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Stavropoulou E, Huguenin A, Caruana G, Opota O, Perrottet N, Blanc DS, Grandbastien B, Senn L, Bochud PY, Lamoth F. Investigations of an increased incidence of non-Aspergillus invasive mould infections in an onco-haematology unit. Swiss Med Wkly 2024; 154:3730. [PMID: 38579310 DOI: 10.57187/s.3730] [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] [Indexed: 04/07/2024] Open
Abstract
AIMS OF THE STUDY Invasive mould infections are life-threatening complications in patients with haematologic cancer and chemotherapy-induced neutropenia. While invasive aspergillosis represents the main cause of invasive mould infections, non-Aspergillus mould infections, such as mucormycosis, are increasingly reported. Consequently, their local epidemiology should be closely monitored. The aim of this study was to investigate the causes of an increased incidence of non-Aspergillus mould infections in the onco-haematology unit of a Swiss tertiary care hospital. METHODS All cases of proven and probable invasive mould infections were retrospectively identified via a local registry for the period 2007-2021 and their incidence was calculated per 10,000 patient-days per year. The relative proportion of invasive aspergillosis and non-Aspergillus mould infections was assessed. Factors that may affect invasive mould infections' incidence, such as antifungal drug consumption, environmental contamination and changes in diagnostic approaches, were investigated. RESULTS A significant increase of the incidence of non-Aspergillus mould infections (mainly mucormycosis) was observed from 2017 onwards (Mann and Kendall test p = 0.0053), peaking in 2020 (8.62 episodes per 10,000 patient-days). The incidence of invasive aspergillosis remained stable across the period of observation. The proportion of non-Aspergillus mould infections increased significantly from 2017 (33% vs 16.8% for the periods 2017-2021 and 2007-2016, respectively, p = 0.02). Building projects on the hospital site were identified as possible contributors of this increase in non-Aspergillus mould infections. However, novel diagnostic procedures may have improved their detection. CONCLUSIONS We report a significant increase in non-Aspergillus mould infections, and mainly in mucormycosis infections, since 2017. There seems to be a multifactorial origin to this increase. Epidemiological trends of invasive mould infections should be carefully monitored in onco-haematology units in order to implement potential corrective measures.
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Affiliation(s)
- Elisavet Stavropoulou
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Anne Huguenin
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgia Caruana
- nfectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Onya Opota
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nancy Perrottet
- Unit of clinical pharmacy, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Dominique S Blanc
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Bruno Grandbastien
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laurence Senn
- Infection prevention and control unit, Infectious diseases Service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frederic Lamoth
- Infectious diseases service, Department of medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Institute of microbiology, Department of laboratory medicine and pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Neidhöfer C, Kherabi Y, Van Asten S, Bulescu C, Kraef C, Power N, Caruana G, Velikov P. Securing the future of clinical microbiology and infectious diseases through mentorship. Clin Microbiol Infect 2023:S1198-743X(23)00356-7. [PMID: 37532128 DOI: 10.1016/j.cmi.2023.07.028] [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: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Claudio Neidhöfer
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Germany.
| | - Yousra Kherabi
- Department of Infectious Diseases, Bichat-Claude Bernard Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Suzanne Van Asten
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Casandra Bulescu
- Clinical Hospital of Infectious and Tropical Diseases "Dr. Victor Babes", Bucharest, Romania
| | - Christian Kraef
- Department of Infectious Diseases, Righospitalet, University Hospital Copenhagen, Denmark
| | - Nicholas Power
- Department of Infectious Diseases, St. James' Hospital, James St., Dublin, Ireland
| | - Giorgia Caruana
- Department of Internal Medicine, Infectious Diseases Unit, Lausanne University Hospital, Lausanne, Switzerland
| | - Petar Velikov
- Infectious Disease Hospital "Prof. Ivan Kirov" and Department of Infectious Diseases, Parasitology and Tropical Medicine, Medical University of Sofia, Bulgaria
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Kritikos A, Caruana G, Lazor-Blanchet C, Currat M, Chiche JD, Vollenweider P, Bart PA, Opota O, Greub G. Comparison of Nasopharyngeal and Saliva Swab Nucleic Acid Amplification and Rapid Antigen Testing To Detect Omicron SARS-CoV-2 Variant of Concern: a Prospective Clinical Trial (OMICRON). Microbiol Spectr 2022; 10:e0392322. [PMID: 36346225 PMCID: PMC9769748 DOI: 10.1128/spectrum.03923-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022] Open
Abstract
In November 2021, the World Health Organization declared the Omicron variant (B.1.1.519) a variant of concern. Since then, worries have been expressed regarding the ability of usual diagnostic tests to detect the Omicron variant. In addition, some recently published data suggested that the salivary reverse transcription (RT)-PCR might perform better than the current gold standard, nasopharyngeal (NP) RT-PCR. In this study, we aimed to compare the sensitivities of nasopharyngeal and saliva RT-PCR and assess the diagnostic performances of rapid antigen testing (RAT) in nasopharyngeal and saliva samples. We conducted a prospective clinical study among symptomatic health care professionals consulting the occupational health service of our hospital for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening and hospitalized patients in internal medicine/intensive care wards screened for SARS-CoV-2 with COVID-19-compatible symptoms. A composite outcome considering NP PCR and/or saliva PCR was used as a reference standard to define COVID-19 cases. A total of 475 paired NP/saliva specimens have been collected with a positivity rate of 40% (n = 192). NP and salivary RT-PCR exhibited sensitivities of 98% (95% CI, 94 to 99%) and 87% (95% CI, 81 to 91%), respectively, for outpatients (n = 453) and 94% (95% CI, 72 to 99%) and 69% (95% CI, 44 to 86%), respectively, for hospitalized patients (n = 22). Nasopharyngeal rapid antigen testing exhibited much lower diagnostic performances (sensitivity of 66% and 31% for outpatients and inpatients, respectively), while saliva RAT showed a sensitivity of less than 5% in both groups. Nasopharyngeal RT-PCR testing remains the gold standard for SARS-CoV-2 Omicron variant screening. Salivary RT-PCR can be used as an alternative in case of contraindication to perform NP sampling. The use of RAT should be limited to settings where access to molecular diagnostic methods is lacking. IMPORTANCE The Omicron variant of concern spread rapidly since it was first reported in November 2021 and currently accounts for the vast majority of new infections worldwide. Recent reports suggest that saliva sampling might outweigh nasopharyngeal sampling for the diagnosis of the Omicron variant. Nevertheless, data investigating the best diagnostic strategy specifically for the Omicron variant of concern remain scarce. This study fills this gap in current knowledge and elucidates the question of which strategy to use in which patient. It provides a new basis for further improving COVID-19 screening programs and managing patients suspected to have COVID-19.
