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Regolo M, Sorce A, Vaccaro M, Colaci M, Stancanelli B, Natoli G, Motta M, Isaia I, Castelletti F, Giangreco F, Fichera D, Aparo P, Lanzafame A, Russo M, Santangelo N, Noto P, Malatino L. Assessing Humoral Immuno-Inflammatory Pathways Associated with Respiratory Failure in COVID-19 Patients. J Clin Med 2023; 12:4057. [PMID: 37373750 DOI: 10.3390/jcm12124057] [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: 05/09/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
All severe cases of SARS-CoV-2 infections are characterized by a high risk of disease progression towards ARDS, leading to a bad outcome. Respiratory symptoms in COVID-19 patients often do not correspond to disease's worsening. In our sample, median age was 74 years (72-75) and 54% were men. The median period of hospitalization was 9 days. Firstly, we observed a significant asynchronous trend of neutrophil-to-lymphocyte ratio (NLR) and C-reactive protein (CRP) in 764 selected among 963 patients, who were consecutively recruited in two hospitals (Cannizzaro, S. Marco) in Catania, Italy. NLR values in deceased patients showed an increase from baseline over time. By contrast, CRP tended to fall from baseline to median day of hospitalization in all three subgroups, but steeply increased at the end of hospitalization only in ICU-admitted patients. Then, we evaluated the relationships between NLR and CRP as continuous variables with PaO2/FiO2 ratio (P/F). NLR was an independent predictor of mortality (HR: 1.77, p < 0.0001), while ICU admission was more significantly associated with CRP (HR: 1.70, p < 0.0001). Finally, age, neutrophils, CRP, and lymphocytes are significantly and directly linked to P/F, while the influence of inflammation on P/F, reflected by CRP, was also mediated by neutrophils.
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Affiliation(s)
- Matteo Regolo
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Alessandra Sorce
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, "G. D'Alessandro" (PROMISE), Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, University of Palermo, 90133 Palermo, Italy
| | - Mauro Vaccaro
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Michele Colaci
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Benedetta Stancanelli
- Unit of Internal Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Giuseppe Natoli
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Massimo Motta
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Ivan Isaia
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Castelletti
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
| | - Federica Giangreco
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Daniela Fichera
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Paola Aparo
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Alessandra Lanzafame
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Mario Russo
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Nicola Santangelo
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
| | - Paola Noto
- Department of Emergency Medicine, San Marco-Polyclinic Academic Hospital, 95121 Catania, Italy
| | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, University of Catania, 95123 Catania, Italy
- Academic Unit of Internal Medicine, Cannizzaro Hospital, 95126 Catania, Italy
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2
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Zanoli L, Gaudio A, Mikhailidis DP, Katsiki N, Castellino N, Lo Cicero L, Geraci G, Sessa C, Fiorito L, Marino F, Antonietta Di Rosolini M, Colaci M, Longo A, Montineri A, Malatino L, Castellino P, Aparo P, Arena A, Barchitta M, Castelletti F, Noto MD, Pino AD, Giarrusso O, Isaia I, Lentini P, Magnano San Lio P, Manuele R, Marino E, Morale W, Sciuto A, Scuto SS, Xourafa A, Zocco S. Vascular Dysfunction of COVID-19 Is Partially Reverted in the Long-Term. Circ Res 2022; 130:1276-1285. [DOI: 10.1161/circresaha.121.320460] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
COVID-19 is characterized by severe inflammation during the acute phase and increased aortic stiffness in the early postacute phase. In other models, aortic stiffness is improved after the reduction of inflammation. We aimed to evaluate the mid- and long-term effects of COVID-19 on vascular and cardiac autonomic function. The primary outcome was aortic pulse wave velocity (aPWV).
Methods:
The cross-sectional Study-1 included 90 individuals with a history of COVID-19 and 180 matched controls. The longitudinal Study-2 included 41 patients with COVID-19 randomly selected from Study-1 who were followed-up for 27 weeks.
