSE In myelodysplastic syndromes (MDS), severe thrombocytopenia is associated with poor prognosis. This multicenter trial presents the second-part long-term efficacy and safety results of eltrombopag in patients with low-risk MDS and severe thrombocytopenia. METHODS In this single-blind, randomized, placebo-controlled, phase-II trial of adult patients with International Prognostic Scoring System low- or intermediate-1-risk MDS, patients with a stable platelet (PLT) count (<30 × 103/mm3) received eltrombopag or placebo until disease progression. Primary end points were duration of PLT response (PLT-R; calculated from the time of PLT-R to date of loss of PLT-R, defined as bleeding/PLT count <30 × 103/mm3 or last date in observation) and long-term safety and tolerability. Secondary end points included incidence and severity of bleeding, PLT transfusions, quality of life, leukemia-free survival, progression-free survival, overall survival and pharmacokinetics. RESULTS From 2011 to 2021, of 325 patients screened, 169 patients were randomly assigned oral eltrombopag (N = 112) or placebo (N = 57) at a starting dose of 50 mg once daily to maximum of 300 mg. PLT-R, with 25-week follow-up (IQR, 14-68) occurred in 47/111 (42.3%) eltrombopag patients versus 6/54 (11.1%) in placebo (odds ratio, 5.9; 95% CI, 2.3 to 14.9; P < .001). In eltrombopag patients, 12/47 (25.5%) lost the PLT-R, with cumulative thrombocytopenia relapse-free survival at 60 months of 63.6% (95% CI, 46.0 to 81.2). Clinically significant bleeding (WHO bleeding score ≥ 2) occurred less frequently in the eltrombopag arm than in the placebo group (incidence rate ratio, 0.54; 95% CI, 0.38 to 0.75; P = .0002). Although no difference in the frequency of grade 1-2 adverse events (AEs) was observed, a higher proportion of eltrombopag patients experienced grade 3-4 AEs (χ2 = 9.5, P = .002). AML evolution and/or disease progression occurred in 17% (for both) of eltrombopag and placebo patients with no difference in survival times. CONCLUSION Eltrombopag was effective and relatively safe in low-risk MDS with severe thrombocytopenia. This trial is registered with ClinicalTrials.gov identifier: NCT02912208 and EU Clinical Trials Register: EudraCT No. 2010-022890-33.
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Affiliation(s)
- Esther Natalie Oliva
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Marta Riva
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milano, Italy
| | | | - Valeria Santini
- U.O. di Ematologia, Azienda Ospedaliera Universitaria Careggi, Firenze, Italy
| | - Massimo Breccia
- Dipartimento di Ematologia Policlinico Umberto I, Università La Sapienza, Roma, Italy
| | - Valentina Giai
- S.C. a Direzione Universitaria di Ematologia A.O., SS. Antonio e Biagio e Cesare Arrigo Alessandria, Alessandria, Italy
| | - Antonella Poloni
- Clinica di Ematologia Azienda Ospedaliera Universitaria—Ospedali Riuniti di Ancona, Ancona, Italy
| | | | - Elena Crisà
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Isabella Capodanno
- U.O. di Ematologia, A.U.S.L.-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Prassede Salutari
- Dipartimento Oncologico-Ematologico, Ospedale Civile Spirito Santo, Pescara, Italy
| | - Gianluigi Reda
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Nicola Cascavilla
- U.O. Ematologia Ospedale Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Dario Ferrero
- Dipartimento Biotecnologie Molecolari, Ematologia Universitaria A.O.U. Citta' della Salute e della Scienza di Torino, Turin, Italy
| | - Attilio Guarini
- U.O. Ematologia I.R.C.C.S. Istituto Tumori “Giovanni Paolo II”, Bari, Italy
| | - Giovanni Tripepi
- IFC-CNR Institute of Clinical Physiology, Reggio Calabria, Italy
| | | | - Emilio Russo
- Department of Pharmacology, University of Germaneto Catanzaro, Catanzaro, Italy
| | | | - Bruno Fattizzo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Milan, Italy
| | - Germana Beltrami
- U.O. Ematologia e terapie cellulari, IRCCS Azienda Ospedaliera Universitaria San Martino, Genova, Italy
| | - Monica Bocchia
- UOC Ematologia, Università di Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Pierre Fenaux
- Groupe Francais desmyélodysplasies (GFM), Paris, France
| | - Ulrich Germing
- Department of Hematology, Oncology, and Clinical Immunology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Alessandra Ricco
- U.O. Ematologia con Trapianto, Azienda Ospedale Policlinicodi Bari, Bari, Italy
| | - Giuseppe A. Palumbo
- Dipartimento di Scienze Mediche Chirurgiche e Tecnologie Avanzate “G.F. Ingrassia”, University of Catania, Catania, Italy
| | - Stefana Impera
- U.O. C. Ematologia, A. O.ad Alta Specializzazione Ospedale Garibaldi Nesima, Catania, Italy
| | | | - Flavia Rivellini
- Divisione Ematologia, P.O. A. Tortora di Pagani-ASL Salerno, Pagani, Italy
| | - Francesco Buccisano
- Divisione di Biopatologia e Diagnostica per Immagini, Policlinico Universitario Tor Vergata, Rome, Italy
| | | | - Anna Marina Liberati
- S.C. Oncoematologia, Università degli Studi di Perugia A.O. Santa Maria, Terni, Italy
| | - Anna Candoni
- Divisione Ematologia, P.O. Santa Maria della Misericordia, A.S.U.F.C di Udine, Udine, Italy
| | - Ilaria Maria Delfino
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Teresa Arcadi
- U.O. Farmacia Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Patrizia Cufari
- U.O.C. Ematologia, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Lorenzo Rizzo
- Dipartimento di Ematologia, Ospedale Niguarda Ca' Granda, Milan, Italy
| | - Irene Bova
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Maria Grazia D'Errigo
- U.O.S. di Genetica Medica Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio di Calabria, Italy
| | - Gina Zini
- Fondazione Policlinico, Universitario A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
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Lattanzi S, Trinka E, Russo E, Del Giovane C, Matricardi S, Meletti S, Striano P, Damavandi PT, Silvestrini M, Brigo F. Pharmacotherapy for Dravet Syndrome: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials. Drugs 2023; 83:1409-1424. [PMID: 37695433 PMCID: PMC10582139 DOI: 10.1007/s40265-023-01936-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Dravet syndrome (DS) is a severe developmental and epileptic encephalopathy characterized by drug-resistant, lifelong seizures. The management of seizures in DS has changed in recent years with the approval of new antiseizure medications (ASMs). OBJECTIVE The aim of this study was to estimate the comparative efficacy and tolerability of the ASMs for the treatment of seizures associated with DS using a network meta-analysis (NMA). METHODS Studies were identified by conducting a systematic search (week 4, January 2023) of the MEDLINE (accessed by PubMed), EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and US National Institutes of Health Clinical Trials Registry ( http://www. CLINICALTRIALS gov ) databases. Any randomized, controlled, double- or single-blinded, parallel-group study comparing at least one ASM therapy against placebo, another ASM, or a different dose of the same ASM in participants with a diagnosis of DS was identified. The efficacy outcomes were the proportions of participants with ≥ 50% (seizure response) and 100% reduction (seizure freedom) in baseline convulsive seizure frequency during the maintenance period. The tolerability outcomes included the proportions of patients who withdrew from treatment for any reason and who experienced at least one adverse event (AE). Effect sizes were estimated by network meta-analyses within a frequentist framework. RESULTS Eight placebo-controlled trials were included, and the active add-on treatments were stiripentol (n = 2), pharmaceutical-grade cannabidiol (n = 3), fenfluramine hydrochloride (n = 2), and soticlestat (n = 1). The studies recruited 680 participants, of whom 409 were randomized to active treatments (stiripentol = 33, pharmaceutical-grade cannabidiol = 228, fenfluramine hydrochloride = 122, and soticlestat = 26) and 271 to placebo. Pharmaceutical-grade cannabidiol was associated with a lower rate of seizure response than fenfluramine hydrochloride (odds ratio [OR] 0.20, 95% confidence interval [CI] 0.07-0.54), and stiripentol was associated with a higher seizure response rate than pharmaceutical-grade cannabidiol (OR 14.07, 95% CI 2.57-76.87). No statistically significant differences emerged across the different ASMs for the seizure freedom outcome. Stiripentol was associated with a lower probability of drug discontinuation for any reason than pharmaceutical-grade cannabidiol (OR 0.45, 95% CI 0.04-5.69), and pharmaceutical-grade cannabidiol was associated with a lower proportion of participants experiencing any AE than fenfluramine hydrochloride (OR 0.22, 95% CI 0.06-0.78). Stiripentol had a higher risk of AE occurrence than pharmaceutical-grade cannabidiol (OR 75.72, 95% CI 3.59-1598.58). The study found high-quality evidence of efficacy and tolerability of the four ASMs in the treatment of convulsive seizures in DS. CONCLUSIONS There exists first-class evidence that documents the efficacy and tolerability of stiripentol, pharmaceutical-grade cannabidiol, fenfluramine hydrochloride, and soticlestat for the treatment of seizures associated with DS, and allows discussion about the expected outcomes regarding seizure frequency reduction and tolerability profiles.
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Affiliation(s)
- Simona Lattanzi
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy.
| | - Eugen Trinka
- Department of Neurology, Christian Doppler Klinik, Paracelsus Medical University, Salzburg, Austria
- Center for Cognitive Neuroscience, Salzburg, Austria
- Public Health, Health Services Research and HTA, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Emilio Russo
- Science of Health Department, University Magna Grecia of Catanzaro, Catanzaro, Italy
| | - Cinzia Del Giovane
- Department of Medical and Surgical Sciences for Children and Adults, University-Hospital of Modena and Reggio Emilia, Modena, Italy
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Stefano Meletti
- Neurology Unit, OCB Hospital, AOU Modena, Modena, Italy
- Department of Biomedical, Metabolic and Neural Science, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, "G. Gaslini" Institute, University of Genoa, Genoa, Italy
| | - Payam Tabaee Damavandi
- Department of Neurology, Fondazione IRCCS San Gerardo, School of Medicine and Surgery and Milan Center for Neuroscience, University of Milano-Bicocca, Monza, Italy
| | - Mauro Silvestrini
- Department of Experimental and Clinical Medicine, Neurological Clinic, Marche Polytechnic University, Via Conca 71, 60020, Ancona, Italy
| | - Francesco Brigo
- Division of Neurology, "Franz Tappeiner" Hospital, Merano, BZ, Italy
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14
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Riva A, Roberti R, D'Onofrio G, Vari MS, Amadori E, De Giorgis V, Cerminara C, Specchio N, Pietrafusa N, Tombini M, Assenza G, Cappanera S, Marini C, Rasmini P, Veggiotti P, Zara F, Russo E, Striano P. A real-life pilot study of the clinical application of pharmacogenomics testing on saliva in epilepsy. Epilepsia Open 2023; 8:1142-1150. [PMID: 36840436 PMCID: PMC10472391 DOI: 10.1002/epi4.12717] [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: 09/14/2022] [Accepted: 02/22/2023] [Indexed: 02/26/2023] Open
Abstract
Response to antiseizure medications (ASMs) can be influenced by several gene polymorphisms, causing either lower efficacy or higher occurrence of adverse drug reactions (ADRs). We investigated the clinical utility of salivary pharmacogenomic testing on epilepsy patients. A commercialized pharmacogenomic salivary test was performed in a cohort of epileptic patients. Genetic variants on five genes (i.e., CYP1A2, CYP2C9, CYP2C19, EPHX1, and ABCB1) involved in common ASMs metabolism were selected. Twenty-one individuals (median age [Q1 -Q3 ]: 15 [6.5-28] years) were enrolled. Six patients harboring the homozygous *1F allele in CYP1A2 could have reduced chance of response to stiripentol due to fast metabolism. CYP2C9 had reduced activity in 10 patients (alleles *2 and *3), potentially affecting phenytoin (PHT), phenobarbital (PB), primidone, lacosamide (LCM), and valproic acid metabolism. Seven patients, carrying the *2 allele of CYP2C19, had an increased risk of ADRs with clobazam (CLB), PB, PHT, LCM, brivaracetam; while one individual with the *17 allele in heterozygosity reported a CLB fast metabolism. Six patients showed a CC polymorphism of EPHX1 associated with the impaired efficacy of carbamazepine. ABCB1 polymorphisms related to drug-resistance (3435 CC) or drug-sensitive phenotype (CT or TT) were found in 6 out of 7 patients. Pharmacogenomic testing on saliva proved easy and safe in clinical practice to convey information for the management of epileptic patients, especially those resistant to treatment or sensitive to severe ADRs.