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Affiliation(s)
- Antonios Kritikos
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Giorgia Caruana
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Michael Currat
- Occupational Health Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jean-Daniel Chiche
- Intensive Care Unit, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Peter Vollenweider
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Alexandre Bart
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Onya Opota
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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Caruana G, Kritikos A, Vocat A, Luraschi A, Delarze E, Sturm A, Pla Verge M, Jozwiak G, Kushwaha S, Delaloye J, Cichocka D, Greub G. Investigating nanomotion-based technology (Resistell AST) for rapid antibiotic susceptibility testing among adult patients admitted to a tertiary-care hospital with Gram-negative bacteraemia: protocol for a prospective, observational, cross-sectional, single-arm study. BMJ Open 2022; 12:e064016. [PMID: 36410804 PMCID: PMC9680170 DOI: 10.1136/bmjopen-2022-064016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Effective treatment of bloodstream infections (BSIs) is relying on rapid identification of the causing pathogen and its antibiotic susceptibility. Still, most commercially available antibiotic susceptibility testing (AST) methods are based on monitoring bacterial growth, thus impacting the time to results. The Resistell AST is based on a new technology measuring the nanomotion caused by physiologically active bacterial cells and detecting the changes in nanomotion caused by the exposure to a drug. METHODS AND ANALYSIS This is a single-centre, prospective, cross-sectional, single-arm diagnostic accuracy study to determine the agreement of the Resistell AST on Gram-negative bacteria isolated from blood cultures among patients admitted to a tertiary-care hospital with the reference method. Up to 300 patients will be recruited. Starting with a pilot phase, enrolling 10%-20% of the subjects and limited to Escherichia coli BSI tested for ceftriaxone susceptibility, the main phase will follow, extending the study to Klebsiella pneumoniae and ciprofloxacin. ETHICS AND DISSEMINATION This study has received ethical approval from the Swiss Ethics Committees (swissethics, project 2020-01622). All the case report forms and clinical samples will be assigned a study code by the local investigators and stored anonymously at the reference centre (Lausanne University Hospital). The results will be broadly distributed through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05002413).
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Affiliation(s)
- Giorgia Caruana
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Antonios Kritikos
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Anthony Vocat
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | | | | | | | | | | | | | | | | | - Gilbert Greub
- Institute of Microbiology, Department of Laboratory Medicine and Pathology, Lausanne University Hospital, Lausanne, Switzerland
- Department of Internal Medicine, Service of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
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Caruana G, Auger C, Pessini LM, Calderon W, de Barros A, Salerno A, Sastre-Garriga J, Montalban X, Rovira À. SWI as an Alternative to Contrast-Enhanced Imaging to Detect Acute MS Lesions. AJNR Am J Neuroradiol 2022; 43:534-539. [PMID: 35332015 PMCID: PMC8993188 DOI: 10.3174/ajnr.a7474] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/04/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Acute inflammatory activity of MS lesions is traditionally assessed through contrast-enhanced T1-weighted MR images. The aim of our study was to determine whether a qualitative evaluation of non-contrast-enhanced SWI of new T2-hyperintense lesions might help distinguish acute and chronic lesions and whether it could be considered a possible alternative to gadolinium-based contrast agents for this purpose. MATERIALS AND METHODS Serial MR imaging studies from 55 patients with MS were reviewed to identify 169 new T2-hyperintense lesions. Two blinded neuroradiologists determined their signal pattern on SWI, considering 5 categories (hypointense rings, marked hypointensity, mild hypointensity, iso-/hyperintensity, indeterminate). Two different blinded neuroradiologists evaluated the presence or absence of enhancement in postcontrast T1-weighted images of the lesions. The Fisher exact test was used to determine whether each category of signal intensity on SWI was associated with gadolinium enhancement. RESULTS The presence of hypointense rings or marked hypointensity showed a strong association with the absence of gadolinium enhancement (P < .001), with a sensitivity of 93.0% and a specificity of 82.9%. The presence of mild hypointensity or isohyperintensity showed a strong association with the presence of gadolinium enhancement (P < .001), with a sensitivity of 68.3% and a specificity of 99.2%. CONCLUSIONS A qualitative analysis of the signal pattern on SWI of new T2-hyperintense MS lesions allows determining the likelihood that the lesions will enhance after administration of a gadolinium contrast agent, with high specificity albeit with a moderate sensitivity. While it cannot substitute for the use of contrast agent, it can be useful in some clinical settings in which the contrast agent cannot be administered.
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Affiliation(s)
- G Caruana
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - C Auger
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - L M Pessini
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - W Calderon
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A de Barros
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - A Salerno
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
| | - J Sastre-Garriga
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Department of Radiology, and Servei de Neurologia-Neuroimmunologia (J.S.-G., X.M.). Centre d'Esclerosi Múltiple de Catalunya, Institut de Recerca Vall d'Hebron, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - À Rovira
- From the Neuroradiology Section (G.C., C.A., L.M.P., W.C., A.d.B., A.S., À.R.)
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6
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Greub G, Caruana G, Schweitzer M, Imperiali M, Muigg V, Risch M, Croxatto A, Opota O, Heller S, Albertos Torres D, Tritten ML, Leuzinger K, Hirsch HH, Lienhard R, Egli A. Multicenter Technical Validation of 30 Rapid Antigen Tests for the Detection of SARS-CoV-2 (VALIDATE). Microorganisms 2021; 9:2589. [PMID: 34946190 PMCID: PMC8704317 DOI: 10.3390/microorganisms9122589] [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: 11/08/2021] [Revised: 12/02/2021] [Accepted: 12/04/2021] [Indexed: 01/25/2023] Open
Abstract
During COVID19 pandemic, SARS-CoV-2 rapid antigen tests (RATs) were marketed with minimal or no performance data. We aimed at closing this gap by determining technical sensitivities and specificities of 30 RATs prior to market release. We developed a standardized technical validation protocol and assessed 30 RATs across four diagnostic laboratories. RATs were tested in parallel using the Standard Q® (SD Biosensor/Roche) assay as internal reference. We used left-over universal transport/optimum media from nasopharyngeal swabs of 200 SARS-CoV-2 PCR-negative and 100 PCR-positive tested patients. Transport media was mixed with assay buffer and applied to RATs according to manufacturer instructions. Sensitivities were determined according to viral loads. Specificity of at least 99% and sensitivity of 95%, 90%, and 80% had to be reached for 107, 106, 105 virus copies/mL, respectively. Sensitivities ranged from 43.5% to 98.6%, 62.3% to 100%, and 66.7% to 100% at 105, 106, 107 copies/mL, respectively. Automated assay readers such as ExDia or LumiraDx showed higher performances. Specificities ranged from 88.8% to 100%. Only 15 of 30 (50%) RATs passed our technical validation. Due to the high failure rate of 50%, mainly caused by lack of sensitivity, we recommend a thorough validation of RATs prior to market release.
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Affiliation(s)
- Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (A.C.); (O.O.)
