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Moroni G, Doria A, Giglio E, Tani C, Zen M, Strigini F, Zaina B, Tincani A, de Liso F, Matinato C, Grossi C, Gatto M, Castellana P, Limardo M, Meroni PL, Messa P, Ravani P, Mosca M. Fetal outcome and recommendations of pregnancies in lupus nephritis in the 21st century. A prospective multicenter study. J Autoimmun 2016; 74:6-12. [PMID: 27496151 DOI: 10.1016/j.jaut.2016.07.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 01/12/2023]
Abstract
The aim of this multicenter study was to assess the present risk of fetal complications and the inherent risk factors in pregnant women with lupus nephritis. Seventy-one pregnancies in 61women (59 Caucasians and 2 Asians) with lupus nephritis were prospectively followed between October 2006 and December 2013. All patients received a counselling visit within 3 months before the beginning of pregnancy and were followed by a multidisciplinary team. At baseline mild active nephritis was present in 15 cases (21.1%). Six pregnancies (8.4%) resulted in fetal loss. Arterial hypertension at baseline (P = 0.003), positivity for lupus anticoagulant (P = 0.001), anticardiolipin IgG antibodies (P = 0.007), antibeta2 IgG (P = 0.018) and the triple positivity for antiphospholipid antibodies (P = 0.004) predicted fetal loss. Twenty pregnancies (28.2%) ended pre-term and 12 newborns (16.4%) were small for gestational age. Among the characteristics at baseline, high SLE disease activity index (SLEDAI) score (P = 0.027), proteinuria (P = 0.045), history of renal flares (P = 0.004), arterial hypertension (P = 0.009) and active lupus nephritis (P = 0.000) increased the probability of preterm delivery. Odds for preterm delivery increased by 60% for each quarterly unit increase in SLEDAI and by 15% for each quarterly increase in proteinuria by 1 g per day. The probability of having a small for gestational age baby was reduced by 85% in women who received hydroxychloroquine therapy (P = 0.023). In this study, the rate of fetal loss was low and mainly associated with the presence of antiphospholipid antibodies. Preterm delivery remains a frequent complication of pregnancies in lupus. SLE and lupus nephritis activity are the main risk factors for premature birth. Arterial hypertension predicted both fetal loss and preterm delivery. Based on our results the key for a successful pregnancy in lupus nephritis is a multidisciplinary approach with close medical, obstetric and neonatal monitoring. This entails: a) a preconception evaluation to establish and inform women about pregnancy risks; b) planning pregnancy during inactive lupus nephritis, maintained inactive with the lowest possible dosage of allowed drugs; c) adequate treatment of known risk factors (arterial hypertension, antiphospholipid and antibodies); d) close monitoring during and after pregnancy to rapidly identify and treat SLE flares and obstetric complications.
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Affiliation(s)
- Gabriella Moroni
- Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Andrea Doria
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Elisa Giglio
- Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Tani
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
| | - Margherita Zen
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Francesca Strigini
- Department of Reproductive Medicine and Child Development Division of Obstetrics and Gynecology, University of Pisa, Italy
| | - Barbara Zaina
- Department of Obstetrics and Gynecology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Angela Tincani
- Rheumatology and Clinical Immunology Unit, Spedali Civili of Brescia, Italy
| | - Federica de Liso
- Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale, Maggiore Policlinico, Milan, Italy
| | - Caterina Matinato
- Laboratory of Clinical Chemistry and Microbiology, Fondazione IRCCS Ca' Granda Ospedale, Maggiore Policlinico, Milan, Italy
| | - Claudia Grossi
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto, Auxologico Italiano, Milan, Italy
| | - Mariele Gatto
- Department of Medicine-DIMED, Division of Rheumatology, University of Padova, Italy
| | - Paola Castellana
- Dipartimento di Scienze della Salute, Azienda Ospedaliera San Paolo, Milan, Italy
| | - Monica Limardo
- Nephrology, Azienda Ospedaliera della Provincia di Lecco, Lecco, Italy
| | - Pier Luigi Meroni
- Experimental Laboratory of Immunological and Rheumatologic Researches, IRCCS Istituto, Auxologico Italiano, Milan, Italy; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Piergiorgio Messa
- Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Pietro Ravani
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada; Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Marta Mosca
- Department of Clinical and Experimental Medicine, Rheumatology Unit, University of Pisa, Italy
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6
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Cirello V, Rizzo R, Crippa M, Campi I, Bortolotti D, Bolzani S, Colombo C, Vannucchi G, Maffini MA, de Liso F, Ferrero S, Finelli P, Fugazzola L. Fetal cell microchimerism: a protective role in autoimmune thyroid diseases. Eur J Endocrinol 2015; 173:111-8. [PMID: 25916393 DOI: 10.1530/eje-15-0028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 04/27/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The physiological persistence of fetal cells in the circulation and tissue of a previously pregnant woman is called fetal cell microchimerism (FCM). It has been hypothesized to play a role in systemic autoimmune disease; however, only limited data are available regarding its role in autoimmune thyroid disease (AITD). DESIGN Circulating FCM was analyzed in a large series of previously pregnant women with Graves' disease (GD), Hashimoto's thyroiditis (HT), or no disease (healthy controls (HCs)). To exclude the possible bias related to placental factors, the polymorphic pattern of human leukocyte antigen-G (HLA-G) gene, which is known to be involved in the tolerance of fetal cells by the maternal immune system, was investigated. METHODS FCM was evaluated by PCR in the peripheral blood, and the Y chromosome was identified by fluorescence in situ hybridization in some GD tissues. HLA-G polymorphism typing was assessed by real-time PCR. RESULTS FCM was significantly more frequent in HC (63.6%) than in GD (33.3%) or HT (27.8%) women (P=0.0004 and P=0.001 respectively). A quantitative analysis confirmed that circulating male DNA was more abundant in HC than it was in GD or HT. Microchimeric cells were documented in vessels and in thyroid follicles. In neither GD/HT patients nor HC women was the HLA-G typing different between FCM-positive and FCM-negative cases. CONCLUSION The higher prevalence of FCM in HC as compared to GD and HT patients suggests that it plays a possible protective role in autoimmune thyroid disorders. Placental factors have been excluded as determinants of the differences found. The vascular and tissue localization of microchimeric cells further highlights the ability of those cells to migrate to damaged tissues.