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Affiliation(s)
- Antonella Riva
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Roberta Roberti
- Science of Health DepartmentUniversity Magna Grecia of CatanzaroCatanzaroItaly
| | - Gianluca D'Onofrio
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Maria Stella Vari
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Elisabetta Amadori
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | | | - Caterina Cerminara
- Pediatric Neurology Unit, Department of NeurosciencesTor Vergata University of RomeRomeItaly
| | - Nicola Specchio
- Rare and Complex Epilepsy Unit, Department of NeuroscienceBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Nicola Pietrafusa
- Rare and Complex Epilepsy Unit, Department of NeuroscienceBambino Gesù Children's Hospital, IRCCSRomeItaly
| | - Mario Tombini
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐MedicoRomeItaly
| | - Giovanni Assenza
- Unit of Neurology, Neurophysiology, Neurobiology, Department of MedicineUniversity Campus Bio‐MedicoRomeItaly
| | - Silvia Cappanera
- Child Neurology and Psychiatric Unit, Pediatric Hospital G. SalesiUnited Hospitals of AnconaAnconaItaly
| | - Carla Marini
- Child Neurology and Psychiatric Unit, Pediatric Hospital G. SalesiUnited Hospitals of AnconaAnconaItaly
| | | | | | - Federico Zara
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Unit of Medical GeneticsIRCCS Istituto “Giannina Gaslini”GenoaItaly
| | - Emilio Russo
- Science of Health DepartmentUniversity Magna Grecia of CatanzaroCatanzaroItaly
| | - Pasquale Striano
- Department of Neurosciences Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI)University of GenoaGenoaItaly
- Pediatric Neurology and Muscular Diseases UnitIRCCS Istituto “Giannina Gaslini”GenoaItaly
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15
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Palmisani M, Tartara E, Johannessen Landmark C, Crema F, De Giorgis V, Varesio C, Fattore C, Rota P, Russo E, Franco V. Therapeutic Salivary Monitoring of Perampanel in Patients with Epilepsy Using a Volumetric Absorptive Microsampling Technique. Pharmaceutics 2023; 15:2030. [PMID: 37631244 PMCID: PMC10458119 DOI: 10.3390/pharmaceutics15082030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/27/2023] Open
Abstract
The objective of this study was to validate a novel assay using the volumetric absorptive microsampling (VAMS) technique combined with liquid chromatography coupled to tandem mass spectrometry (LC-MS/MS) for the determination of the antiseizure medication perampanel in saliva and its clinical applicability in patients with epilepsy. VAMS tips were loaded with 30 μL of saliva and dried for 60 min. Analytes were extracted with methanol. The supernatant was evaporated under a gentle stream of nitrogen and reconstituted with 60 μL of methanol. Separation and quantification were achieved on a monolithic column connected to a mass spectrometer. Calibration curves were linear between 0.5 and 300 ng/mL. Intra- and inter-day accuracy was within 85.6-103.2% and intra-day and inter-day precision did not exceed 12.1%. Perampanel was stable in samples collected by VAMS and stored under different storage conditions. The VAMS-LC-MS/MS method was validated according to internationally accepted criteria and tested in patients with epilepsy who were receiving a combination of perampanel and other antiseizure medications. The method showed adequate bioanalytical performances, holding great potential as an alternative strategy to support domiciliary TDM in patients with epilepsy treated with perampanel according to the simplicity of sample collection.
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Affiliation(s)
- Michela Palmisani
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Elena Tartara
- Epilepsy Center, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Cecilie Johannessen Landmark
- Department of Pharmacy, Faculty of Health Sciences, Oslo Metropolitan University, 0316 Oslo, Norway;
- The National Center for Epilepsy, Sandvika, ERN Network EpiCare, Oslo University Hospital, 0372 Oslo, Norway
- Section for Clinical Pharmacology, Department of Pharmacology, Oslo University Hospital, 0372 Oslo, Norway
| | - Francesca Crema
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
| | - Valentina De Giorgis
- Department of Child Neurology and Psychiatry, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.D.G.); (C.V.)
| | - Costanza Varesio
- Department of Child Neurology and Psychiatry, ERN Network EpiCare, IRCCS Mondino Foundation, 27100 Pavia, Italy; (V.D.G.); (C.V.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | | | - Paola Rota
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20100 Milan, Italy;
- Institute for Molecular and Translational Cardiology (IMTC), San Donato Milanese, 20097 Milan, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, 88100 Catanzaro, Italy;
| | - Valentina Franco
- Clinical and Experimental Pharmacology Unit, Department of Internal Medicine and Therapeutics, University of Pavia, 27100 Pavia, Italy; (M.P.); (F.C.)
- IRCCS Mondino Foundation, 27100 Pavia, Italy;
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16
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Angeli A, Ferraroni M, Granchi C, Minutolo F, Chen X, Shriwas P, Russo E, Leo A, Selleri S, Carta F, Supuran CT. First-in-Class Dual Targeting Compounds for the Management of Seizures in Glucose Transporter Type 1 Deficiency Syndrome. J Med Chem 2023. [PMID: 37436184 DOI: 10.1021/acs.jmedchem.3c00938] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
The genetic disorder glucose transporter type 1 deficiency syndrome (GLUT1-DS) heavily affects the main intake of energy in tissues and determines the most relevant outcomes at the central nervous system (CNS) district, which is highly dependent on glucose. Herein, we report the design and development of a set of compounds bearing the glucosyl and galactosyl moieties. We assessed their ability to enhance the GLUT1 mediated glucose intake in non-small-cell lung cancer (NSCLC) cells and to inhibit the carbonic anhydrase (CA; EC 4.2.1.1) isoforms implicated in the physiopathology of uncontrolled seizures associated to epilepsy (i.e., I, II, IV, VA, VB, and XII). The binding mode of 8 in adduct with hCA II was determined by X-ray crystallography. Among the selected derivatives, compound 4b proved effective in suppressing the occurrence of uncontrolled seizures on the in vivo induced maximal electroshock (MES) model and thus gives sustainment of an unprecedently reported pharmacological approach for the management of GLUT1-DS associated diseases.
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Affiliation(s)
- Andrea Angeli
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche e Nutraceutiche, University of Florence, Via Ugo Schiff 6, Sesto Fiorentino, Florence 50019, Italy
| | - Marta Ferraroni
- Department of Chemistry "Ugo Schiff", University of Florence, Via della Lastruccia 3-13, Sesto Fiorentino, Florence I-50019, Italy
| | - Carlotta Granchi
- Department of Pharmacy, University of Pisa, Via Bonanno 6, Pisa 56126, Italy
| | - Filippo Minutolo
- Department of Pharmacy, University of Pisa, Via Bonanno 6, Pisa 56126, Italy
| | - Xiaozhuo Chen
- Edison Biotechnology Institute, Department of Biological Sciences, Molecular and Cellular Biology Program, Ohio University, Athens, Ohio 45701, United States
| | - Pratik Shriwas
- Edison Biotechnology Institute, Department of Biological Sciences, Molecular and Cellular Biology Program, Ohio University, Athens, Ohio 45701, United States
| | - Emilio Russo
- School of Medicine, Science of Health Department, FAS@UMG Research Center, University of Catanzaro, 88100 Catanzaro, Italy
| | - Antonio Leo
- School of Medicine, Science of Health Department, FAS@UMG Research Center, University of Catanzaro, 88100 Catanzaro, Italy
| | - Silvia Selleri
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche e Nutraceutiche, University of Florence, Via Ugo Schiff 6, Sesto Fiorentino, Florence 50019, Italy
| | - Fabrizio Carta
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche e Nutraceutiche, University of Florence, Via Ugo Schiff 6, Sesto Fiorentino, Florence 50019, Italy
| | - Claudiu T Supuran
- NEUROFARBA Department, Sezione di Scienze Farmaceutiche e Nutraceutiche, University of Florence, Via Ugo Schiff 6, Sesto Fiorentino, Florence 50019, Italy
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17
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De Giorgis V, Tagliabue A, Bisulli F, Brambilla I, Camerini A, Cusmai R, Darra F, Dianin A, Domenica E, Lodi MAM, Matricardi S, Messana T, Operto F, Ragona F, Russo E, Varesio C, Volpi L, Zanaboni MP, Pasca L, Veggiotti P. Ketogenic dietary therapies in epilepsy: recommendations of the Italian League against Epilepsy Dietary Therapy Study Group. Front Neurol 2023; 14:1215618. [PMID: 37497012 PMCID: PMC10368245 DOI: 10.3389/fneur.2023.1215618] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023] Open
Abstract
A stepwise increase in the utilization of ketogenic dietary therapies for drug-resistant epilepsy has been observed in Italy in the last decade, although it is still considered often underused in many centers when compared to other countries. The Dietary Therapy Study Group of the Italian League against Epilepsy proposes practical recommendations to improve shared knowledge and facilitate the application of ketogenic dietary therapies, optimizing its efficacy and tolerability. The experts involved (11 child neuropsychiatrists, two adult neurologists, one psychologist, one pharmacologist, one pediatric endocrinologist, one representative of patients' associations, and three dietitians and clinical nutritionists) responded to a survey on current clinical practice issues and were asked to discuss controversial topics related to supplementation, long-term maintenance, transition, and a multidisciplinary approach to ketogenic dietary therapies. Practical indications for patient selection, diet initiation, management, side effects prevention, and follow-up are provided.
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Affiliation(s)
- Valentina De Giorgis
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Tagliabue
- Department of Public Health, Human Nutrition and Eating Disorder Research Center and Ketogenic Metabolic Therapy Laboratory—Experimental and Forensic Medicine University of Pavia, Pavia, Italy
| | - Francesca Bisulli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Full Member of the European Reference Network for Rare and Complex Epilepsies (EpiCARE), Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Ilaria Brambilla
- Endocrinologia, Diabetologia e Ginecologia Pediatrica, Fondazione IRCCS Policlinico San Matteo di Pavia, Università degli Studi di Pavia, Pavia, Italy
| | | | - Raffaella Cusmai
- Child Neurology Unit, Department of Neuroscience and Neurorehabilitation, Bambino Gesù Children's Research Hospital, IRCCS, Rome, Italy
| | - Francesca Darra
- Child Neuropsychiatry Unit, Department of Engineering for Innovation Medicine, University of Verona, Full Member of European Reference Network EpiCARE, Verona, Italy
| | - Alice Dianin
- Inherited Metabolic Diseases Unit and Regional Centre for Newborn Screening, Diagnosis and Treatment of Inherited Metabolic Diseases and Congenital Endocrine Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Elia Domenica
- Artificial Nutrition Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Monica Anna Maria Lodi
- Department of Child Neuropsychiatry, Epilepsy Center, Fatebenefratelli Hospital, Milan, Italy
| | - Sara Matricardi
- Department of Pediatrics, University of Chieti, Chieti, Italy
| | - Tullio Messana
- Istituto delle Scienze Neurologiche di Bologna, UOC Neuropsichiatria dell'etá pediatrica, Member of the ERN Epicare, Bologna, Italy
| | - Francesca Operto
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesca Ragona
- Department of Pediatric Neurology, IRCCS Foundation Carlo Besta Neurological Institute, Milan, Italy
| | - Emilio Russo
- Science of Health Department, University of Catanzaro, Catanzaro, Italy
| | - Costanza Varesio
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Lilia Volpi
- UOC Neurologia, IRCCS Istituto delle Scienze Neurologiche, Azienda USL di Bologna, Ospedale Bellaria Bologna, Bologna, Italy
| | | | - Ludovica Pasca
- Department of Brain and Behaviour Neuroscience, University of Pavia, Pavia, Italy
- Child Neurology and Psychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Pierangelo Veggiotti
- Vittore Buzzi Children's Hospital, Pediatric Neurology Unit, Milan, Italy
- Department of Biomedical and Clinical Sciences, L. Sacco, University of Milan, Milan, Italy
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18
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Perversi F, Costa C, Labate A, Lattanzi S, Liguori C, Maschio M, Meletti S, Nobili L, Operto FF, Romigi A, Russo E, Di Bonaventura C. The broad-spectrum activity of perampanel: state of the art and future perspective of AMPA antagonism beyond epilepsy. Front Neurol 2023; 14:1182304. [PMID: 37483446 PMCID: PMC10359664 DOI: 10.3389/fneur.2023.1182304] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [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: 03/08/2023] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Glutamate is the brain's main excitatory neurotransmitter. Glutamatergic neurons primarily compose basic neuronal networks, especially in the cortex. An imbalance of excitatory and inhibitory activities may result in epilepsy or other neurological and psychiatric conditions. Among glutamate receptors, AMPA receptors are the predominant mediator of glutamate-induced excitatory neurotransmission and dictate synaptic efficiency and plasticity by their numbers and/or properties. Therefore, they appear to be a major drug target for modulating several brain functions. Perampanel (PER) is a highly selective, noncompetitive AMPA antagonist approved in several countries worldwide for treating different types of seizures in various epileptic conditions. However, recent data show that PER can potentially address many other conditions within epilepsy and beyond. From this perspective, this review aims to examine the new preclinical and clinical studies-especially those produced from 2017 onwards-on AMPA antagonism and PER in conditions such as mesial temporal lobe epilepsy, idiopathic and genetic generalized epilepsy, brain tumor-related epilepsy, status epilepticus, rare epileptic syndromes, stroke, sleep, epilepsy-related migraine, cognitive impairment, autism, dementia, and other neurodegenerative diseases, as well as provide suggestions on future research agenda aimed at probing the possibility of treating these conditions with PER and/or other AMPA receptor antagonists.