- Infectious Diseases Service, Department of Internal Medicine, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Coordination Commission of Clinical Microbiology, Swiss Society of Microbiology, 1033 Cheseaux, Switzerland; (M.R.); (R.L.); (A.E.)
| | - Giorgia Caruana
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (A.C.); (O.O.)
| | - Michael Schweitzer
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland; (M.S.); (V.M.); (S.H.); (D.A.T.)
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Mauro Imperiali
- Centro Medicina di Laboratorio Dr Risch, Via Arbostra 2, 6963 Pregassona, Switzerland;
| | - Veronika Muigg
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland; (M.S.); (V.M.); (S.H.); (D.A.T.)
| | - Martin Risch
- Coordination Commission of Clinical Microbiology, Swiss Society of Microbiology, 1033 Cheseaux, Switzerland; (M.R.); (R.L.); (A.E.)
- Centro Medicina di Laboratorio Dr Risch, Via Arbostra 2, 6963 Pregassona, Switzerland;
| | - Antony Croxatto
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (A.C.); (O.O.)
- ADMed Microbiologie Laboratory, 2300 La Chaux-de-Fonds, Switzerland;
| | - Onya Opota
- Institute of Microbiology, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (A.C.); (O.O.)
| | - Stefanie Heller
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland; (M.S.); (V.M.); (S.H.); (D.A.T.)
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Diana Albertos Torres
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland; (M.S.); (V.M.); (S.H.); (D.A.T.)
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | | | - Karoline Leuzinger
- Clinical Virology, University Hospital Basel, 4031 Basel, Switzerland; (K.L.); (H.H.H.)
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Hans H. Hirsch
- Clinical Virology, University Hospital Basel, 4031 Basel, Switzerland; (K.L.); (H.H.H.)
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland
| | - Reto Lienhard
- Coordination Commission of Clinical Microbiology, Swiss Society of Microbiology, 1033 Cheseaux, Switzerland; (M.R.); (R.L.); (A.E.)
- ADMed Microbiologie Laboratory, 2300 La Chaux-de-Fonds, Switzerland;
| | - Adrian Egli
- Coordination Commission of Clinical Microbiology, Swiss Society of Microbiology, 1033 Cheseaux, Switzerland; (M.R.); (R.L.); (A.E.)
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland; (M.S.); (V.M.); (S.H.); (D.A.T.)
- Clinical Virology, University Hospital Basel, 4031 Basel, Switzerland; (K.L.); (H.H.H.)
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Kritikos A, Caruana G, Brouillet R, Miroz JP, Abed-Maillard S, Stieger G, Opota O, Croxatto A, Vollenweider P, Bart PA, Chiche JD, Greub G. Sensitivity of Rapid Antigen Testing and RT-PCR Performed on Nasopharyngeal Swabs versus Saliva Samples in COVID-19 Hospitalized Patients: Results of a Prospective Comparative Trial (RESTART). Microorganisms 2021; 9:1910. [PMID: 34576805 PMCID: PMC8464722 DOI: 10.3390/microorganisms9091910] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 08/31/2021] [Accepted: 09/07/2021] [Indexed: 12/17/2022] Open
Abstract
Saliva sampling could serve as an alternative non-invasive sample for SARS-CoV-2 diagnosis while rapid antigen tests (RATs) might help to mitigate the shortage of reagents sporadically encountered with RT-PCR. Thus, in the RESTART study we compared antigen and RT-PCR testing methods on nasopharyngeal (NP) swabs and salivary samples. We conducted a prospective observational study among COVID-19 hospitalized patients between 10 December 2020 and 1 February 2021. Paired saliva and NP samples were investigated by RT-PCR (Cobas 6800, Roche-Switzerland, Basel, Switzerland) and by two rapid antigen tests: One Step Immunoassay Exdia® COVID-19 Ag (Precision Biosensor, Daejeon, Korea) and Standard Q® COVID-19 Rapid Antigen Test (Roche-Switzerland). A total of 58 paired NP-saliva specimens were collected. A total of 32 of 58 (55%) patients were hospitalized in the intensive care unit, and the median duration of symptoms was 11 days (IQR 5-19). NP and salivary RT-PCR exhibited sensitivity of 98% and 69% respectively, whereas the specificity of these RT-PCRs assays was 100%. The NP RATs exhibited much lower diagnostic performance, with sensitivities of 35% and 41% for the Standard Q® and Exdia® assays, respectively, when a wet-swab approach was used (i.e., when the swab was diluted in the viral transport medium (VTM) before testing). The sensitivity of the dry-swab approach was slightly better (47%). These antigen tests exhibited very low sensitivity (4% and 8%) when applied to salivary swabs. Nasopharyngeal RT-PCR is the most accurate test for COVID-19 diagnosis in hospitalized patients. RT-PCR on salivary samples may be used when nasopharyngeal swabs are contraindicated. RATs are not appropriate for hospitalized patients.
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Affiliation(s)
- Antonios Kritikos
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
| | - Giorgia Caruana
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
| | - René Brouillet
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
| | - John-Paul Miroz
- Intensive Care Unit, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (J.-P.M.); (S.A.-M.); (G.S.); (J.-D.C.)
| | - Samia Abed-Maillard
- Intensive Care Unit, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (J.-P.M.); (S.A.-M.); (G.S.); (J.-D.C.)
| | - Geraldine Stieger
- Intensive Care Unit, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (J.-P.M.); (S.A.-M.); (G.S.); (J.-D.C.)
| | - Onya Opota
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
| | - Antony Croxatto
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
| | - Peter Vollenweider
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.V.); (P.-A.B.)
| | - Pierre-Alexandre Bart
- Service of Internal Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (P.V.); (P.-A.B.)
| | - Jean-Daniel Chiche
- Intensive Care Unit, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (J.-P.M.); (S.A.-M.); (G.S.); (J.-D.C.)
| | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland; (G.C.); (R.B.); (O.O.); (A.C.)
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Caruana G, Lebrun LL, Aebischer O, Opota O, Urbano L, de Rham M, Marchetti O, Greub G. The dark side of SARS-CoV-2 rapid antigen testing: screening asymptomatic patients. New Microbes New Infect 2021; 42:100899. [PMID: 34007453 PMCID: PMC8119292 DOI: 10.1016/j.nmni.2021.100899] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 12/13/2022] Open
Abstract
Several reports showed SARS-CoV-2 rapid antigen tests (RATs) performances among COVID-19 symptomatic subjects in outpatient settings during periods of highest incidence of infections and high rates of hospital admissions, but few data are present for asymptomatic patients. We investigated the role of RATs in an emergency department, as a novel screening tool before admission for COVID-19 asymptomatic patients. A total of 116 patients were screened on admission in a 250-bed community hospital in Morges, Switzerland. RAT detected 2/7 RT-PCR-positive patients and delivered two false-positive results. These data suggest the non-fiability of RATs screening in this clinical scenario.