Results:
Study-1: Compared with controls, patients with COVID-19 had higher aPWV and brachial PWV 12 to 24 (but not 25–48) weeks after COVID-19 onset, and they had higher carotid Young’s elastic modulus and lower distensibility 12 to 48 weeks after COVID-19 onset. In partial least squares structural equation modeling, the higher the hs-CRP (high-sensitivity C-reactive protein) at hospitalization was, the higher the aPWV 12 to 48 weeks from COVID-19 onset (path coefficient: 0.184;
P
=0.04). Moreover, aPWV (path coefficient: −0.186;
P
=0.003) decreased with time. Study-2: mean blood pressure and carotid intima-media thickness were comparable at the end of follow-up, whereas aPWV (−9%;
P
=0.01), incremental Young’s elastic modulus (−17%;
P
=0.03), baroreflex sensitivity (+28%;
P
=0.049), heart rate variability triangular index (+15%;
P
=0.01), and subendocardial viability ratio (+12%;
P
=0.01×10
−4
) were significantly improved. There was a trend toward improvement in brachial PWV (−6%;
P
=0.14) and carotid distensibility (+18%;
P
=0.05). Finally, at the end of follow-up (48 weeks after the onset of COVID-19) aPWV (+6%;
P
=0.04) remained significantly higher in patients with COVID-19 than in control subjects.
Conclusions:
COVID-19-related arterial stiffening involves several arterial tree portions and is partially resolved in the long-term.
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Affiliation(s)
- Luca Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry, Royal Free Hospital campus, University College London, United Kingdom (D.P.M.)
| | - Niki Katsiki
- Diabetes Center, Division of Endocrinology and Metabolism, First Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece (N.K.)
| | | | - Lorenzo Lo Cicero
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Giulio Geraci
- Internal Medicine, St Elia Hospital, Caltanissetta, Italy (G.G.)
| | - Concetto Sessa
- Nephrology and Dialysis Unit, Giovanni Paolo II Hospital, Ragusa, Italy (C.S.)
| | - Letizia Fiorito
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Francesca Marino
- Infectious Diseases, Giovanni Paolo II Hospital, Ragusa, Italy (F.M., M.A.D.R.)
| | | | - Michele Colaci
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Antonio Longo
- Eye Clinic, University of Catania, Italy. (N.C., A.L.)
| | | | - Lorenzo Malatino
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
| | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania, Italy. (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.)
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3
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Noris M, Caprioli J, Bresin E, Mossali C, Pianetti G, Gamba S, Daina E, Fenili C, Castelletti F, Sorosina A, Piras R, Donadelli R, Maranta R, van der Meer I, Conway EM, Zipfel PF, Goodship TH, Remuzzi G. Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 2010. [PMID: 20595690 DOI: 10.2215/cjn.02210310)] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND AND OBJECTIVES Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. Most childhood cases are caused by Shiga toxin-producing bacteria. The other form, atypical HUS (aHUS), accounts for 10% of cases and has a poor prognosis. Genetic complement abnormalities have been found in aHUS. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We screened 273 consecutive patients with aHUS for complement abnormalities and studied their role in predicting clinical phenotype and response to treatment. We compared mutation frequencies and localization and clinical outcome in familial (82) and sporadic (191) cases. RESULTS In >70% of sporadic and familial cases, gene mutations, disease-associated factor H (CFH) polymorphisms, or anti-CFH autoantibodies were found. Either mutations or CFH polymorphisms were also found in the majority of patients with secondary aHUS, suggesting a genetic predisposition. Familial cases showed a higher prevalence of mutations in SCR20 of CFH and more severe disease than sporadic cases. Patients with CFH or THBD (thrombomodulin) mutations had the earliest onset and highest mortality. Membrane-cofactor protein (MCP) mutations were associated with the best prognosis. Plasma therapy induced remission in 55 to 80% of episodes in patients with CFH, C3, or THBD mutations or autoantibodies, whereas patients with CFI (factor I) mutations were poor responders. aHUS recurred frequently after kidney transplantation except for patients with MCP mutations. CONCLUSIONS Results underline the need of genetic screening for all susceptibility factors as part of clinical management of aHUS and for identification of patients who could safely benefit from kidney transplant.