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Affiliation(s)
| | - Cinzia Costa
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
- Neurological Clinic, S. Maria Della Misericordia Hospital, Perugia, Italy
| | - Angelo Labate
- Neurophysiopatology and Movement Disorders Clinic, University of Messina, Messina, Italy
| | - Simona Lattanzi
- Neurological Clinic, Department of Experimental and Clinical Medicine, Marche Polytechnic University, Ancona, Italy
| | - Claudio Liguori
- Department of Systems Medicine, University of Rome ‘Tor Vergata”, Rome, Italy
- Epilepsy Center, Neurology Unit, University Hospital “Tor Vergata”, Rome, Italy
| | - Marta Maschio
- Center for Tumor-Related Epilepsy, UOSD Neuro-Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Stefano Meletti
- Neurology Department, University Hospital of Modena, Modena, Italy
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio-Emilia, Modena, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS Istituto G. Gaslini, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Andrea Romigi
- Sleep Medicine Center, Neurological Mediterranean Institute IRCCS Neuromed, Pozzilli, Italy
- Psychology Faculty, International Telematic University Uninettuno, Rome, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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19
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Aronica E, Ciusani E, Coppola A, Costa C, Russo E, Salmaggi A, Perversi F, Maschio M. Epilepsy and brain tumors: Two sides of the same coin. J Neurol Sci 2023; 446:120584. [PMID: 36842341 DOI: 10.1016/j.jns.2023.120584] [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: 09/29/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
Epilepsy is the most common symptom in patients with brain tumors. The shared genetic, molecular, and cellular mechanisms between tumorigenesis and epileptogenesis represent 'two sides of the same coin'. These include augmented neuronal excitatory transmission, impaired inhibitory transmission, genetic mutations in the BRAF, IDH, and PIK3CA genes, inflammation, hemodynamic impairments, and astrocyte dysfunction, which are still largely unknown. Low-grade developmental brain tumors are those most commonly associated with epilepsy. Given this strict relationship, drugs able to target both seizures and tumors would be of extreme clinical usefulness. In this regard, anti-seizure medications (ASMs) are optimal candidates as they have well-characterized effects and safety profiles, do not increase the risk of developing cancer, and already offer well-defined seizure control. The most important ASMs showing preclinical and clinical efficacy are brivaracetam, lacosamide, perampanel, and especially valproic acid and levetiracetam. However, the data quality is low or limited to preclinical studies, and results are sometimes conflicting. Future trials with a prospective, randomized, and controlled design accounting for different prognostic factors will help clarify the role of these ASMs and the clinical setting in which they might be used. In conclusion, brain tumor-related epilepsies are clear examples of how close, multidisciplinary collaborations among investigators with different expertise are warranted for pursuing scientific knowledge and, more importantly, for the well-being of patients needing targeted and effective therapies.
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Affiliation(s)
- Eleonora Aronica
- Amsterdam UMC location the University of Amsterdam, Department of (Neuro)Pathology Amsterdam Neuroscience, Meibergdreef 9, Amsterdam, the Netherlands; Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Emilio Ciusani
- Department of Research and Technology, Fondazione IRCCS Istituto Neurologico C. Besta Milan, Italy
| | - Antonietta Coppola
- Department of Neuroscience, Odontostomatology and Reproductive Sciences, Federico II University of Naples, Naples, Italy
| | - Cinzia Costa
- Neurology Clinic, Department of Medicine and Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
| | - Emilio Russo
- Science of Health Department, Magna Grecia University, Catanzaro, Italy
| | - Andrea Salmaggi
- Department of Neurosciences, Unit of Neurology, Presidio A. Manzoni, ASST Lecco, Italy
| | | | - Marta Maschio
- Center for tumor-related epilepsy, UOSD Neurooncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
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20
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Russo E, Misasi G, Montt-Guevara MM, Giannini A, Simoncini T. Effects of ospemifene on overactive bladder in postmenopausal women with vulvovaginal atrophy. Climacteric 2023; 26:284-288. [PMID: 36912363 DOI: 10.1080/13697137.2023.2184251] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Overactive bladder (OAB) is a complex and multifactorial syndrome associated with urinary frequency, urgency and incontinence. The menopause-associated hormonal changes play a role in the development of this condition. Vaginal estrogens are effective in improving OAB in postmenopausal women (PMW) with vulvovaginal atrophy (VVA). Ospemifene is a selective estrogen receptor modulator licensed for the treatment of VVA. This study aimed to evaluate the effects of ospemifene on OAB symptoms in PMW with VVA. METHODS Forty PMW suffering from OAB and VVA received oral ospemifene (60 mg/day) for 12 weeks. All patients were assessed with a urodynamic study, a 3-day bladder diary and validated questionnaires (International Consultation on Incontinence Questionnaire - Urinary Incontinence Short Form [ICIQ-UI SF] and International Consultation on Incontinence Questionnaire - Overactive Bladder [ICIQ-OAB]) at enrollment and at the end of the study. RESULTS Cytometric capacity, bladder compliance and verbal sensory threshold responses during bladder filling were improved after treatment. The voiding diary showed a significant reduction of daily voids, urge urinary incontinence episodes and nocturnal events. The median overall scores of the ICIQ-UI and ICIQ-OAB were also significantly improved. CONCLUSIONS Our study suggest that treatment with ospemifene in PMW suffering from OAB is associated with a reduction of OAB symptoms due to a decreased bladder sensitivity and with an improvement in quality of life.
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Affiliation(s)
- E Russo
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Misasi
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M M Montt-Guevara
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Giannini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - T Simoncini
- Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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21
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Staino A, Russo E, Costabile M, Leccadito A. Minimum capital requirement and portfolio allocation for non-life insurance: a semiparametric model with Conditional Value-at-Risk (CVaR) constraint. Comput Manag Sci 2023; 20:12. [PMID: 37520270 PMCID: PMC9982813 DOI: 10.1007/s10287-023-00439-1] [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] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 01/31/2023] [Indexed: 08/01/2023]
Abstract
We present an optimization problem to determine the minimum capital requirement for a non-life insurance company. The optimization problem imposes a non-positive Conditional Value-at-Risk (CVaR) of the insurer's net loss and a portfolio performance constraint. When expressing the optimization problem in a semiparametric form, we demonstrate its convexity for any integrable random variable representing the insurer's liability. Furthermore, we prove that the function defining the CVaR constraint in the semiparametric formulation is continuously differentiable when the insurer's liability has a continuous distribution. We use the Kelley-Cheney-Goldstein algorithm to solve the optimization problem in the semiparametric form and show its convergence. An empirical analysis is carried out by assuming three different liability distributions: a lognormal distribution, a gamma distribution, and a mixture of Erlang distributions with a common scale parameter. The numerical experiments show that the choice of the liability distribution plays a crucial role since marked differences emerge when comparing the mixture distribution with the other two distributions. In particular, the mixture distribution describes better the right tail of the empirical distribution of liabilities with respect to the other two distributions and implies higher capital requirements and different assets in the optimal portfolios.
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Affiliation(s)
- Alessandro Staino
- Department of Economics, Statistics and Finance, University of Calabria, Ponte Bucci cubo 1C, 87036 Rende (CS), Italy
| | - Emilio Russo
- Department of Economics, Statistics and Finance, University of Calabria, Ponte Bucci cubo 1C, 87036 Rende (CS), Italy
| | - Massimo Costabile
- Department of Economics, Statistics and Finance, University of Calabria, Ponte Bucci cubo 1C, 87036 Rende (CS), Italy
| | - Arturo Leccadito
- Department of Economics, Statistics and Finance, University of Calabria, Ponte Bucci cubo 1C, 87036 Rende (CS), Italy
- LFIN/LIDAM, UCLouvain, Voie du Roman Pays 34, 1348 Louvain la neuve, Belgium
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22
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Riva A, D'Onofrio G, Pisati A, Roberti R, Amadori E, Bosch F, de Souza CFM, Thomas A, Russo E, Striano P, Bayat A. Cannabidiol Add-On in Glycosylphosphatidylinositol-Related Drug-Resistant Epilepsy. Cannabis Cannabinoid Res 2023. [PMID: 36862522 DOI: 10.1089/can.2022.0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Background: Glycosylphosphatidylinositol-anchored protein deficiencies (GPI-ADs) are commonly associated with drug-resistant epilepsy (DRE). Cannabidiol (CBD) is approved for the adjunctive treatment of seizures in Dravet/Lennox-Gastaut Syndromes and Tuberous Sclerosis Complex. We report on the efficacy and safety of CBD for the treatment of DRE in patients with genetically proven GPI-AD. Patients and Methods: Patients received add-on treatment with purified GW-pharma CBD (Epidyolex®). Efficacy endpoints were the percentage of patients with ≥50% (responders) or >25<50% (partial responders) reduction in monthly seizures from baseline and at 12 (M12) months of follow-up. Safety was evaluated through adverse events (AEs) monitoring. Results: Six patients (5 males) were enrolled. The median age at seizures onset was 5 months and the syndromic diagnosis was early infantile developmental and epileptic encephalopathy in 4 patients and focal non-lesional epilepsy or GEFS+ in one patient each. Five out of six (83%) patients were responders at M12, while one was a partial responder. No severe AEs were reported. Mean prescribed CBD dose was 17.85 mg/kg/day and median treatment duration is currently 27 months. Conclusions: In summary, off-label treatment with CBD was effective and safe in patients with DRE due to GPI-ADs.
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Affiliation(s)
- Antonella Riva
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini," Genoa, Italy
| | - Gianluca D'Onofrio
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini," Genoa, Italy
| | - Angelica Pisati
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini," Genoa, Italy
| | - Roberta Roberti
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Elisabetta Amadori
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini," Genoa, Italy
| | | | | | | | - Emilio Russo
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto "Giannina Gaslini," Genoa, Italy
| | - Allan Bayat
- Department of Epilepsy Genetics and Personalized Medicine, Danish Epilepsy Center, Dianalund, Denmark
- Institute for Regional Health Services, University of Southern Denmark, Odense, Denmark
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23
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Andreozzi F, Di Fatta C, Spiga R, Mannino GC, Mancuso E, Averta C, De Caro C, Tallarico M, Leo A, Citraro R, Russo E, De Sarro G, Sesti G. Glucagon induces the hepatic expression of inflammatory markers in vitro and in vivo. Diabetes Obes Metab 2023; 25:556-569. [PMID: 36305474 DOI: 10.1111/dom.14902] [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: 06/21/2022] [Revised: 10/12/2022] [Accepted: 10/24/2022] [Indexed: 02/02/2023]
Abstract
Glucagon exerts multiple hepatic actions, including stimulation of glycogenolysis/gluconeogenesis. The liver plays a crucial role in chronic inflammation by synthesizing proinflammatory molecules, which are thought to contribute to insulin resistance and hyperglycaemia. Whether glucagon affects hepatic expression of proinflammatory cytokines and acute-phase reactants is unknown. Herein, we report a positive relationship between fasting glucagon levels and circulating interleukin (IL)-1β (r = 0.252, p = .042), IL-6 (r = 0.230, p = .026), fibrinogen (r = 0.193, p = .031), complement component 3 (r = 0.227, p = .024) and high sensitivity C-reactive protein (r = 0.230, p = .012) in individuals without diabetes. In CD1 mice, 4-week continuous treatment with glucagon induced a significant increase in circulating IL-1β (p = .02), and IL-6 (p = .001), which was countered by the contingent administration of the glucagon receptor antagonist, GRA-II. Consistent with these results, we detected a significant increase in the hepatic activation of inflammatory pathways, such as expression of NLRP3 (p < .02), and the phosphorylation of nuclear factor kappaB (NF-κB; p < .02) and STAT3 (p < .01). In HepG2 cells, we found that glucagon dose-dependently stimulated the expression of IL-1β (p < .002), IL-6 (p < .002), fibrinogen (p < .01), complement component 3 (p < .01) and C-reactive protein (p < .01), stimulated the activation of NLRP3 inflammasome (p < .01) and caspase-1 (p < .05), induced the phosphorylation of TRAF2 (p < .01), NF-κB (p < .01) and STAT3 (p < .01). Preincubating cells with GRA-II inhibited the ability of glucagon to induce an inflammatory response. Using HepaRG cells, we confirmed the dose-dependent ability of glucagon to stimulate the expression of NLRP3, the phosphorylation of NF-κB and STAT3, in the absence of GRA-II. These results suggest that glucagon has proinflammatory effects that may participate in the pathogenesis of hyperglycaemia and unfavourable cardiometabolic risk profile.