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Affiliation(s)
- G. Caruana
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - L.-L. Lebrun
- Patients Safety Program, Ensemble Hospitalier de la Côte (EHC), Morges, Switzerland
| | - O. Aebischer
- Patients Safety Program, Ensemble Hospitalier de la Côte (EHC), Morges, Switzerland
| | - O. Opota
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Switzerland
| | - L. Urbano
- Patients Safety Program, Ensemble Hospitalier de la Côte (EHC), Morges, Switzerland
| | - M. de Rham
- CoVID-19 Task Force Direction, Ensemble Hospitalier de la Côte (EHC), Morges, Switzerland
| | - O. Marchetti
- Patients Safety Program, Ensemble Hospitalier de la Côte (EHC), Morges, Switzerland
| | - G. Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, Switzerland
- Department of Medicine, Infectious Diseases Division, Lausanne University Hospital, Lausanne, Switzerland
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Caruana G, Croxatto A, Kampouri E, Kritikos A, Opota O, Foerster M, Brouillet R, Senn L, Lienhard R, Egli A, Pantaleo G, Carron PN, Greub G. Implementing SARS-CoV-2 Rapid Antigen Testing in the Emergency Ward of a Swiss University Hospital: The INCREASE Study. Microorganisms 2021; 9:798. [PMID: 33920307 PMCID: PMC8069749 DOI: 10.3390/microorganisms9040798] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [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: 03/12/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 02/06/2023] Open
Abstract
Following the Swiss Federal Office of Public Health (FOPH) authorization of the rapid antigen test (RAT), we implemented the use of the RAT in the emergency ward of our university hospital for patients' cohorting. RAT triaging in association with RT-PCR allowed us to promptly isolate positive patients and save resources. Among 532 patients, overall sensitivities were 48.3% for Exdia and 41.2% for Standard Q®, PanbioTM and BD Veritor™. All RATs exhibited specificity above 99%. Sensitivity increased to 74.6%, 66.2%, 66.2% and 64.8% for Exdia, Standard Q®, PanbioTM and BD Veritor™, respectively, for viral loads above 105 copies/mL, to 100%, 97.8%, 96.6% and 95.6% for viral loads above 106 copies/mL and 100% for viral loads above 107 copies/mL. Sensitivity was significantly higher for patients with symptoms onset within four days (74.3%, 69.2%, 69.2% and 64%, respectively) versus patients with the evolution of symptoms longer than four days (36.8%, 21.1%, 21.1% and 23.7%, respectively). Among COVID-19 asymptomatic patients, sensitivity was 33%. All Immunoglobulin-A-positive patients resulted negative for RAT. The RAT might represent a useful resource in selected clinical settings as a complementary tool in RT-PCR for rapid patient triaging, but the lower sensitivity, especially in late presenters and COVID-19 asymptomatic subjects, must be taken into account.
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Affiliation(s)
- Giorgia Caruana
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Antony Croxatto
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Eleftheria Kampouri
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Antonios Kritikos
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Onya Opota
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Maryline Foerster
- Emergency Department, Lausanne University Hospital, 1011 Lausanne, Switzerland
| | - René Brouillet
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Laurence Senn
- Service of Hospital Preventive Medicine, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
| | - Reto Lienhard
- ADMed Microbiologie Laboratory, 2300 La Chaux-de-Fonds, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, 4001 Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4031 Basel, Switzerland
| | - Giuseppe Pantaleo
- Institute of immunology, University Hospital of Lausanne, 1011 Lausanne, Switzerland
| | | | - Gilbert Greub
- Institute of Microbiology, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Service of Infectious Diseases, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
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10
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Rottier WC, Deelen JWT, Caruana G, Buiting AGM, Dorigo-Zetsma JW, Kluytmans JAJW, van der Linden PD, Thijsen SFT, Vlaminckx BJM, Weersink AJL, Ammerlaan HSM, Bonten MJM. Attributable mortality of antibiotic resistance in gram-negative infections in the Netherlands: a parallel matched cohort study. Clin Microbiol Infect 2020; 27:S1198-743X(20)30420-1. [PMID: 32698043 DOI: 10.1016/j.cmi.2020.07.014] [Citation(s) in RCA: 8] [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: 03/29/2020] [Revised: 07/05/2020] [Accepted: 07/10/2020] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Antibiotic resistance in Gram-negative bacteria has been associated with increased mortality. This was demonstrated mostly for third-generation cephalosporin-resistant (3GC-R) Enterobacterales bacteraemia in international studies. Yet, the burden of resistance specifically in the Netherlands and created by all types of Gram-negative infection has not been quantified. We therefore investigated the attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands. METHODS In eight hospitals, a sample of Gram-negative infections was identified between 2013 and 2016, and separated into resistant and susceptible infection cohorts. Both cohorts were matched 1:1 to non-infected control patients on hospital, length of stay at infection onset, and age. In this parallel matched cohort set-up, 30-day mortality was compared between infected and non-infected patients. The impact of resistance was then assessed by dividing the two separate risk ratios (RRs) for mortality attributable to Gram-negative infection. RESULTS We identified 1954 Gram-negative infections, of which 1190 (61%) involved Escherichia coli, 210 (11%) Pseudomonas aeruginosa, and 758 (39%) bacteraemia. Resistant Gram-negatives caused 243 infections (12%; 189 (78%) 3GC-R Enterobacterales, nine (4%) multidrug-resistant P. aeruginosa, no carbapenemase-producing Enterobacterales). Subsequently, we matched 1941 non-infected controls. After adjustment, point estimates for RRs comparing mortality between infections and controls were similarly higher than 1 in case of resistant infections and susceptible infections (1.42 (95% confidence interval 0.66-3.09) and 1.32 (1.06-1.65), respectively). By dividing these, the RR reflecting attributable mortality of resistance was calculated as 1.08 (0.48-2.41). CONCLUSIONS In the Netherlands, antibiotic resistance did not increase 30-day mortality in Gram-negative infections.