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Affiliation(s)
- Marina Noris
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Via Camozzi, 3-24020 Ranica (BG), Italy.
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4
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Noris M, Caprioli J, Bresin E, Mossali C, Pianetti G, Gamba S, Daina E, Fenili C, Castelletti F, Sorosina A, Piras R, Donadelli R, Maranta R, van der Meer I, Conway EM, Zipfel PF, Goodship TH, Remuzzi G. Relative role of genetic complement abnormalities in sporadic and familial aHUS and their impact on clinical phenotype. Clin J Am Soc Nephrol 2010; 5:1844-59. [PMID: 20595690 DOI: 10.2215/cjn.02210310] [Citation(s) in RCA: 680] [Impact Index Per Article: 48.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia, and renal impairment. Most childhood cases are caused by Shiga toxin-producing bacteria. The other form, atypical HUS (aHUS), accounts for 10% of cases and has a poor prognosis. Genetic complement abnormalities have been found in aHUS. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We screened 273 consecutive patients with aHUS for complement abnormalities and studied their role in predicting clinical phenotype and response to treatment. We compared mutation frequencies and localization and clinical outcome in familial (82) and sporadic (191) cases. RESULTS In >70% of sporadic and familial cases, gene mutations, disease-associated factor H (CFH) polymorphisms, or anti-CFH autoantibodies were found. Either mutations or CFH polymorphisms were also found in the majority of patients with secondary aHUS, suggesting a genetic predisposition. Familial cases showed a higher prevalence of mutations in SCR20 of CFH and more severe disease than sporadic cases. Patients with CFH or THBD (thrombomodulin) mutations had the earliest onset and highest mortality. Membrane-cofactor protein (MCP) mutations were associated with the best prognosis. Plasma therapy induced remission in 55 to 80% of episodes in patients with CFH, C3, or THBD mutations or autoantibodies, whereas patients with CFI (factor I) mutations were poor responders. aHUS recurred frequently after kidney transplantation except for patients with MCP mutations. CONCLUSIONS Results underline the need of genetic screening for all susceptibility factors as part of clinical management of aHUS and for identification of patients who could safely benefit from kidney transplant.
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Affiliation(s)
- Marina Noris
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Via Camozzi, 3-24020 Ranica (BG), Italy.
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5
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Mossali C, Fenili C, Castelletti F, Caprioli J, Pianetti G, Bresin E, Remuzzi G, Noris M. Results for C3 and CFB genetic screening in atypical-HUS. Mol Immunol 2008. [DOI: 10.1016/j.molimm.2008.08.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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6
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Castelletti F, Donadelli R, Banterla F, Hildebrandt F, Zipfel PF, Bresin E, Otto E, Skerka C, Renieri A, Todeschini M, Caprioli J, Caruso RM, Artuso R, Remuzzi G, Noris M. Mutations in FN1 cause glomerulopathy with fibronectin deposits. Proc Natl Acad Sci U S A 2008; 105:2538-43. [PMID: 18268355 PMCID: PMC2268172 DOI: 10.1073/pnas.0707730105] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [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: 08/16/2007] [Indexed: 12/12/2022] Open
Abstract
Glomerulopathy with fibronectin (FN) deposits (GFND) is an autosomal dominant disease with age-related penetrance, characterized by proteinuria, microscopic hematuria, hypertension, and massive glomerular deposits of FN that lead to end-stage renal failure. The genetic abnormality underlying GFND was still unknown. We hypothesized that mutations in FN1, which encodes FN, were the cause of GFND. In a large Italian pedigree with eight affected subjects, we found linkage with GFND at the FN1 locus at 2q32. We sequenced the FN1 in 15 unrelated pedigrees and found three heterozygous missense mutations, the W1925R, L1974R, and Y973C, that cosegregated with the disease in six pedigrees. The mutations affected two domains of FN (Hep-II domain for the W1925R and the L1974R, and Hep-III domain for the Y973C) that play key roles in FN-cell interaction and in FN fibrillogenesis. Mutant recombinant Hep-II fragments were expressed, and functional studies revealed a lower binding to heparin and to endothelial cells and podocytes compared with wild-type Hep-II and an impaired capability to induce endothelial cell spreading and cytoskeletal reorganization. Overall dominant mutations in FN1 accounted for 40% of cases of GFND in our study group. These findings may help understanding the pathogenesis of proteinuria and glomerular FN deposits in GFND and possibly in more common renal diseases such as diabetic nephropathy, IgA nephropathy, and lupus nephritis. To our knowledge no FN1 mutation causing a human disease was previously reported.