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Affiliation(s)
- Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases (CR METDIS), University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Concetta Di Fatta
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rosangela Spiga
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Gaia Chiara Mannino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elettra Mancuso
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carolina Averta
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Carmen De Caro
- Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Martina Tallarico
- Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Science of Health, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | | | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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24
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Caselli M, Russo E, Guéry JP, Demuru E, Norscia I. More Than Just Kibbles: Keeper Familiarity and Food Can Affect Bonobo Behavior. Animals (Basel) 2023; 13:ani13030410. [PMID: 36766299 PMCID: PMC9913499 DOI: 10.3390/ani13030410] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 01/10/2023] [Accepted: 01/23/2023] [Indexed: 01/27/2023] Open
Abstract
The welfare of captive animals relies on numerous factors. Keepers can affect animals' welfare and this could especially apply to emotionally and cognitively complex species, such as great apes. We collected video data over three months on 17 bonobos (La Vallée des Singes, France) and extracted five behaviours (play, aggression, anxiety, gestures, sociosexual interactions) -during two-minute slots-under three conditions: keeper-present/food-unavailable; keeper-present/food-available; keeper-absent/food-unavailable. We ran generalized linear models to investigate whether behavioral frequencies were affected by food presence/quality and keeper familiarity. Anxiety-related behaviors increased when the keeper was present and in absence of food, due to food expectation. Sociosexual interactions increased in presence of more familiar keepers and in absence of food, maybe to decrease the tension around food. Gestures increased in presence of more familiar keepers and with low-quality food, which was provided in large 'catchable' pieces. Aggression levels increased with high-quality food with no effect of keeper. Play behavior was not affected by any variable. Hence, bonobos were affected not just by food but also by keeper features. Considering multiple variables in the 'welfare equation' can improve captive management and increase the well-being of bonobos, a species that is much closer to humans than to other non-human animals.
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Affiliation(s)
- Marta Caselli
- Department of Life Science and System Biology, University of Torino, Via Accademia Albertina 13, 10123 Torino, Italy
| | - Emilio Russo
- Department of Life Science and System Biology, University of Torino, Via Accademia Albertina 13, 10123 Torino, Italy
| | | | - Elisa Demuru
- Laboratoire Dynamique du Langage, CNRS-UMR 5596, Université de Lyon, 14 Avenue Berthelot, 69363 Lyon, France
- ENES Bioacoustics Research Lab, CRNL, CNRS-UMR 5292, InsermUMR_S1028, Université de Saint-Etienne, 21, rue du Dr. Paul Michelon, 42100 Saint-Etienne, France
- Correspondence: (E.D.); (I.N.); Tel.: +33-0472-726546 (E.D.); +39-011-670-4547 (I.N.)
| | - Ivan Norscia
- Department of Life Science and System Biology, University of Torino, Via Accademia Albertina 13, 10123 Torino, Italy
- Correspondence: (E.D.); (I.N.); Tel.: +33-0472-726546 (E.D.); +39-011-670-4547 (I.N.)
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25
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Sancandi M, De Caro C, Cypaite N, Marascio N, Avagliano C, De Marco C, Russo E, Constanti A, Mercer A. Effects of a probiotic suspension Symprove™ on a rat early-stage Parkinson's disease model. Front Aging Neurosci 2023; 14:986127. [PMID: 36742204 PMCID: PMC9890174 DOI: 10.3389/fnagi.2022.986127] [Citation(s) in RCA: 1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 12/28/2022] [Indexed: 01/19/2023] Open
Abstract
An increasing number of studies in recent years have focused on the role that the gut may play in Parkinson's Disease (PD) pathogenesis, suggesting that the maintenance of a healthy gut may lead to potential treatments of the disease. The health of microbiota has been shown to be directly associated with parameters that play a potential role in PD including gut barrier integrity, immunity, function, metabolism and the correct functioning of the gut-brain axis. The gut microbiota (GM) may therefore be employed as valuable indicators for early diagnosis of PD and potential targets for preventing or treating PD symptoms. Preserving the gut homeostasis using probiotics may therefore lead to a promising treatment strategy due to their known benefits in improving constipation, motor impairments, inflammation, and neurodegeneration. However, the mechanisms underlying the effects of probiotics in PD are yet to be clarified. In this project, we have tested the efficacy of an oral probiotic suspension, Symprove™, on an established animal model of PD. Symprove™, unlike many commercially available probiotics, has been shown to be resistant to gastric acidity, improve symptoms in gastrointestinal diseases and improve gut integrity in an in vitro PD model. In this study, we used an early-stage PD rat model to determine the effect of Symprove™ on neurodegeneration and neuroinflammation in the brain and on plasma cytokine levels, GM composition and short chain fatty acid (SCFA) release. Symprove™ was shown to significantly influence both the gut and brain of the PD model. It preserved the gut integrity in the PD model, reduced plasma inflammatory markers and changed microbiota composition. The treatment also prevented the reduction in SCFAs and striatal inflammation and prevented tyrosine hydroxylase (TH)-positive cell loss by 17% compared to that observed in animals treated with placebo. We conclude that Symprove™ treatment may have a positive influence on the symptomology of early-stage PD with obvious implications for the improvement of gut integrity and possibly delaying/preventing the onset of neuroinflammation and neurodegeneration in human PD patients.
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Affiliation(s)
- Marco Sancandi
- Department of Pharmacology, UCL School of Pharmacy, London, United Kingdom
| | - Carmen De Caro
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Neringa Cypaite
- Department of Pharmacology, UCL School of Pharmacy, London, United Kingdom
| | - Nadia Marascio
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Carmen Avagliano
- Department of Pharmacy, University of Naples Federico II, Napoli, Italy
| | - Carmela De Marco
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Science of Health, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Andrew Constanti
- Department of Pharmacology, UCL School of Pharmacy, London, United Kingdom
| | - Audrey Mercer
- Department of Pharmacology, UCL School of Pharmacy, London, United Kingdom,*Correspondence: Audrey Mercer,
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26
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Tallarico M, Leo A, Russo E, Citraro R, Palma E, De Sarro G. Seizure susceptibility to various convulsant stimuli in the BTBR mouse model of autism spectrum disorders. Front Pharmacol 2023; 14:1155729. [PMID: 37153775 PMCID: PMC10157402 DOI: 10.3389/fphar.2023.1155729] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/31/2023] [Accepted: 04/07/2023] [Indexed: 05/10/2023] Open
Abstract
Background: Autism spectrum disorders (ASDs) are one of the most severe chronic childhood disorders in terms of prevalence, morbidity, and impact on society. Interestingly, several systematic reviews and meta-analyses documented a bidirectional link between epilepsy and ASD, supporting the hypothesis that both disorders may have common neurobiological pathways. According to this hypothesis, an imbalance of the excitatory/inhibitory (E/I) ratio in several brain regions may represent a causal mechanism underpinning the co-occurrence of these neurological diseases. Methods: To investigate this bidirectional link, we first tested the seizure susceptibility to chemoconvulsants acting on GABAergic and glutamatergic systems in the BTBR mice, in which an imbalance between E/I has been previously demonstrated. Subsequently, we performed the PTZ kindling protocol to study the impact of seizures on autistic-like behavior and other neurological deficits in BTBR mice. Results: We found that BTBR mice have an increased susceptibility to seizures induced by chemoconvulsants impairing GABAA neurotransmission in comparison to C57BL/6J control mice, whereas no significant difference in seizure susceptibility was observed after administration of AMPA, NMDA, and Kainate. This data suggests that deficits in GABAergic neurotransmission can increase seizure susceptibility in this strain of mice. Interestingly, BTBR mice showed a longer latency in the development of kindling compared to control mice. Furthermore, PTZ-kindling did not influence autistic-like behavior in BTBR mice, whereas it was able to significantly increase anxiety and worsen cognitive performance in this strain of mice. Interestingly, C57BL/6J displayed reduced sociability after PTZ injections, supporting the hypothesis that a tight connection exists between ASD and epilepsy. Conclusion: BTBR mice can be considered a good model to study epilepsy and ASD contemporarily. However, future studies should shed light on the mechanisms underpinning the co-occurrence of these neurological disorders in the BTBR model.
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Affiliation(s)
- Martina Tallarico
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
- *Correspondence: Antonio Leo,
| | - Emilio Russo
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Ernesto Palma
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine and Surgery, Magna Graecia University of Catanzaro, Catanzaro, Italy
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27
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Shaikh MF, Ngadimon IW, Chakraborti A, Abdullah JM, Russo E. Editorial: Experimental models of epilepsy and related comorbidities, Volume II. Front Pharmacol 2023; 14:1182958. [PMID: 37033657 PMCID: PMC10080249 DOI: 10.3389/fphar.2023.1182958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 04/11/2023] Open
Affiliation(s)
- Mohd Farooq Shaikh
- School of Dentistry and Medical Sciences, Charles Sturt University, Orange, NSW, Australia
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
- *Correspondence: Mohd Farooq Shaikh, ; Ayanabha Chakraborti, ; Jafri Malin Abdullah, ; Emilio Russo,
| | - Irma Wati Ngadimon
- Neuropharmacology Research Laboratory, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Ayanabha Chakraborti
- Department of Translational Neurosciences, College of Medicine Phoenix, University of Arizona, Phoenix, AZ, United States
- *Correspondence: Mohd Farooq Shaikh, ; Ayanabha Chakraborti, ; Jafri Malin Abdullah, ; Emilio Russo,
| | - Jafri Malin Abdullah
- Brain Behaviour Cluster and Department of Neurosciences, School of Medical Sciences/Hospital Universiti Sains Malaysia, Universiti Sains Malaysia, Kubang Kerian, Kota Bharu, Malaysia
- *Correspondence: Mohd Farooq Shaikh, ; Ayanabha Chakraborti, ; Jafri Malin Abdullah, ; Emilio Russo,
| | - Emilio Russo
- Magna Græcia University, Catanzaro, Italy
- *Correspondence: Mohd Farooq Shaikh, ; Ayanabha Chakraborti, ; Jafri Malin Abdullah, ; Emilio Russo,
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28
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Tallarico M, Pisano M, Leo A, Russo E, Citraro R, De Sarro G. Antidepressant Drugs for Seizures and Epilepsy: Where do we Stand? Curr Neuropharmacol 2023; 21:1691-1713. [PMID: 35761500 PMCID: PMC10514547 DOI: 10.2174/1570159x20666220627160048] [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: 02/26/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/22/2022] Open
Abstract
People with epilepsy (PWE) are more likely to develop depression and both these complex chronic diseases greatly affect health-related quality of life (QOL). This comorbidity contributes to the deterioration of the QOL further than increasing the severity of epilepsy worsening prognosis. Strong scientific evidence suggests the presence of shared pathogenic mechanisms. The correct identification and management of these factors are crucial in order to improve patients' QOL. This review article discusses recent original research on the most common pathogenic mechanisms of depression in PWE and highlights the effects of antidepressant drugs (ADs) against seizures in PWE and animal models of seizures and epilepsy. Newer ADs, such as selective serotonin reuptake inhibitors (SRRI) or serotonin-noradrenaline reuptake inhibitors (SNRI), particularly sertraline, citalopram, mirtazapine, reboxetine, paroxetine, fluoxetine, escitalopram, fluvoxamine, venlafaxine, duloxetine may lead to improvements in epilepsy severity whereas the use of older tricyclic antidepressant (TCAs) can increase the occurrence of seizures. Most of the data demonstrate the acute effects of ADs in animal models of epilepsy while there is a limited number of studies about the chronic antidepressant effects in epilepsy and epileptogenesis or on clinical efficacy. Much longer treatments are needed in order to validate the effectiveness of these new alternatives in the treatment and the development of epilepsy, while further clinical studies with appropriate protocols are warranted in order to understand the real potential contribution of these drugs in the management of PWE (besides their effects on mood).