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Affiliation(s)
- Wouter C Rottier
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - J W Timotëus Deelen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Giorgia Caruana
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Unit of Infectious Diseases, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Anton G M Buiting
- Laboratory for Medical Microbiology and Immunology, Elisabeth-TweeSteden Hospital, Tilburg/Waalwijk, the Netherlands
| | | | - Jan A J W Kluytmans
- Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands
| | | | - Steven F T Thijsen
- Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, the Netherlands
| | - Bart J M Vlaminckx
- Department of Medical Microbiology and Immunology, St. Antonius Hospital, Utrecht/Nieuwegein, the Netherlands
| | - Annemarie J L Weersink
- Laboratory for Medical Microbiology and Immunology, Meander Medical Center, Amersfoort, the Netherlands
| | - Heidi S M Ammerlaan
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Internal Medicine, Catharina Hospital, Eindhoven, the Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Caruana G, Croxatto A, Coste AT, Opota O, Lamoth F, Jaton K, Greub G. Diagnostic strategies for SARS-CoV-2 infection and interpretation of microbiological results. Clin Microbiol Infect 2020; 26:1178-1182. [PMID: 32593741 PMCID: PMC7315992 DOI: 10.1016/j.cmi.2020.06.019] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [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: 04/17/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND To face the current COVID-19 pandemic, diagnostic tools are essential. It is recommended to use real-time RT-PCR for RNA viruses in order (a) to perform a rapid and accurate diagnostic, (b) to guide patient care and management and (c) to guide epidemiological strategies. Further studies are warranted to define the role of serological diagnosis and a possible correlation between serological response and prognosis. OBJECTIVES The aim was to guide clinical microbiologists in the use of these diagnostic tests and clinicians in the interpretation of their results. SOURCES A search of literature was performed through PubMed and Google Scholar using the keywords SARS-CoV-2, SARS-CoV-2 molecular diagnosis, SARS-CoV-2 immune response, SARS-CoV-2 serology/antibody testing, coronavirus diagnosis. CONTENT The present review discusses performances, limitations and use of current and future diagnostic tests for SARS-CoV-2. IMPLICATIONS Real-time RT-PCR remains the reference method for diagnosis of SARS-CoV-2 infection. On the other hand, notwithstanding its varying sensitivity according to the time of infection, serology represents a valid asset (a) to try to solve possible discrepancies between a highly suggestive clinical and radiological presentation and negative RT-PCR, (b) to solve discrepancies between different PCR assays and (c) for epidemiological purposes.
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Affiliation(s)
- G Caruana
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - A Croxatto
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - A T Coste
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - O Opota
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - F Lamoth
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland; Service de Maladies Infectieuses, Département de médecine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - K Jaton
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland
| | - G Greub
- Institut de Microbiologie, Département de médecine de laboratoire et pathologie (DMLP), Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland; Service de Maladies Infectieuses, Département de médecine, Centre Hospitalier Universitaire Vaudois and Université de Lausanne, Lausanne, Switzerland.
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12
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Vena A, Giacobbe DR, Mussini C, Cattelan A, Bassetti M, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E, Bassetti M, Vena A, Castaldo N, Pecori D, Righi E, Carnellutti A, Givone F, Graziano E, Merelli M, Cadeo B, Peghin M, Cattelan A, Cipriani L, Coletto D, Mussini C, Digaetano M, Tascini C, Carrannante N, Menichetti F, Verdenelli S, Fabiani S, Mastroianni CM, Gianluca R, Oliva A, Ciardi MR, Ajassa C, Tieghi T, Tumbarello M, Losito AR, Raffaelli F, Grossi P, Rovelli C, Artioli S, Caruana G, Luzzati R, Bontempo G, Petrosillo N, Capone A, Rizzardini G, Coen M, Passerini M, Mastroianni A, Urso F, Bianco MF, Borgia G, Gentile I, Maraolo AE, Crapis M, Venturini S, Parruti G, Trave F, Angarano G, Carbonara S, Mariani MF, Girardis M, Cascio A, Anselmo M, Malfatto E. Clinical Efficacy of Ceftolozane-Tazobactam Versus Other Active Agents for the Treatment of Bacteremia and Nosocomial Pneumonia due to Drug-Resistant Pseudomonas aeruginosa. Clin Infect Dis 2020; 71:1799-1801. [DOI: 10.1093/cid/ciaa003] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Antonio Vena
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
| | - Cristina Mussini
- Infectious Diseases Clinics, University of Modena and Reggio Emilia, Modena, Italy
| | - Annamaria Cattelan
- Infectious Diseases Unit, Department of Internal Medicine, Azienda Ospedaliera-Universitaria di Padova, Padua, Italy
| | - Matteo Bassetti
- Department of Health Sciences, Infectious Disease Clinic, University of Genoa and Hospital Policlinico San Martino–Istituto di Ricovero e Cura a Carattere Scientifico, Genoa, Italy
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Nuvoli S, Caruana G, Babudieri S, Solinas P, Pellicanò G, Piras B, Fiore V, Bagella P, Calia GM, Yue M, Spanu A, Madeddu G. Body fat changes in HIV patients on highly active antiretroviral therapy (HAART): a longitudinal DEXA study. Eur Rev Med Pharmacol Sci 2019; 22:1852-1859. [PMID: 29630136 DOI: 10.26355/eurrev_201803_14606] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE We aimed to quantitatively evaluate body fat composition in a group of HIV patients treated with Highly Active Anti-retroviral Therapy (HAART) to ascertain both fat loss and fat distribution changes and to identify possible therapeutic and host related associated risk factors. PATIENTS AND METHODS A total of 180 patients with available total body DEXA scan were assigned to a) Group 1, with clinically evident body fat changes, (BFC) and b) Group 2, without BFC. Clinical and immunovirologic data were collected. We used Student t-test and x2 or Fisher exact test to compare the characteristics of the two groups. Paired t-test was used to compare basal and follow-up data. The relationships between variables were evaluated by calculating Pearson's correlation coefficient and its significance. RESULTS HAART duration was significantly (p<0.0001) higher for patients in Group 1 than in Group 2, as well as PI (p<0.02) and NRTI (p<0.002) therapy duration. Current CD4 count and CD4 rise from nadir resulted significantly higher in Group 1 than in Group 2 (p<0.02 and 0.006, respectively). Whole Body Fat (WBF), Peripheral Fat (PF) and Leg (L) fat negatively correlated with PI and NRTI therapy duration, while Trunk Fat (TF)/PF positively correlated with PI and NNRTI duration. No significant correlation was found, instead, with NNRTI therapy duration. At 5-year follow-up, we registered a further increase in TF, Arms (A) and L fat, especially in PI-treated patients. CONCLUSIONS Body fat changes should always be considered when dealing with HIV-affected patients on HAART. The fat loss seemed to involve mainly peripheral regions, while fat accumulation tendency occurred in the trunk.
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Affiliation(s)
- S Nuvoli
- Unit of Nuclear Medicine, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy.