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Affiliation(s)
- Federica Castelletti
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Roberta Donadelli
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Federica Banterla
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Friedhelm Hildebrandt
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI 48109
| | - Peter F. Zipfel
- Department of Infection Biology, Leibniz Institute for Natural Products Research and Infection Biology, Hans Knoell Institute D-07745, Jena, Germany
| | - Elena Bresin
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Edgar Otto
- Departments of Pediatrics and of Human Genetics, University of Michigan, Ann Arbor, MI 48109
| | - Christine Skerka
- Department of Infection Biology, Leibniz Institute for Natural Products Research and Infection Biology, Hans Knoell Institute D-07745, Jena, Germany
| | | | - Marta Todeschini
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Jessica Caprioli
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
| | - Rosa Maria Caruso
- Department of Nephrology and Dialysis, Azienda Ospedaliera, Ospedali Riuniti di Bergamo 24128, Italy
| | - Rosangela Artuso
- University of Siena Policlinico Le Scotte, Siena 53100, Italy; and
| | - Giuseppe Remuzzi
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
- Department of Nephrology and Dialysis, Azienda Ospedaliera, Ospedali Riuniti di Bergamo 24128, Italy
| | - Marina Noris
- *Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo 24020, Italy
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7
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Pianetti G, Castelletti F, Monteferrante G, Bresin E, Remuzzi G, Noris M. Candidate genes screening in non-Stx-HUS. Mol Immunol 2007. [DOI: 10.1016/j.molimm.2007.06.136] [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: 11/16/2022]
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8
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Pela I, Seracini D, Caprioli A, Castelletti F, Giammanco A. Hemolytic uremic syndrome in an infant following Bordetella pertussis infection. Eur J Clin Microbiol Infect Dis 2006; 25:515-7. [PMID: 16871374 DOI: 10.1007/s10096-006-0171-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Reported here is the case of a 6-week-old female infant with a severe Bordetella pertussis infection requiring supportive pressure-positive ventilation in the intensive care unit. After being discharged from the intensive care unit, she developed hemolytic anemia, thrombocytopenia and acute renal failure, which suggested a diagnosis of hemolytic uremic syndrome. The clinical outcome was favorable with no renal consequences. This case suggests there may be a direct cause-effect relationship between B. pertussis infection and hemolytic uremic syndrome.