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Affiliation(s)
- Martina Tallarico
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Maria Pisano
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Antonio Leo
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- System and Applied Pharmacology, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Celli R, Striano P, Citraro R, Di Menna L, Cannella M, Imbriglio T, Koko M, Consortium EEC, De Sarro G, Monn JA, Battaglia G, van Luijtelaar G, Nicoletti F, Russo E, Leo A. mGlu3 Metabotropic Glutamate Receptors as a Target for the Treatment of Absence Epilepsy: Preclinical and Human Genetics Data. Curr Neuropharmacol 2023; 21:105-118. [PMID: 35579153 PMCID: PMC10193767 DOI: 10.2174/1570159x20666220509160511] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/16/2022] [Accepted: 02/18/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Previous studies suggest that different metabotropic glutamate (mGlu) receptor subtypes are potential drug targets for treating absence epilepsy. However, no information is available on mGlu3 receptors. OBJECTIVE To examine whether (i) changes of mGlu3 receptor expression/signaling are found in the somatosensory cortex and thalamus of WAG/Rij rats developing spontaneous absence seizures; (ii) selective activation of mGlu3 receptors with LY2794193 affects the number and duration of spikewave discharges (SWDs) in WAG/Rij rats; and (iii) a genetic variant of GRM3 (encoding the mGlu3 receptor) is associated with absence epilepsy. METHODS Animals: immunoblot analysis of mGlu3 receptors, GAT-1, GLAST, and GLT-1; realtime PCR analysis of mGlu3 mRNA levels; assessment of mGlu3 receptor signaling; EEG analysis of SWDs; assessment of depressive-like behavior. Humans: search for GRM3 and GRM5 missense variants in 196 patients with absence epilepsy or other Idiopathic Generalized Epilepsy (IGE)/ Genetic Generalized Epilepsy (GGE) and 125,748 controls. RESULTS mGlu3 protein levels and mGlu3-mediated inhibition of cAMP formation were reduced in the thalamus and somatosensory cortex of pre-symptomatic (25-27 days old) and symptomatic (6-7 months old) WAG/Rij rats compared to age-matched controls. Treatment with LY2794193 (1 or 10 mg/kg, i.p.) reduced absence seizures and depressive-like behavior in WAG/Rij rats. LY2794193 also enhanced GAT1, GLAST, and GLT-1 protein levels in the thalamus and somatosensory cortex. GRM3 and GRM5 gene variants did not differ between epileptic patients and controls. CONCLUSION We suggest that mGlu3 receptors modulate the activity of the cortico-thalamo-cortical circuit underlying SWDs and that selective mGlu3 receptor agonists are promising candidate drugs for absence epilepsy treatment.
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Affiliation(s)
| | - Pasquale Striano
- Department Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genova, Italy
- I.R.C.C.S. “G. Gaslini” Institute, Genova, Italy
| | - Rita Citraro
- University of Catanzaro, School of Medicine, Science of Health Department, FAS@UMG Research Center, Catanzaro, Italy
| | | | | | | | - Mahmoud Koko
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tuebingen, Tuebingen, Germany
| | | | - Giovambattista De Sarro
- University of Catanzaro, School of Medicine, Science of Health Department, FAS@UMG Research Center, Catanzaro, Italy
| | | | - Giuseppe Battaglia
- I.R.C.C.S. Neuromed, Pozzilli, Italy
- Department of Physiology and Pharmacology, University Sapienza, Rome, Italy
| | | | - Ferdinando Nicoletti
- I.R.C.C.S. Neuromed, Pozzilli, Italy
- Department of Physiology and Pharmacology, University Sapienza, Rome, Italy
| | - Emilio Russo
- University of Catanzaro, School of Medicine, Science of Health Department, FAS@UMG Research Center, Catanzaro, Italy
| | - Antonio Leo
- University of Catanzaro, School of Medicine, Science of Health Department, FAS@UMG Research Center, Catanzaro, Italy
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Falcicchio G, Russo E, Fabiano A, Scalese M, Boero G, Trojano M, de Tommaso M, La Neve A. Current safety concerns about the use of antiseizure medications in pregnancy. Expert Opin Drug Saf 2022; 21:1459-1468. [PMID: 36537559 DOI: 10.1080/14740338.2022.2160443] [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] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Given the high prevalence of epilepsy in women of childbearing potential (15 million out of 50 million people worldwide), antiseizure medication (ASM) use in pregnancy is common. Identifying the safest and most effective ASM to use during pregnancy is often difficult, but also crucially important. The challenge is to balance two needs: maintaining seizure control while minimizing teratogenicity. AREAS COVERED This review looks at seizure- and treatment-related risks to mother and fetus during pregnancy, existing healthcare information programmes, strengths and pitfalls of the main pregnancy registries, known and supposed pharmacokinetic changes during gestation, the utility of therapeutic drug monitoring, and safety concerns. Articles and related content were screened on available publications after January 2000. EXPERT OPINION The use of newer ASMs during pregnancy is still limited, as shown by the paucity of data collected by different pregnancy registries. Choosing these medications can be challenging, partly due to unknown pharmacokinetic modifications in pregnancy, an aspect that serum drug monitoring might help to clarify. The safest treatment is chosen also taking into account the woman's needs, concerns and wishes, but adequate pre-pregnancy counseling is necessary to properly inform her about personal and fetal risks related both to seizures and to medications.
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Affiliation(s)
- Giovanni Falcicchio
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Antonio Fabiano
- Science of Health Department, School of Medicine, University Magna Graecia, Catanzaro, Italy
| | - Micaela Scalese
- Pharmacy Department, Azienda Sanitaria Provinciale Di Catanzaro, Catanzaro, Italy
| | - Giovanni Boero
- Complex Structure of Neurology, SS Annunziata Hospital, Taranto, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Marina de Tommaso
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Angela La Neve
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
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Bolignano D, Greco M, Arcidiacono V, Presta P, Caglioti A, Russo E, Andreucci M, Tripolino O, Carullo N, Foti DP, Coppolino G. Decreased Cathepsin-K Mirrors the Severity of Subclinical Atherosclerosis in Kidney Transplant Recipients. Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2309311] [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: 11/06/2022] Open
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Russo E, Carboni D, Baldi S, Fioretto B, Romano E, El Aoufy K, Ramazzotti M, Rosa I, Lepri G, DI Gloria L, Bruni C, Melchiorre D, Guiducci S, Manetti M, Matucci-Cerinic M, Amedei A, Bellando Randone S. POS0487 THE CROSSTALK OF THE SKIN-ORAL-GUT MICROBIOME AXIS IN LIMITED AND DIFFUSE CUTANEOUS SYSTEMIC SCLEROSIS. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4630] [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: 11/04/2022]
Abstract
BackgroundSystemic sclerosis (SSc) is a complex and still unclear rare disease. Microbiota has recently emerged as an important environmental factor in SSc pathogenesis, either at gut, oral and skin level.ObjectivesTo investigate the role of microbiota in SSc subsets, focusing on the skin-oral-gut microbiota axis and serum and fecal free fatty acids (FFA) profile.MethodsTwenty-six consecutive SSc patients (22 females) (mean disease duration (SD): 13 ± 6.91 yrs), classified according to the ACR/EULAR2013 criteria, were enrolled. Demographic, clinical and laboratory data were recorded. Gastrointestinal symptoms were investigated with UCLA GIT-2.0-questionnaire. Fecal, unstimulated saliva and superficial epidermal samples were collected. Microbiota was assessed through 16S ribosomal RNA Next Generation gene-sequencing analysis. Gas Cromatography-Mass Spettroscopy was used to measure FFAs in serum and fecal samples.ResultsThirteen patients had limited cutaneous SSc (lcSSc), 13 diffuse cutaneous (dcSSc). The two subsets displayed a different cutaneous and fecal microbiota profile. In detail, the class of cutaneous Sphingobacteria was significantly higher in lcSSc (p<0.05), while the phylum of Lentisphaerae, the family of Victivallaceae and the genus of Victivallis were significantly higher in fecal samples of lcSSc (all p<0.05). A significant increase of fecal propionic acid was observed in lcSSc patients (p<0.05). Moreover, all fecal medium-chain FAs and hexanoic acids were significantly higher in lcSSc (p<0.05 and p<0.001, respectively). The analysis of serum FFAs levels showed an increase of valeric and octanoic acids in lcSSc (both p<0.05). A negative correlation between UCLA-GIT-2.0 total score and fecal octanoic acid (rho=-0.61; p=0.03), and a positive correlation with serum propionic acid (rho=0.55; p=0.05) was found in lcSSc.ConclusionOur findings show a different microbiota signature in the skin and gut, and a different FFAs profile in lcSSc and dcSSc. Such a differential regulation of microbiota composition and bacterial metabolite production suggests different dynamics of skin-oral-gut microbiota axis in SSc subsets. This data could be useful to develop personalized therapies targeting gastrointestinal and skin involvement.Disclosure of InterestsNone declared.
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Riva A, Pozzati E, Grasso M, De Caro C, Russo E, Verrotti A, Striano P. Targeting the MGBA with -biotics in epilepsy: New insights from preclinical and clinical studies. Neurobiol Dis 2022; 170:105758. [PMID: 35588991 DOI: 10.1016/j.nbd.2022.105758] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 01/15/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Data accumulation reveals that the bidirectional communication between the gut microbiota and the brain, called the microbiota-gut-brain axis (MGBA), can be modulated by different compounds including prebiotics, probiotics, symbiotic (a fair combination of both), and diet, thus exerting a beneficial impact on brain activity and behaviors. This review aims to give an overview of the possible beneficial effects of the supplementation of -biotics in epilepsy treatment. METHODS A search on PubMed and ClinicalTrials.gov databases using the terms "probiotics", OR "prebiotics", AND "gut microbiota", AND "epilepsy" was performed. The search covered the period of the last eleven years (2010-2021). CONCLUSIONS Nowadays, studies analyzing the clinical impact of gut microbiota-modulating intervention strategies on epilepsy are limited and heterogenous due either to the different experimental populations studied (i.e., genetic vs lesional mouse models) or the various primary outcomes measure evaluated. However, positive effects have invariably been noticed; particularly, there have been improvements in behavioral comorbidities and associated gastrointestinal (GI) symptoms. More studies will be needed in the next few years to strictly evaluate the feasibility to introduce these new therapeutic strategies in the clinical treatment of highly refractory epilepsies.
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Affiliation(s)
- Antonella Riva
- Paediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
| | - Elisa Pozzati
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
| | - Mattia Grasso
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy
| | - Carmen De Caro
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University of Catanzaro, Catanzaro, Italy
| | - Alberto Verrotti
- Department of Paediatrics, University of Perugia, Perugia, Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Università degli Studi di Genova, Genova, Italy.
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Roberti R, Rocca M, Iannone LF, Gasparini S, Pascarella A, Neri S, Cianci V, Bilo L, Russo E, Quaresima P, Aguglia U, Di Carlo C, Ferlazzo E. Status epilepticus in pregnancy: a literature review and a protocol proposal. Expert Rev Neurother 2022; 22:301-312. [PMID: 35317697 DOI: 10.1080/14737175.2022.2057224] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Status epilepticus (SE) in pregnancy represents a life-threatening medical emergency for both mother and fetus. Pregnancy-related pharmacokinetic modifications and the risks for fetus associated with the use of antiseizure medications (ASMs) and anesthetic drugs complicate SE management. No standardized treatment protocol for SE in pregnancy is available to date. AREAS COVERED In this review, we provide an overview of the current literature on the management of SE in pregnancy and we propose a multidisciplinary-based protocol approach. EXPERT OPINION Literature data are scarce (mainly anecdotal case reports or small case series). Prompt treatment of SE during pregnancy is paramount and a multidisciplinary team is needed. Benzodiazepines are the drugs of choice for SE in pregnancy. Levetiracetam and phenytoin represent the most suitable second-line agents. Valproic acid should be administered only if other ASMs failed and preferably avoided in the first trimester of pregnancy. For refractory SE, anesthetic drugs are needed, with propofol and midazolam as preferred drugs. Magnesium sulfate is the first-line treatment for SE in eclampsia. Termination of pregnancy, via delivery or abortion, is recommended in case of failure of general anesthetics. Further studies are needed to identify the safest and most effective treatment protocol.