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Fazio C, Castiglia P, Piana A, Neri A, Mura MS, Caruana G, Vacca P, Anselmo A, Ciammaruconi A, Fortunato A, Palozzi AM, Fillo S, Lista F, Stefanelli P. Pericarditis Caused by Hyperinvasive Strain of Neisseria meningitidis, Sardinia, Italy, 2015. Emerg Infect Dis 2018; 22:1136-7. [PMID: 27191370 PMCID: PMC4880104 DOI: 10.3201/eid2206.160160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Doria C, Doyle HR, Mandalà L, Marino IR, Caruana G, Gruttadauria S, Lauro A, Magnone M, Scotti Foglieni C, Lamonaca V, Scott VL. Changes in Serum Electrolytes during Treatment of Patients in Liver Failure with Molecular Adsorbent Recirculating System. Int J Artif Organs 2018; 26:918-23. [PMID: 14636008 DOI: 10.1177/039139880302601008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 01/21/2023]
Abstract
PURPOSE To study the effect of MARS on serum electrolytes during liver failure. DESIGN Twenty-three patients admitted to a quaternary health care facility from September 2000 to May 2002, 22 adults and 1 child, 11 males (48%) and 12 females (52%), age 15-70 (median 53), treated with MARS for: 12 acute-on-chronic liver failure (52%); 4 fulminant hepatic failure (17%); 3 intractable pruritus (13%); 2 primary-non-function (9%); 2 following major liver resection (9%). PROCEDURES Sodium, potassium, chloride, phosphorus, calcium, and magnesium were measured in the serum, ultrafiltrate and albumin circuit before and after MARS. STATISTICAL METHODS A comparison of electrolyte concentrations, before and after MARS, was performed using a paired t test. MAIN FINDINGS Serum electrolyte concentrations before and after MARS, while statistically significant in some cases, were very small, and of no clinical relevance. CONCLUSION MARS exchanges potassium, chloride, calcium, and magnesium by ultrafiltration; sodium by the albumin dialysis.
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Affiliation(s)
- C Doria
- Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
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Bagella P, Fiore V, Caruana G, Madeddu G. Editorial - Non AIDS-defining malignancies: a new epidemic in HIV-infected population for the upcoming decades? Eur Rev Med Pharmacol Sci 2017; 21:4744-4745. [PMID: 29131237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- P Bagella
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
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Abstract
BACKGROUND The aim of this study was to evaluate a possible relationship between lunar cycles and haemorrhagic complication rate in surgery. MATERIALS AND METHODS The possible relationship between moon phases and surgical outcome was tested by evaluating the haemorrhagic complication rate for 18,760 patients who underwent surgery between January 2001 and December 2008 at the National Institute for Cancer Research in Genoa. A total of 103 lunar phases were considered using Chi-square (χ2) test analysis, and patients were allocated a surgery date. RESULTS One hundred and sixty-seven haemorrhagic complications were observed. Three hundred and nine new moon phase days were analysed and 12 incidences of complications detected, with a 3.9% complication rate per day. In the waxing moon phase, 1184.5 d were analysed with 68 incidences of complications at a daily rate of 5.7%. In the full moon phase there was a 4.9% complication rate per day (15 incidences in 309 d), whereas in the waning moon phase, the 6% percentage rate per day resulted from 72 incidences in 1184.5 d. CONCLUSIONS No statistically significant correlations were found between moon cycles and postoperative haemorrhagic complications (p = .50).
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Affiliation(s)
- Edoardo Raposio
- Department of Medicine and Surgery, Plastic Surgery Unit, University of Parma, Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Section, Parma University Hospital, Parma, Italy
| | - Giorgia Caruana
- Department of Medicine and Surgery, Plastic Surgery Unit, University of Parma, Parma, Italy
- Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Section, Parma University Hospital, Parma, Italy
| | - Pierluigi Santi
- Department of Surgical and Integrated Methodological Sciences (DICMI), University of Genova, Genova, Italy
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Caruana G, Vidili G, Serra PA, Bagella P, Spanu A, Fiore V, Calvisi DF, Manetti R, Rocchitta G, Nuvoli S, Babudieri S, Simile MM, Madeddu G. The burden of HIV-associated neurocognitive disorder (HAND) in post-HAART era: a multidisciplinary review of the literature. Eur Rev Med Pharmacol Sci 2017; 21:2290-2301. [PMID: 28537651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE The purpose of the present multidisciplinary review is to give an updated insight into the most recent findings regarding the pathophysiology, diagnosis and therapeutics of HIV-associated neurocognitive disorder (HAND). MATERIALS AND METHODS We performed a comprehensive search, through electronic databases (Pubmed - MEDLINE) and search engines (Google Scholar), of peer-reviewed publications (articles and reviews) and conferences proceedings on HAND pathophysiology, diagnosis, and therapy, from 1999 to 2016. RESULTS It seems to be increasingly clear that neurodegeneration in HIV-1 affected patients is a multi-faceted disease involving numerous factors, from chronic inflammation to central nervous system (CNS) compartmentalization of HIV. Diagnosis of HAND may benefit from both laboratory analysis and advanced specific neuroimaging techniques. As regards HAND therapy, modified HAART combinations and simplification strategies have been tested, while novel exciting frontiers seem to involve the use of nanoparticles with the ability to cross the Blood-Brain Barrier (BBB). CONCLUSIONS Albeit highly active antiretroviral therapy (HAART) allowed a major decrease in morbidity and mortality for AIDS patients, CNS involvement still represents a challenge in HIV patients even today, affecting up to 50% of patients with access to combination antiretroviral therapy (cART). Future studies will have to focus on CNS compartmentalization, drugs' ability to penetrate and suppress viral replication in this compartment, and on new approaches to reduce HIV-associated neuroinflammation.
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Affiliation(s)
- G Caruana
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy.
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Bagella P, Fiore V, Caruana G, Ortu S, Babudieri S, Madeddu G. Human Papilloma Virus Infections in Men: Focus on Vaccination and Treatment Options. Curr Treat Options Infect Dis 2017. [DOI: 10.1007/s40506-017-0112-1] [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: 11/30/2022]
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Caruana G, Candotti M, Cesca M, Thuries V, Crampe S, Demay L, Giacomin S, Boutges A, Germain S, Pistre C, Lagriffoul L, Baud M, Campse T, Darre K, Jalabert L, Perez G, Gaston A, Estival A, Gordien K, Silvagni C. Anatomie pathologique : le groupe des techniciens de Midi-Pyrénées. Ann Pathol 2016. [DOI: 10.1016/j.annpat.2016.06.012] [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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Faure A, Bouty A, Caruana G, Williams L, Burgess T, Wong MN, James PA, O'Brien M, Walker A, Bertram JF, Heloury Y. DNA copy number variants: A potentially useful predictor of early onset renal failure in boys with posterior urethral valves. J Pediatr Urol 2016; 12:227.e1-7. [PMID: 27160979 DOI: 10.1016/j.jpurol.2016.02.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 02/29/2016] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Posterior urethral valves (PUV) are among the most common urological causes of chronic kidney disease (CKD) in childhood. Recently, genomic imbalances have been cited as potential risk factors for altered kidney function and have been associated with CKD. The phenotypic effects of a copy number variant (CNV) in boys with PUV are unknown. Here, it was hypothesised that the progression to early renal failure in PUV patients may be influenced by genetic aberrations. OBJECTIVE To assess the relationship between CNVs and renal outcomes. PATIENTS AND METHODS Between September 2012 and July 2015, 45 children with PUV were recruited to evaluate the presence of CNVs in their DNA. The patients' medical records were retrospectively reviewed. The criteria for outcomes of renal function included: assessments of the nadir serum creatinine in the first year of life, the estimated glomerular filtration rate at 1 and 5 years, and the requirement for renal replacement. RESULTS Thirteen CNVs were identified in 12 boys (29% of the cohort). Microarray analysis revealed two pathogenic CNVs (well-established CNVs known to be associated with genetic disease) and 11 of unknown significance (CNVs with insufficient current available evidence for unequivocal determination of clinical significance), including genes that have been previously implicated in kidney diseases and urogenital disorders. The median follow-up was 10.2 years (range 3-17.5) in the group of patients with CNV compared with 5.8 years (range 1-16.6) in those CNV-. The nadir creatinine values were significantly higher in boys with CNVs than in those without CNVs (57.5 μmol/L (range 23-215) and 28 μmol/L (range 18-155), respectively (P = 0.05) (Figure). Boys CNV+ had a worse prognosis, with a higher incidence of Stage-V CKD compared with the control group (33% with CNVs vs. 9% in CNV-, P = 0.06) at a median age of 22 months (range 8 months-16 years). Four (33%) patients CNV+ underwent renal transplantation. DISCUSSION The role of CNVs in the deterioration of renal function remains unknown. It can be hypothesised that CNVs could be a contributing factor or may serve as an accelerant for the progression to renal failure. CONCLUSION The CNVs >100 Kb were significantly associated with early onset renal failure in children with PUV. Prenatal detection of CNV could help to identify foetuses at high risk of severe renal impairment in cases of suspected PUV, especially in cases without oligohydramnios or severe pulmonary hypoplasia. These preliminary results should be confirmed in a larger cohort of patients.