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Affiliation(s)
- Valentina Cirello
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Roberta Rizzo
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Milena Crippa
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Irene Campi
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Daria Bortolotti
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Silvia Bolzani
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Carla Colombo
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Guia Vannucchi
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Maria Antonia Maffini
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Federica de Liso
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Stefano Ferrero
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Palma Finelli
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
| | - Laura Fugazzola
- Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy Endocrine UnitFondazione IRCCS Ca' Granda, Via F. Sforza, 35-20122 Milan, ItalyDepartment of Pathophysiology and TransplantationUniversity of Milan, Milan, ItalySection of Microbiology and Medical GeneticsDepartment of Medical Sciences, University of Ferrara, Ferrara, ItalyLaboratory of Medical Cytogenetics and Molecular GeneticsIstituto Auxologico Italiano, Milan, ItalyDepartment of Clinical Sciences and Community HealthUniversity of Milan, Milan, ItalyLaboratory of Clinical Chemistry and MicrobiologyFondazione IRCCS Ca' Granda, Milan, ItalyDivision of PathologyFondazione IRCCS Ca' Granda, Milan, ItalyDepartments of BiomedicalSurgical and Dental SciencesMedical Biotechnology and Translational MedicineUniversity of Milan, Milan, Italy
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8
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Cighetti G, Bamonti F, Aman CS, Gregori D, De Giuseppe R, Novembrino C, de Liso F, Maiavacca R, Paroni R. Oxidative status in different settings and with different methodological approaches compared by Receiver Operating Characteristic curve analysis. Clin Biochem 2014; 48:73-8. [PMID: 25305628 DOI: 10.1016/j.clinbiochem.2014.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 09/19/2014] [Accepted: 09/30/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To test the performance of different analytical approaches in highlighting the occurrence of deregulated redox status in various physio-pathological situations. DESIGN AND METHODS 35 light and 61 heavy smokers, 19 chronic renal failure, 59 kidney transplanted patients, and 87 healthy controls were retrospectively considered for the study. Serum oxidative stress and antioxidant status, assessed by spectrophotometric Reactive Oxygen Metabolites (d-ROMs) and Total Antioxidant Capacity (TAC) tests, respectively, were compared with plasma free (F-MDA) and total (T-MDA) malondialdehyde, both quantified by isotope-dilution-gas chromatography-mass spectrometry (ID-GC-MS). Sensitivity, specificity and cut-off points of T-MDA, F-MDA, d-ROMs and TAC were evaluated by both Receiver Operating Characteristic (ROC) analyses and area under the ROC curve (AUC). RESULTS Only T-MDA assay showed a clear absence of oxidative stress in controls and significant increase in all patients (AUC 1.00, sensitivity and specificity 100%). Accuracy was good for d-ROMs (AUC 0.87, sensitivity 72.8%, specificity 100%) and F-MDA (AUC 0.82, sensitivity 74.7%, specificity 83.9%), but not high enough for TAC to show in patients impaired antioxidant defense (AUC 0.66, sensitivity 52.0%, specificity 92.9%). CONCLUSIONS This study reveals T-MDA as the best marker to detect oxidative stress, shows the ability of d-ROMs to identify modified oxidative status particularly in the presence of high damages, and evidences the poor TAC performance. d-ROMs and TAC assays could be useful for routine purposes; however, for an accurate clinical data evaluation, their comparison versus a "gold standard method" is required.
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Affiliation(s)
- Giuliana Cighetti
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Fabrizia Bamonti
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy; U.O. Ematologia e CTMO, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Caroline S Aman
- Dipartimento di Scienze Biomediche e Cliniche "L. Sacco", Università degli Studi di Milano, Milano, Italy
| | - Dario Gregori
- Unità di Biostatistica, Epidemiologia e Salute Pubblica, Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari, Università degli Studi di Padova, Padova, Italy
| | - Rachele De Giuseppe
- Dipartimento di Scienze Biomediche, Chirurgiche ed Odontoiatriche, Università degli Studi di Milano, Milano, Italy; U.O. Ematologia e CTMO, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Cristina Novembrino
- Laboratorio di Chimica Clinica e Microbiologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Federica de Liso
- Laboratorio di Chimica Clinica e Microbiologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rita Maiavacca
- Laboratorio di Chimica Clinica e Microbiologia, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Rita Paroni
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, H San Paolo, Milano, Italy.
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