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Affiliation(s)
- Roberta Roberti
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Morena Rocca
- Obstetrics and Gynecology Unit, "Pugliese-ciaccio" Hospital of Catanzaro, Catanzaro, Italy
| | | | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Angelo Pascarella
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy
| | - Leonilda Bilo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, Magna Græcia University, Catanzaro, Italy
| | - Paola Quaresima
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Costantino Di Carlo
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, Federico II University, Naples, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "Bianchi-Melacrino-Morelli" Hospital, Reggio Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Græcia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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Battisti S, Sanson G, Paolucci E, Giampalma E, Russo E, Bergamini C, Agnoletti V, Di Bella S, Palermo A, Scarlata S. Transient diaphragmatic thinning in patients with interstitial pneumonia due to SARS-CoV-2. Int J Tuberc Lung Dis 2022; 26:369-371. [PMID: 35351243 DOI: 10.5588/ijtld.21.0673] [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: 11/10/2022] Open
Affiliation(s)
- S Battisti
- Radiology Department, Bufalini Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, Cesena, Italy, Istituto Romagnolo per lo Studio dei Tumori, Meldola, Italy, Dipartimento di Medicina Specialistica Diagnostica e Sperimentale, Alma Mater Studiorum, University of Bologna, Italy
| | - G Sanson
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | | | - E Giampalma
- Radiology Department, Bufalini Hospital, Azienda Unità Sanitaria Locale (AUSL) Romagna, Cesena, Italy
| | - E Russo
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - C Bergamini
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - V Agnoletti
- Anesthesia and Intensive Care Unit, Bufalini Hospital, AUSL Romagna, Cesena, Italy
| | - S Di Bella
- Infectious Diseases Department, University Hospital of Trieste, Trieste, Italy
| | - A Palermo
- Unit of Endocrinology and Diabetes, Campus Bio Medico University and Teaching Hospital, Rome, Italy
| | - S Scarlata
- Unit of Respiratory Pathophysiology and Thoracic Endoscopy, Campus Bio Medico University and Teaching Hospital, Rome, Italy
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Fusco F, Perottoni S, Giordano C, Riva A, Iannone LF, De Caro C, Russo E, Albani D, Striano P. The microbiota‐gut‐brain axis and epilepsy from a multidisciplinary perspective: clinical evidence and technological solutions for improvement of
in vitro
preclinical models. Bioeng Transl Med 2022; 7:e10296. [PMID: 35600638 PMCID: PMC9115712 DOI: 10.1002/btm2.10296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/09/2022] Open
Affiliation(s)
- Federica Fusco
- Dipartimento di Chimica, materiali e ingegneria chimica "Giulio Natta" Politecnico di Milano Milan Italy
| | - Simone Perottoni
- Dipartimento di Chimica, materiali e ingegneria chimica "Giulio Natta" Politecnico di Milano Milan Italy
| | - Carmen Giordano
- Dipartimento di Chimica, materiali e ingegneria chimica "Giulio Natta" Politecnico di Milano Milan Italy
| | - Antonella Riva
- Paediatric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini Genova Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Università degli Studi di Genova Genova Italy
| | | | - Carmen De Caro
- Science of Health Department Magna Graecia University Catanzaro Italy
| | - Emilio Russo
- Science of Health Department Magna Graecia University Catanzaro Italy
| | - Diego Albani
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS Milan Italy
| | - Pasquale Striano
- Paediatric Neurology and Muscular Disease Unit, IRCCS Istituto Giannina Gaslini Genova Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Università degli Studi di Genova Genova Italy
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Dastoli S, Nisticò SP, Morrone P, Patruno C, Leo A, Citraro R, Gallelli L, Russo E, De Sarro G, Bennardo L. Colchicine in Managing Skin Conditions: A Systematic Review. Pharmaceutics 2022; 14:pharmaceutics14020294. [PMID: 35214027 PMCID: PMC8878049 DOI: 10.3390/pharmaceutics14020294] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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] [Received: 12/19/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Colchicine is a natural alkaloid with anti-inflammatory properties used to treat various disorders, including some skin diseases. This paper aims to incorporate all the available studies proposing colchicine as a treatment alternative in the management of cutaneous conditions. (2) Methods: In this systematic review, the available articles present in various databases (PubMed, Scopus-Embase, and Web of Science), proposing colchicine as a treatment for cutaneous pathological conditions, have been selected. Exclusion criteria included a non-English language and non-human studies. (3) Results: Ninety-six studies were included. Most of them were case reports and case series studies describing colchicine as single therapy, or in combination with other drugs. Hidradenitis suppurativa, pyoderma gangrenosum, erythema nodosum, erythema induratum, storage diseases, perforating dermatosis, bullous diseases, psoriasis, vasculitis, acne, urticaria, stomatitis, actinic keratosis, and pustular dermatosis were the main diseases discussed in literature. Although the therapeutic outcomes were variable, most of the studies reported, on average, good clinical results (4) Conclusions: Colchicine could be, as a single therapy or in combination with other drugs, a possible treatment to manage several skin diseases.
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Affiliation(s)
- Stefano Dastoli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Steven Paul Nisticò
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | | | - Cataldo Patruno
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Antonio Leo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Rita Citraro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luca Gallelli
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Giovambattista De Sarro
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
| | - Luigi Bennardo
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (S.D.); (S.P.N.); (C.P.); (A.L.); (R.C.); (L.G.); (E.R.); (G.D.S.)
- Azienda Ospedaliera di Cosenza, 87100 Cosenza, Italy;
- Correspondence: ; Tel.: +39-09-613627195
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Carbone EA, de Filippis R, Roberti R, Rania M, Destefano L, Russo E, De Sarro G, Segura-Garcia C, De Fazio P. The Mental Health of Caregivers and Their Patients With Dementia During the COVID-19 Pandemic: A Systematic Review. Front Psychol 2022; 12:782833. [PMID: 35002872 PMCID: PMC8740146 DOI: 10.3389/fpsyg.2021.782833] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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: 09/24/2021] [Accepted: 11/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Coronavirus Disease 2019 (COVID-19) is a worldwide public health concern. It continues to spread rapidly throughout the world causing multiple physical and psychological consequences in the population. Especially, people affected by severe psychiatric or neurological diseases are highly susceptible to serious health complications not only due to the direct effect of the infection but also to the indirect effect of COVID-19 following social distancing during lockdowns and its general social consequences. Indeed, lockdown and difficulties in using the care services produced psychological consequences in caregivers such as depression, anxiety, and worsening of the quality of life which in turn affected the ability to manage patients. Our aim was to systematically review the psychological consequences of the COVID-19 lockdown in caregivers of patients with cognitive impairment and dementia and the impact on the health of their patients. Methods: A systematic literature search was conducted by searching in MEDLINE/PubMed, Scopus, and Web of Science by two independent researchers following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. Data extraction and quality assessment were also performed. Papers were screened for eligibility by abstract and then those which met inclusion criteria were included in this review. Results: The initial search returned 410 records. After the abstract screening and the inclusion/exclusion criteria were applied, 315 were excluded because they were irrelevant, 30 because they were reviews, meta-analyses, letters to editors, editorials, guidelines, or case reports, and 10 because they were duplicates. Then, 38 out of 55 abstracts/full-text articles were excluded because they did not simultaneously assess mental health of patients and caregivers. In the end, 17 papers were deemed eligible and included in the present review. Conclusion: Based on current literature, the COVID-19 pandemic and the ensuing lockdown caused severe psychological consequences for caregivers of patients with dementia, worsening their mental health, and increasing the psychological and physical burden, independently from the severity of the disease of their relatives, which resulted also independently globally worsened.
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Affiliation(s)
- Elvira Anna Carbone
- Psychiatry Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Roberta Roberti
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Marianna Rania
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Laura Destefano
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy.,Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | | | - Cristina Segura-Garcia
- Psychiatry Unit, Department of Medical and Surgical Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
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Gareri P, Russo E, Condito A, De Sarro G. The risks of polypharmacy in ambulatory and home care patients affected with dementia: The PharE Study. Alzheimers Dement 2022. [PMID: 34971273 DOI: 10.1002/alz.053117] [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: 11/06/2022]
Abstract
BACKGROUND Older patients affected with comorbidities often take a lot of potentially inappropriate drugs. This can cause side effects, hospitalization and even death. AIM The aim of the present study was to assess dangerous drug interactions and potentially inappropriate drugs administered to a sample of ambulatory and home care patients affected with dementia. METHODS 41 ambulatory outpatients and 53 home care patients affected with dementia were selected randomly between January 1st 2017 and December 31st 2019. They were visited at the Center for Cognitive Disorders and Dementia, Catanzaro Lido, Italy. Personal, clinical data and drugs taken were collected; comorbidities were assessed through CIRS, ADL, IADL, MMSE. Beers criteria were used in order to assess the potentially inappropriate drugs. RESULTS Of 100 patients, 64 were women and 36 men, mean age 83,7 ± 4,9 and 82,1 years old ± 11,8 years old respectively. 50% of them were affected with mixed dementia, 13% Alzheimer's dementia, 9% Parkinsonism, 10% depression with associated cognitive impairment, 18% dementia of other kind. Mean MMSE score was 15,99 ± 8,84. Each patient was taking 9,17 ± 3,31 drugs on the average, 56% of them 5-9 drugs and 39% 10 drugs or more. 66% of patients was taking one inappropriate drugs or more, proton pump inhibitors (PPI) (51%), atypical and conventional antipsychotics (23% and 6% respectively), benzodiazepines, amiodarone, calcium antagonists (3%), tricyclic antidepressants and a-blockers (2%), old generation anti-histamine drugs (1%). 56% of them were taking a drug with anticholinergic properties. CONCLUSIONS The study shows a high percentage of drugs with anticholinergic properties, which can increase the risk for dementia or even worsen cognitive impairment. Furthermore, inappropriate drugs were stopped and changed with more tolerated compounds. PPI use was dramatically reduced. The study suggests the need for a careful check of treatment in every patient, and for personalizing treatment in older patients with dementia. A larger sample could bring more information to healthcare providers as well as the use of softwares for helping doctors to limit the risk for drug interactions.
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Affiliation(s)
- Pietro Gareri
- Center for Cognitive Disorders and Dementia, Catanzaro Lido, ASP Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Chair of Pharmacology, School of Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy
| | - Andrea Condito
- Emergency Territorial Medicine, ASP Catanzaro, Catanzaro, Italy
| | - Giovambattista De Sarro
- Chair of Pharmacology, Faculty of Medicine, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Abstract
Biomarkers are defined as objectively measurable variables of a biologic process, either physiologic or pathologic, that provide reliable information on the status of that specific process in a specific moment. Validated biomarkers in epilepsy research represent an urgent unmet need being essential to improve research quality; as an example, biomarkers in epileptogenesis identifying these subjects at risk to develop epilepsy after an initial insult definitively would lead to an improvement in clinical studies to find antiepileptogenic drugs. The gut microbiota (GM) has recently encountered the interest of neuroscience which confirmed its clear involvement in several neurological disorders. GM's role in epilepsy has only recently been studied, however, interesting results are already available. Besides the interest in GM as a suitable therapeutic target and a few preclinical and clinical studies indicating the potential antiseizure effects of GM manipulation, microbiota composition has been found altered in patients with epilepsy as well as some animal models. Only few studies have tried to analyse GM composition as a suitable biomarker and, despite very promising, several drawbacks limit our understanding. On the other hand, GM composition may be useful in discriminating drug-resistant from drug-responsive patients at any stage or patients at risk of developing epilepsy after an insult. The main limitation in the area is the lack of large studies in homogeneous patients and standardization is a must for a proper understanding. Finally, considering the number of variables coming both from epilepsy and GM, big data analysis as in the case of genetics should be considered.