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Affiliation(s)
- A Faure
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia.
| | - A Bouty
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - G Caruana
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - L Williams
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - T Burgess
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia; Department of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC 3010, Australia
| | - M N Wong
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - P A James
- Royal Children's Hospital, VCGS, Parkville, VIC 3052, Australia
| | - M O'Brien
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - A Walker
- Department of Paediatric Nephrology, Royal Children's Hospital, Parkville, VIC 3052, Australia
| | - J F Bertram
- Development and Stem Cells Program, Monash Biomedicine Discovery Institute, and Department of Anatomy and Developmental Biology, Monash University, Clayton, VIC 3800, Australia
| | - Y Heloury
- Department of Urology, Royal Children's Hospital, Parkville, VIC 3052, Australia
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Raposio E, Caruana G. Experimental Evidence in Hair Restoration Procedures: Plucked Hair Survival and Growth Rate. J Clin Aesthet Dermatol 2016; 9:39-41. [PMID: 27354887 PMCID: PMC4896820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Limitations of hair restoration procedures are the amount of hairs available and the invasiveness of follicular harvesting. OBJECTIVE The aim of this study was to compare conventional human micrografts and plucked hair follicles in an in vitro model in order to test hair growth rates for experimentally assessing the soundness of plucked follicle use in hair transplantation procedures. METHODS AND MATERIALS A total of 100 conventional one-hair micrografts (group A; control) and a total of 80 plucked hair follicles (group B; experimental) were obtained from 14 healthy male patients. The length of each graft was measured immediately following isolation and at the end of the 10-day culture period. The Kruskal-Wallis one-way analysis of variance by ranks test was used in order to statistically analyze the data obtained. RESULTS A statistically significant difference was found between the growth rate of micrografts in control (mean 10-day shaft growth rate = 0.30mm) and experimental (mean 10-day shaft growth rate = 0.36mm) groups. CONCLUSION The obtained data shows a higher plucked hair follicle growth rate compared to one-hair micrografts, which leads us to believe that plucked micrografts could be a useful and less invasive adjunct in the field of hair transplantation surgery.
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Affiliation(s)
- Edoardo Raposio
- Department of Surgical Sciences, Plastic Surgery Unit, University of Parma, and Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
| | - Giorgia Caruana
- Department of Surgical Sciences, Plastic Surgery Unit, University of Parma, and Cutaneous, Mini-invasive, Regenerative and Plastic Surgery Unit, Parma University Hospital, Parma, Italy
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Caruana G, Bertozzi N, Boschi E, Pio Grieco M, Grignaffini E, Raposio E. Role of adipose-derived stem cells in chronic cutaneous wound healing. Ann Ital Chir 2015; 86:1-4. [PMID: 25818696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM Adipose tissue represent an alternative source of multipotent stem cells with characteristics similar to bone marrowderived mesenchymal stem cells (BMSCs), easier to isolate and effective in wound healing enhancement. MATERIAL OF STUDY Each patient being considered for stem cells graft was subjected to a conventional liposuction procedure (local anaesthesia, aspirated volume about 80cc), in order to isolate a pellet of adipose-derived stem cells (ASCs), which was then mixed with the platelet-rich plasma (PRP) previously collected, in order to obtain an enhanced-ASCs- PRP (e-PRP), now ready for grafting in the context of skin edges as well as at the bottom of the lesion itself. RESULTS Flow cytometric analysis performed on the pellet obtained with our isolation process, showed that a mean of 5 x 105 ASCs (range: 4,0-6,0 x 105, SD: ± 1 x 105) were collected from 80 ml of adipose tissue, harvested with standard wet liposuction procedure. It represented the 5% of all sample cells (1 x 107), while the others 95% were mostly being blood-derived and endothelial cells. DISCUSSION By now, the most used isolation protocols take about two hours due to the complex isolation procedure, requiring both animal-derived reagents and collagenase. The amount of ASCs obtained with our isolation process is sufficient to be directly engrafted in the wound without the need of in vitro expansion but, neither serum nor animalderived reagents are used, and it takes only 15' minutes. CONCLUSION ASCs application is an innovative, effective approach in the treatment of chronic wounds.
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Caruana G, Bertozzi N, Boschi E, Pio Grieco M, Grignaffini E, Raposio E. Endoscopic forehead surgery for migraine therapy Personal technique. Ann Ital Chir 2014; 85:583-586. [PMID: 25711848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study is to prove the therapeutic effectiveness of nerve decompression, performed endoscopically for frontal migraine and by open surgery for occipital migraine. MATERIALS AND METHODS Twenty patients were enrolled and underwent surgery for endoscopic resection of the glabellar muscle group, including the corrugator supercilii, depressor supercilii, and procerus muscles, while the occipital decompression was performed in open surgery through decompression of occipital nerves from occipital, semispinalis capitis, trapezius and sternocleidomastoid muscles. Every patient was diagnosed with: migraine without aura, chronic tensiontype headache and new daily persistent headache, refractory to medical management. RESULTS Analyzing the answers given by the patients to validated questionnaires, 9 referred alleviation of migraine symptoms (45%), 8 described elimination of their migraine headaches (40%) while 3 didn't report any improvement. DISCUSSION Our data confirmed the results of previous studies, pointing out the effectiveness of trigeminal branches and occipital nerves (trigger points) decompression from the surrounding muscles. Moreover, our technique has the same results but it's less invasive and has less collateral effects. CONCLUSIONS Our results highlight migraine surgery as an effective treatment for patients with migraine headaches who do not tolerate or do not wish to continue medical interventions. KEY WORDS Endoscopic surgery, Headache migraine.