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Affiliation(s)
- I Pela
- Pediatric Nephrology Unit, Department of Pediatrics, University of Florence, 13 Via Luca Giordano, 50132 Florence, Italy
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9
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Caprioli J, Noris M, Brioschi S, Pianetti G, Castelletti F, Bettinaglio P, Mele C, Bresin E, Cassis L, Gamba S, Porrati F, Bucchioni S, Monteferrante G, Fang CJ, Liszewski MK, Kavanagh D, Atkinson JP, Remuzzi G. Genetics of HUS: the impact of MCP, CFH, and IF mutations on clinical presentation, response to treatment, and outcome. Blood 2006; 108:1267-79. [PMID: 16621965 PMCID: PMC1895874 DOI: 10.1182/blood-2005-10-007252] [Citation(s) in RCA: 504] [Impact Index Per Article: 28.0] [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] [Indexed: 12/12/2022] Open
Abstract
Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy with manifestations of hemolytic anemia, thrombocytopenia, and renal impairment. Genetic studies have shown that mutations in complement regulatory proteins predispose to non-Shiga toxin-associated HUS (non-Stx-HUS). We undertook genetic analysis on membrane cofactor protein (MCP), complement factor H (CFH), and factor I (IF) in 156 patients with non-Stx-HUS. Fourteen, 11, and 5 new mutational events were found in MCP, CFH, and IF, respectively. Mutation frequencies were 12.8%, 30.1%, and 4.5% for MCP, CFH, and IF, respectively. MCP mutations resulted in either reduced protein expression or impaired C3b binding capability. MCP-mutated patients had a better prognosis than CFH-mutated and nonmutated patients. In MCP-mutated patients, plasma treatment did not impact the outcome significantly: remission was achieved in around 90% of both plasma-treated and plasma-untreated acute episodes. Kidney transplantation outcome was favorable in patients with MCP mutations, whereas the outcome was poor in patients with CFH and IF mutations due to disease recurrence. This study documents that the presentation, the response to therapy, and the outcome of the disease are influenced by the genotype. Hopefully this will translate into improved management and therapy of patients and will provide the way to design tailored treatments.
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Affiliation(s)
- Jessica Caprioli
- Mario Negri Institute for Pharmacologic Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Bergamo, Italy
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10
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Bresin E, Daina E, Noris M, Castelletti F, Stefanov R, Hill P, Goodship THJ, Remuzzi G. Outcome of renal transplantation in patients with non-Shiga toxin-associated hemolytic uremic syndrome: prognostic significance of genetic background. Clin J Am Soc Nephrol 2005; 1:88-99. [PMID: 17699195 DOI: 10.2215/cjn.00050505] [Citation(s) in RCA: 186] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
More than 50% of patients with non-Shiga toxin-associated hemolytic uremic syndrome (non-Stx-HUS) progress to ESRD. Kidney transplant failure for disease recurrence is common; hence, whether renal transplantation is appropriate in this clinical setting remains a debated issue. The aim of this study was to identify possible prognostic factors for renal transplant outcome by focusing on specific genetic abnormalities associated with the disease. All articles in literature that describe renal transplant outcome in patients with ESRD secondary to non-Stx-HUS, genotyped for CFH, MCP, and IF mutations, were reviewed, and data of patients who were referred to the International Registry of Recurrent and Familial HUS/TTP and data from the Newcastle cohort were examined. This study confirmed that the overall outcome of kidney transplantation in patients with non-Stx-HUS is poor, with disease recurring in 60% of patients, 91.6% of whom developed graft failure. No clinical prognostic factor that could identify patients who were at high risk for graft failure was found. The presence of a factor H (CFH) mutation was associated with a high incidence of graft failure (77.8 versus 54.9% in patients without CFH mutation). Similar results were seen in patients with a factor I (IF) mutation. In contrast, graft outcome was favorable in all patients who carried a membrane co-factor protein (MCP) mutation. Patients with non-Stx-HUS should undergo genotyping before renal transplantation to help predict the risk for graft failure. It is debatable whether a kidney transplant should be recommended for patients with CFH or IF mutation. Reasonably, patients with an MCP mutation can undergo a kidney transplant without risk for recurrence.