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Affiliation(s)
- Emilio Russo
- Department of Science of Health, School of Medicine, University Magna Graecia of Catanzaro, Via T. Campanella, 115, 88100 Catanzaro, Italy.
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Abstract
BACKGROUND Resistant hypertension is highly prevalent among the general hypertensive population and the clinical management of this condition remains problematic. Different approaches, including a more intensified antihypertensive therapy, lifestyle modifications or both, have largely failed to improve patients' outcomes and to reduce cardiovascular and renal risk. As renal sympathetic hyperactivity is a major driver of resistant hypertension, in the last decade renal sympathetic ablation (renal denervation) has been proposed as a possible therapeutic alternative to treat this condition. OBJECTIVES We sought to evaluate the short- and long-term effects of renal denervation in individuals with resistant hypertension on clinical end points, including fatal and non-fatal cardiovascular events, all-cause mortality, hospital admissions, quality of life, blood pressure control, left ventricular hypertrophy, cardiovascular and metabolic profile and kidney function, as well as the potential adverse events related to the procedure. SEARCH METHODS For this updated review, the Cochrane Hypertension Information Specialist searched the following databases for randomised controlled trials up to 3 November 2020: Cochrane Hypertension's Specialised Register, CENTRAL (2020, Issue 11), Ovid MEDLINE, and Ovid Embase. The World Health Organization International Clinical Trials Registry Platform (via CENTRAL) and the US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov were searched for ongoing trials. We also contacted authors of relevant papers regarding further published and unpublished work. The searches had no language restrictions. SELECTION CRITERIA We considered randomised controlled trials (RCTs) that compared renal denervation to standard therapy or sham procedure to treat resistant hypertension, without language restriction. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed study risk of bias. We summarised treatment effects on available clinical outcomes and adverse events using random-effects meta-analyses. We assessed heterogeneity in estimated treatment effects using Chi² and I² statistics. We calculated summary treatment estimates as a mean difference (MD) or standardised mean difference (SMD) for continuous outcomes, and a risk ratio (RR) for dichotomous outcomes, together with their 95% confidence intervals (CI). Certainty of evidence has been assessed using the GRADE approach. MAIN RESULTS We found 15 eligible studies (1416 participants). In four studies, renal denervation was compared to sham procedure; in the remaining studies, renal denervation was tested against standard or intensified antihypertensive therapy. Most studies had unclear or high risk of bias for allocation concealment and blinding. When compared to control, there was low-certainty evidence that renal denervation had little or no effect on the risk of myocardial infarction (4 studies, 742 participants; RR 1.31, 95% CI 0.45 to 3.84), ischaemic stroke (5 studies, 892 participants; RR 0.98, 95% CI 0.33 to 2.95), unstable angina (3 studies, 270 participants; RR 0.51, 95% CI 0.09 to 2.89) or hospitalisation (3 studies, 743 participants; RR 1.24, 95% CI 0.50 to 3.11). Based on moderate-certainty evidence, renal denervation may reduce 24-hour ambulatory blood pressure monitoring (ABPM) systolic BP (9 studies, 1045 participants; MD -5.29 mmHg, 95% CI -10.46 to -0.13), ABPM diastolic BP (8 studies, 1004 participants; MD -3.75 mmHg, 95% CI -7.10 to -0.39) and office diastolic BP (8 studies, 1049 participants; MD -4.61 mmHg, 95% CI -8.23 to -0.99). Conversely, this procedure had little or no effect on office systolic BP (10 studies, 1090 participants; MD -5.92 mmHg, 95% CI -12.94 to 1.10). Moderate-certainty evidence suggested that renal denervation may not reduce serum creatinine (5 studies, 721 participants, MD 0.03 mg/dL, 95% CI -0.06 to 0.13) and may not increase the estimated glomerular filtration rate (eGFR) or creatinine clearance (6 studies, 822 participants; MD -2.56 mL/min, 95% CI -7.53 to 2.42). AUTHORS' CONCLUSIONS: In patients with resistant hypertension, there is low-certainty evidence that renal denervation does not improve major cardiovascular outomes and renal function. Conversely, moderate-certainty evidence exists that it may improve 24h ABPM and diastolic office-measured BP. Future trials measuring patient-centred instead of surrogate outcomes, with longer follow-up periods, larger sample size and more standardised procedural methods are necessary to clarify the utility of this procedure in this population.
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Affiliation(s)
- Anna Pisano
- Institute of Clinical Physiology, CNR - Italian National Council of Research, Reggio Calabria, Italy
| | | | - Antonio Leo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Davide Bolignano
- Department of Medical and Surgical Sciences, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Mumoli L, Vescio V, Pirritano D, Russo E, Bosco D. ADEM anti-MOG antibody-positive after SARS-CoV2 vaccination. Neurol Sci 2021; 43:763-766. [PMID: 34796418 PMCID: PMC8601784 DOI: 10.1007/s10072-021-05761-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Laura Mumoli
- Neurology Department, Pugliese-Ciaccio Hospital, Viale Pio X, 8810, Catanzaro, Italy.
| | - Virginia Vescio
- Radiology Department, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | - Domenico Pirritano
- Neurology Department, Pugliese-Ciaccio Hospital, Viale Pio X, 8810, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, University of Catanzaro, Catanzaro, Italy
| | - Domenico Bosco
- Neurology Department, Pugliese-Ciaccio Hospital, Viale Pio X, 8810, Catanzaro, Italy
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Cattaneo C, Giovannelli I, De Nigris N, Russo E, Buoncristiano M, Rosa B, Ripoli G, Parenti I, Indorato E. Life skills training to promote health and well-being at school: an evaluation. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.411] [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
Background
In educational settings, health promotion refers to a whole-school approach to help individuals realize their potential, cope with the everyday stresses of life, work productively and fruitfully, and contribute to their community. In these regards, it is essential to enhance a vast repertoire of knowledge, skills, attitudes, and values, a narrower set of psychosocial skills (Life Skills - LS). The Local Health Unit of Palermo, the Centre of Training and the National Institute of Health (ISS) developed the project “Life Skills and resilience: effective strategies to promote health at school”.
Objectives
The project's general aim was to provide headteachers and teachers with methodologies and tools to develop and promote LS in educational settings. Through the participatory approach, training was structured in 5 modules of 16 hours each. The training activities began in October 2019 and ended online due to the Covid-19 emergency in July 2020. The evaluation plan provides the assessment of learning, satisfaction, monitoring and assessment of attitudes and behaviours using a validated questionnaire. The aim was to identify improvements in relationships inside and outside the school context and increase self-efficacy and job satisfaction among teachers. Data analysis is currently being processed.
Results
169 Teachers, 12 Healthcare workers attended the training. The preliminary results show that: i. there is an improvement in relationships between colleagues, students and parents; ii. there is a slight improvement in the perceived self-efficacy in managing negative emotions; iii. there is an improvement in the personal and collective effectiveness perceived in the school environment and job satisfaction.
Conclusions
The project was designed for implementing sustainable interventions. The advent of COVID-19 has allowed further reflection on the usefulness of this approach for promoting resilience and protective factors and managing the consequences of the pandemic.
Key messages
The training improved personal and professional skills on design and methods to apply LS. The use of qualitative/quantitative assessment made it possible to illustrate the entire training process.
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Affiliation(s)
- C Cattaneo
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - I Giovannelli
- Department of Political Science, University of Perugia, Perugia, Italy
| | - N De Nigris
- Association “Social promotion - Across”, Rome, Italy
| | - E Russo
- Association “The house of the heart”, Aversa, Italy
| | - M Buoncristiano
- National Centre for Disease Prevention and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - B Rosa
- Local Health Unit of Palermo, Palermo, Italy
| | - G Ripoli
- Local Health Unit of Palermo, Palermo, Italy
| | - I Parenti
- Centre of Training - CEFPAS, Caltanissetta, Italy
| | - E Indorato
- Centre of Training - CEFPAS, Caltanissetta, Italy
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Leo A, De Caro C, Mainardi P, Tallarico M, Nesci V, Marascio N, Striano P, Russo E, Constanti A, De Sarro G, Citraro R. Increased efficacy of combining prebiotic and postbiotic in mouse models relevant to autism and depression. Neuropharmacology 2021; 198:108782. [PMID: 34492286 DOI: 10.1016/j.neuropharm.2021.108782] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022]
Abstract
The Microbiota-Gut-Brain axis (MGBA) is a bidirectional communication pathway between gut bacteria and the central nervous system (CNS) (including the intestine) that exerts a profound influence on neural development, neuroinflammation, activation of stress response and neurotransmission, in addition to modulating complex behaviours, such as sociability and anxiety. Several MGBA modulating approaches are possible, such as probiotic administration. A reasonable pharmacological approach would also be the contemporarily administration of both prebiotics and postbiotics. To test this hypothesis, we probed the effects of α-lactalbumin (ALAC; a prebiotic in the dose range of 125-500 mg/kg) and sodium butyrate (NaB; a postbiotic in the dose range of 30-300 mg/kg) alone and in combination. We used two animal behavioural models of idiopathic autism, (BTBR mice) and anxiety/depression (chronic unexpected mild stress - CUMS mice) respectively, using several standard behavioural paradigms such as Three-chamber social interaction test, Marble burying assay, depression-, anxiety- and memory-tests. In BTBR autistic mice, we found that both ALAC and NaB improve animal sociability, and memory in the passive avoidance (PA); drug combination was more effective in almost all tests also reducing immobility time in the forced swimming test (FST), which was not affected by single drug administration. Similarly, in the CUMS mice, single drug administration was effective in improving: 1) depressive-like behaviour in the FST and sucrose preference test; 2) memory and learning in the PA, novel object recognition and Morris water maze tests. Drug combination was again more effective than single drug administration in most cases; however, in the CUMS model, neither single drug or combination was effective in the elevated plus maze test for anxiety. Our results suggest that in both models, ALAC and NaB combination is more effective in improving some pathological aspects of animal behaviour than single administration and that the prebiotic/postbiotic approach should be considered a reasonable approach for the manipulation of the MGBA to improve efficacy.
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Affiliation(s)
- Antonio Leo
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Carmen De Caro
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Paolo Mainardi
- People's University for Food and Health Studies, Genoa, Italy
| | - Martina Tallarico
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Valentina Nesci
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Nadia Marascio
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Pasquale Striano
- Pediatric Neurology and Muscular Diseases Unit, Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) 'G. Gaslini' Institute, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, University of Genoa, Genoa, Italy
| | - Emilio Russo
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Andrew Constanti
- Department of Pharmacology, University College London School of Pharmacy, London, UK.
| | - Giovambattista De Sarro
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Rita Citraro
- System and Applied Pharmacology@University Magna Grecia, Science of Health Department, School of Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
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Carullo N, Zicarelli MT, Casarella A, Nicotera R, Castagna A, Urso A, Presta P, Andreucci M, Russo E, Bolignano D, Coppolino G. Retarding Progression of Chronic Kidney Disease in Autosomal Dominant Polycystic Kidney Disease with Metformin and Other Therapies: An Update of New Insights. Int J Gen Med 2021; 14:5993-6000. [PMID: 34588803 PMCID: PMC8473846 DOI: 10.2147/ijgm.s305491] [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: 07/12/2021] [Accepted: 09/13/2021] [Indexed: 12/13/2022] Open
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent single-gene disorder leading to renal failure. Current therapies are aimed to treat renal and extrarenal complications of ADPKD, but improved knowledge of the pathophysiological mechanisms leading to the generation and growth of cysts has permitted the identification of new drug candidates for clinical trials. Among these, in this review, we will examine above all the role of metformin, hypothesized to be able to activate the AMP-activated protein kinase (AMPK) pathway and potentially modulate some mechanisms implicated in the onset and the growth of the cysts.
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Affiliation(s)
- Nazareno Carullo
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | | | | | - Ramona Nicotera
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Alberto Castagna
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Alessandra Urso
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Pierangela Presta
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Michele Andreucci
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Davide Bolignano
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Giuseppe Coppolino
- Renal Unit, Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
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Larussa T, Basile A, Palleria C, Iannelli C, Vero A, Giubilei L, De Sarro C, Suraci E, Marasco R, Imeneo M, Russo E, Abenavoli L, De Sarro G, Luzza F. Real-life burden of adverse reactions to biological therapy in inflammatory bowel disease: a single-centre prospective case series. Med Pharm Rep 2021; 94:289-297. [PMID: 34430850 DOI: 10.15386/mpr-1897] [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: 09/16/2020] [Revised: 02/20/2021] [Accepted: 03/15/2021] [Indexed: 12/13/2022] Open
Abstract
Background/aim Biologics represent a key therapeutic option in inflammatory bowel disease (IBD), but are associated with several side effects. Post-marketing surveillance, through a spontaneous adverse drug reactions (ADRs) monitoring system, is essential to assess the safety profile of biologics. The aim of the study was to prospectively evaluate the occurrence of ADRs in IBD patients treated with biologics from a single centre in Southern Italy. Methods Data from patients with Crohn's Disease (CD) and Ulcerative Colitis (UC) who underwent biological therapy were prospectively collected. ADRs were classified according to the Medical Dictionary for Regulatory Activities (MedDRA®). Results Overall, 68 (54% male, 68% with UC and 32% with CD) biologic-naïve IBD patients underwent biological therapy. Mean follow-up was 11.7 ± 6.2 months. As a results of switches, for 68 patients we obtained 96 biologic prescriptions. Overall, 45 ADRs occurred in 36 (53%) patients, distributed as follows (ADRs/prescriptions): 19/37 with IFX-Remicade, 5/12 with IFX-Remsima, 8/9 with GOL, 11/26 with ADA, and 2/12 with VDZ. Mild ADRs were 29 (64%), moderate 15 (34%) and 1 (2%) severe. General disorders and administration related reactions were the most frequent ADRs (35%), followed by skin and subcutaneous tissue disorders (20%), infections (15%), musculoskeletal (11%), respiratory (6%) blood (4%), gastrointestinal (4%), and vascular disorders (2%). In 9 cases (20%) the ADRs resulted in definitive discontinuation of biologic therapy. Conclusion In a prospective cohort of IBD patients, more than half experienced ADRs during biologic therapy. General disorders and administration related reactions were the most common ADRs, while infections were less common and rarely led to discontinuation of therapy. Findings underline the importance of surveillance in management of IBD patients during biologic therapy and implementing safety protocols with data from real-life settings.
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Affiliation(s)
- Tiziana Larussa
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Antonio Basile
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina Palleria
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Chiara Iannelli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ada Vero
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Lidia Giubilei
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Caterina De Sarro
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Evelina Suraci
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Raffaella Marasco
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Maria Imeneo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | - Ludovico Abenavoli
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
| | | | - Francesco Luzza
- Department of Health Sciences, University "Magna Græcia" of Catanzaro, Italy
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Avorio F, Cerulli Irelli E, Morano A, Fanella M, Orlando B, Albini M, Basili LM, Ruffolo G, Fattouch J, Manfredi M, Russo E, Striano P, Carabotti M, Giallonardo AT, Severi C, Di Bonaventura C. Functional Gastrointestinal Disorders in Patients With Epilepsy: Reciprocal Influence and Impact on Seizure Occurrence. Front Neurol 2021; 12:705126. [PMID: 34421803 PMCID: PMC8377227 DOI: 10.3389/fneur.2021.705126] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/04/2021] [Accepted: 07/09/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: The complex relationship between the microbiota-gut-brain axis (MGBA) and epilepsy has been increasingly investigated in preclinical studies. Conversely, evidence from clinical studies is still scarce. In recent years, the pivotal role of MGBA dysregulation in the pathophysiology of functional gastrointestinal disorders (FGID) has been recognized. With this background, we aimed to investigate the prevalence of FGID in patients with epilepsy (PWE) and the possible impact of bowel movement abnormalities on seizure recurrence. Methods: A total of 120 PWE and 113 age-, sex-, and BMI-matched healthy subjects (HS) were consecutively enrolled. A questionnaire to evaluate the presence of FGID (according to Rome III diagnostic criteria) was administrated to all participants. In a subgroup of drug-resistant patients, we administered an ad-hoc questionnaire combining Bristol stool charts and seizure diaries to evaluate seizure trends and bowel movement changes. Results: A higher prevalence of FGID in PWE (62.5%) than in HS (39.8%) was found (p < 0.001). The most frequently observed disorder was constipation, which was significantly higher in PWE than in HS (43.3 vs. 21.2%, p < 0.001), and was not associated with anti-seizure medication intake according to multivariable analysis. In drug-resistant patients, most seizures occurred during periods of altered bowel movements, especially constipation. A significant weak negative correlation between the number of days with seizures and the number of days with normal bowel movements was observed (p = 0.04). According to multivariable logistic regression analysis, FGID was significantly associated with temporal lobe epilepsy as compared with other lobar localization (p = 0.03). Conclusions: Our clinical findings shed new light on the complex relationship between epilepsy and the MGBA, suggesting a bidirectional link between bowel movement abnormalities and seizure occurrence. However, larger studies are required to better address this important topic.
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Affiliation(s)
- Federica Avorio
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,Neurology Service, Therapeutic and Diagnostic Service Department, Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), Palermo, Italy
| | | | - Alessandra Morano
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Martina Fanella
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Biagio Orlando
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mariarita Albini
- Neurophysiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Neuromed, Pozzilli, Italy
| | - Luca M Basili
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gabriele Ruffolo
- Department of Physiology and Pharmacology, Istituto Pasteur-Fondazione Cenci Bolognetti, Sapienza University of Rome, Rome, Italy
| | - Jinane Fattouch
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Mario Manfredi
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Emilio Russo
- Science of Health Department, School of Medicine, University Magna Graecia, Calabria, Italy
| | - Pasquale Striano
- Institute for Research, Hospitalization, and Health Care (IRCCS) "G. Gaslini" Institute, Genoa, Italy
| | - Marilia Carabotti
- Medical-Surgical Department of Clinical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Anna T Giallonardo
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Carola Severi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Di Bonaventura
- Epilepsy Unit, Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Hunt LT, Daw ND, Kaanders P, MacIver MA, Mugan U, Procyk E, Redish AD, Russo E, Scholl J, Stachenfeld K, Wilson CRE, Kolling N. Formalizing planning and information search in naturalistic decision-making. Nat Neurosci 2021; 24:1051-1064. [PMID: 34155400 DOI: 10.1038/s41593-021-00866-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 03/23/2021] [Indexed: 02/05/2023]
Abstract
Decisions made by mammals and birds are often temporally extended. They require planning and sampling of decision-relevant information. Our understanding of such decision-making remains in its infancy compared with simpler, forced-choice paradigms. However, recent advances in algorithms supporting planning and information search provide a lens through which we can explain neural and behavioral data in these tasks. We review these advances to obtain a clearer understanding for why planning and curiosity originated in certain species but not others; how activity in the medial temporal lobe, prefrontal and cingulate cortices may support these behaviors; and how planning and information search may complement each other as means to improve future action selection.
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Affiliation(s)
- L T Hunt
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
| | - N D Daw
- Princeton Neuroscience Institute and Department of Psychology, Princeton University, Princeton, NJ, USA
| | - P Kaanders
- Department of Experimental Psychology, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - M A MacIver
- Center for Robotics and Biosystems, Department of Neurobiology, Department of Biomedical Engineering, Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - U Mugan
- Center for Robotics and Biosystems, Department of Neurobiology, Department of Biomedical Engineering, Department of Mechanical Engineering, Northwestern University, Evanston, IL, USA
| | - E Procyk
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, Stem Cell and Brain Research Institute U1208, Bron, France
| | - A D Redish
- Department of Neuroscience, University of Minnesota, Minneapolis, MN, USA
| | - E Russo
- Department of Theoretical Neuroscience, Central Institute of Mental Health, Mannheim, Germany.,Department of Psychiatry and Psychotherapy, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - J Scholl
- Department of Experimental Psychology, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | - C R E Wilson
- Univ Lyon, Université Claude Bernard Lyon 1, INSERM, Stem Cell and Brain Research Institute U1208, Bron, France
| | - N Kolling
- Department of Psychiatry, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK.
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Casarella A, Nicotera R, Zicarelli MT, Urso A, Presta P, Deodato F, Bolignano D, De Sarro G, Andreucci M, Russo E, Coppolino G. Autosomic dominant polycystic kidney disease and metformin: Old knowledge and new insights on retarding progression of chronic kidney disease. Med Res Rev 2021; 42:629-640. [PMID: 34328226 DOI: 10.1002/med.21850] [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: 02/22/2021] [Revised: 05/24/2021] [Accepted: 07/22/2021] [Indexed: 01/19/2023]
Abstract
Autosomal dominant polycystic kidney disease (ADPKD) is the most common congenital kidney disorder, generally caused by mutations in the PKD1 and PKD2 genes, coding for polycystins 1 and 2. Its pathogenesis is accompanied by alterations of the cAMP, mTOR, MAPK/ERK, and JAK/STAT pathways. ADPKD is clinically characterized by the formation of many growing cysts with kidney enlargement and a progressive damage to the parenchyma, up to its complete loss of function, and the onset of end-stage renal disease (ESRD). The current aim of ADPKD therapy is the inhibition of cyst development and retardation of chronic kidney disease progression. Several drugs have been recently included as potential therapies for ADPKD including metformin, the drug of choice for the treatment of type 2 diabetes mellitus, according to its potential inhibitory effects on cystogenesis. In this review, we summarize preclinical and clinical evidence endorsing or rejecting metformin administration in ADPKD evolution and pathological mechanisms. We explored the biology of APDKD and the role of metformin in slowing down cystogenesis searching PubMed and Clinical Trials to identify relevant data from the database inception to December 2020. From our research analysis, evidence for metformin as emerging cure for ADPKD mainly arise from preclinical studies. In fact, clinical studies are still scanty and stronger evidence is awaited. Its effects are likely mediated by inhibition of the ERK pathway and increase of AMPK levels, which are both linked to ADPKD pathogenesis.
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Affiliation(s)
| | - Ramona Nicotera
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Maria T Zicarelli
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Alessandra Urso
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Pierangela Presta
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Francesca Deodato
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Davide Bolignano
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | | | - Michele Andreucci
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
| | - Emilio Russo
- Department of Health Sciences, "Magna Graecia" University, Catanzaro, Italy
| | - Giuseppe Coppolino
- Department of Health Sciences, Renal Unit, "Magna Graecia" University, Catanzaro, Italy
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50
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Mastroianni G, Ascoli M, Gasparini S, Brigo F, Cianci V, Neri S, Russo E, Aguglia U, Ferlazzo E. Therapeutic approach to difficult-to-treat typical absences and related epilepsy syndromes. Expert Rev Clin Pharmacol 2021; 14:1427-1433. [PMID: 34289757 DOI: 10.1080/17512433.2021.1959317] [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] [Indexed: 10/20/2022]
Abstract
Introduction: typical absences (TAs), are brief, generalized epileptic seizures of abrupt onset and termination clinically manifesting with impairment of awareness and associated with 3 Hz spike-wave discharges on EEG. TAs may occur in different idiopathic generalized epilepsies (IGE). Despite treatment with adequate anti-seizure medications (ASMs), TAs may persist in ~25% of subjects. This narrative review focuses on the therapeutic approach to difficult-to-treat TAs occurring in the setting of IGE.Areas covered: a literature search was conducted on the topic of treatment of TAs.Expert opinion: ethosuximide (ESX), valproic acid (VPA) and lamotrigine (LTG), alone or in combination, are considered the first-choice drugs. In women of childbearing potential, VPA should be avoided. Alternative therapies (benzodiazepines, levetiracetam, topiramate, or zonisamide) should be considered in subjects unresponsive to monotherapy after the exclusion of pseudo-drug resistance. Newer ASMs such as brivaracetam and perampanel seem to be promising options. Well-conducted clinical trials aimed to evaluate the efficacy of alternative monotherapy (beyond ESX, VPA or LTG) or combination of ASMs on difficult-to-treat TAs, are warranted.
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Affiliation(s)
- Giovanni Mastroianni
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Michele Ascoli
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Sara Gasparini
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Francesco Brigo
- Department of Neurology, Hospital of Merano (SABES-ASDAA), Merano, Italy
| | - Vittoria Cianci
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy
| | - Sabrina Neri
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Emilio Russo
- Science of Health Department, Magna Graecia University, Catanzaro, Italy
| | - Umberto Aguglia
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
| | - Edoardo Ferlazzo
- Regional Epilepsy Centre, Great Metropolitan "BMM" Hospital, Reggio, Calabria, Italy.,Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy.,Institute of Molecular Bioimaging and Physiology, National Research Council, Catanzaro, Italy
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