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Affiliation(s)
- Elena Bresin
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases Aldo e Cele Daccò, Via Camozzi, 3, 24020 RANICA (Bergamo), Italy
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11
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Noris M, Bucchioni S, Galbusera M, Donadelli R, Bresin E, Castelletti F, Caprioli J, Brioschi S, Scheiflinger F, Remuzzi G. Complement factor H mutation in familial thrombotic thrombocytopenic purpura with ADAMTS13 deficiency and renal involvement. J Am Soc Nephrol 2005; 16:1177-83. [PMID: 15800115 DOI: 10.1681/asn.2005010086] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [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] [Indexed: 11/03/2022] Open
Abstract
Thrombotic thrombocytopenic purpura is a rare disorder of small vessels that is associated with deficiency of the von Willebrand factor-cleaving protease ADAMTS13, which favors platelet adhesion and aggregation in the microcirculation. The disease manifests mainly with central nervous system symptoms, but cases of renal insufficiency have been reported. Presented are findings of the genetic basis of phenotype heterogeneity in thrombotic thrombocytopenic purpura in two sisters within one family. The patients had ADAMTS13 deficiency as a result of two heterozygous mutations (causing V88M and G1239V changes). In addition, a heterozygous mutation (causing an S890I change) in factor H of complement was found in the patient who developed chronic renal failure but not in her sister, who presented with exclusive neurologic symptoms.
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Affiliation(s)
- Marina Noris
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi-Ranica, Via Gavazzeni 11, 24125 Bergamo, Italy
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12
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Caprioli J, Castelletti F, Bucchioni S, Bettinaglio P, Bresin E, Pianetti G, Gamba S, Brioschi S, Daina E, Remuzzi G, Noris M. Complement factor H mutations and gene polymorphisms in haemolytic uraemic syndrome: the C-257T, the A2089G and the G2881T polymorphisms are strongly associated with the disease. Hum Mol Genet 2003; 12:3385-95. [PMID: 14583443 DOI: 10.1093/hmg/ddg363] [Citation(s) in RCA: 241] [Impact Index Per Article: 11.5] [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] [Indexed: 01/24/2023] Open
Abstract
Mutations in complement factor H (HF1) gene have been reported in non-Shiga toxin-associated and diarrhoea-negative haemolytic uraemic syndrome (D-HUS). We analysed the complete HF1 in 101 patients with HUS, in 32 with thrombotic thrombocytopenic purpura (TTP) and in 106 controls to evaluate the frequency of HF1 mutations, the clinical outcome in mutation and non-mutation carriers and the role of HF1 polymorphisms in the predisposition to HUS. We found 17 HF1 mutations (16 heterozygous, one homozygous) in 33 HUS patients. Thirteen mutations were located in exons XXII and XXIII. No TTP patient carried HF1 mutations. The disease manifested earlier and the mortality rate was higher in mutation carriers than in non-carriers. Kidney transplants invariably failed for disease recurrences in patients with HF1 mutations, while in non-mutated patients half of the grafts were functioning after 1 year. Three HF1 polymorphic variants were strongly associated with D-HUS: -257T (promoter region), 2089G (exonXIV, silent) and 2881T (963Asp, SCR16). The association was stronger in patients without HF1 mutations. Two or three disease-associated variants led to a higher risk of HUS than a single one. Analysis of available relatives of mutated patients revealed a penetrance of 50%. In 5/9 families the proband inherited the mutation from one parent and two disease-associated variants from the other, while unaffected carriers inherited the protective variants. In conclusion HF1 mutations are frequent in patients with D-HUS (24%). Common polymorphisms of HF1 may contribute to D-HUS manifestation in subjects with and without HF1 mutations.
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Affiliation(s)
- Jessica Caprioli
- Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases 'Aldo e Cele Daccò', Villa Camozzi, Via Camozzi 3, 24020 Ranica, Italy
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Appollonio I, Rozzini R, Castelletti F, Trabucchi M. Recent life events as major predictors of mental health in the oldest old. Int J Geriatr Psychiatry 1998; 13:813-4. [PMID: 9850878 DOI: 10.1002/(sici)1099-1166(1998110)13:11<813::aid-gps858>3.0.co;2-o] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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