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San Juan J, Pérez-Sáez R, Recarte V, Nó M, Caruana G, Lieblich M, Ruano O. Martensitic Transformation in Cu-Al-Ni Shape Memory Alloys Processed by Powder Metallurgy. ACTA ACUST UNITED AC 2014. [DOI: 10.1051/jp4/199558919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Moritz KM, Wintour EM, Black MJ, Bertram JF, Caruana G. Factors influencing mammalian kidney development: implications for health in adult life. Adv Anat Embryol Cell Biol 2008; 196:1-78. [PMID: 18637522 DOI: 10.1007/978-3-540-77768-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There are many reasons why it is timely to review the development of the mammalian kidney. Perhaps the most important of these is the increasing amount of evidence to demonstrate that factors which impinge on/alter the normal developmental processes of this organ can have lifelong consequences for the health of the adult. The'Developmental Origins of Health and Adult Disease' (DOHaD) hypothesis, proposes that changes in the environment during the development of an organ or system, can have permanent deleterious effects leading to increased risk of cardiovascular and/or metabolic disease. The permanent metanephric kidney has been shown to be very vulnerable to such influences with many factors shown to alter both the permanent structure and the level of expression of important functional genes. Thus it is important to understand the precise timing of kidney development in terms of both structure and the genes involved at each stage. Such knowledge has been gained by significant advances in technology, which allow quantification of the number of nephrons by unbiased stereology, detections of both levels and site of gene expression,'knock-out' and knock-in' of genes in animal (mainly mouse) models and by the ability to examine nephron development, in real time, in culture systems.
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Affiliation(s)
- K M Moritz
- School of Biomedical Sciences, University of Queensland, St Lucia, Australia.
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Challen G, Gardiner B, Caruana G, Kostoulias X, Martinez G, Crowe M, Taylor DF, Bertram J, Little M, Grimmond SM. Temporal and spatial transcriptional programs in murine kidney development. Physiol Genomics 2005; 23:159-71. [PMID: 15998744 DOI: 10.1152/physiolgenomics.00043.2005] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We have performed a systematic temporal and spatial expression profiling of the developing mouse kidney using Compugen long-oligonucleotide microarrays. The activity of 18,000 genes was monitored at 24-h intervals from 10.5-day-postcoitum (dpc) metanephric mesenchyme (MM) through to neonatal kidney, and a cohort of 3,600 dynamically expressed genes was identified. Early metanephric development was further surveyed by directly comparing RNA from 10.5 vs. 11.5 vs. 13.5dpc kidneys. These data showed high concordance with the previously published dynamic profile of rat kidney development (Stuart RO, Bush KT, and Nigam SK. Proc Natl Acad Sci USA 98: 5649-5654, 2001) and our own temporal data. Cluster analyses were used to identify gene ontological terms, functional annotations, and pathways associated with temporal expression profiles. Genetic network analysis was also used to identify biological networks that have maximal transcriptional activity during early metanephric development, highlighting the involvement of proliferation and differentiation. Differential gene expression was validated using whole mount and section in situ hybridization of staged embryonic kidneys. Two spatial profiling experiments were also undertaken. MM (10.5dpc) was compared with adjacent intermediate mesenchyme to further define metanephric commitment. To define the genes involved in branching and in the induction of nephrogenesis, expression profiling was performed on ureteric bud (GFP+) FACS sorted from HoxB7-GFP transgenic mice at 15.5dpc vs. the GFP- mesenchymal derivatives. Comparisons between temporal and spatial data enhanced the ability to predict function for genes and networks. This study provides the most comprehensive temporal and spatial survey of kidney development to date, and the compilation of these transcriptional surveys provides important insights into metanephric development that can now be functionally tested.
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Affiliation(s)
- G Challen
- Institute of Molecular Bioscience, University of Queensland, St. Lucia, Queensland, Victoria, Australia
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Caruana G, Bernstein A. Craniofacial dysmorphogenesis including cleft palate in mice with an insertional mutation in the discs large gene. Mol Cell Biol 2001; 21:1475-83. [PMID: 11238884 PMCID: PMC86693 DOI: 10.1128/mcb.21.5.1475-1483.2001] [Citation(s) in RCA: 116] [Impact Index Per Article: 5.0] [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: 09/19/2000] [Accepted: 11/28/2000] [Indexed: 11/20/2022] Open
Abstract
The discs large (Dlg) protein, or synapse-associated protein 97 (SAP97), is a member of the membrane-associated guanylate kinase family of multidomain scaffolding proteins which recruits transmembrane and signaling molecules to localized plasma membrane sites. Murine dlg is the homologue of the Drosophila dlg tumor suppressor gene. The loss of dlg function in Drosophila disrupts cellular growth control, apicobasal polarity, and cell adhesion of imaginal disc epithelial cells, resulting in embryonic lethality. In this study, we isolated a mutational insertion in the murine dlg locus by gene trapping in totipotent embryonic stem cells. This insertion results in a truncated protein product that contains the N-terminal three PSD-95/DLG/ZO-1 domains of Dlg fused to the LacZ reporter and subsequently lacks the src homology 3 (SH3), protein 4.1 binding, and guanylate kinase (GUK)-like domains. The Dlg-LacZ fusion protein is expressed in epithelial, mesenchymal, neuronal, endothelial, and hematopoietic cells during embryogenesis. Mice homozygous for the dlg mutation exhibit growth retardation in utero, have hypoplasia of the premaxilla and mandible, have a cleft secondary palate, and die perinatally. Consistent with this phenotype, Dlg-LacZ is expressed in mesenchymal and epithelial cells throughout palatal development. Our genetic and phenotypic analysis of dlg mutant mice suggests that protein-protein interactions involving the SH3, protein 4.1 binding, and/or GUK-like domains are essential to the normal function of murine Dlg within craniofacial and palatal morphogenesis.
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MESH Headings
- Adaptor Proteins, Signal Transducing
- Animals
- Blotting, Northern
- Blotting, Western
- Cleft Palate/genetics
- Colon/embryology
- Craniofacial Abnormalities/genetics
- Cytoskeletal Proteins
- Discs Large Homolog 1 Protein
- Drosophila Proteins
- Embryo, Mammalian/metabolism
- Epithelium/metabolism
- Genes, Reporter
- Genotype
- Guanylate Kinases
- Homozygote
- Immunohistochemistry
- Insect Proteins/chemistry
- Insect Proteins/genetics
- Lac Operon
- Lung/embryology
- Membrane Proteins/chemistry
- Mesoderm/metabolism
- Mice
- Mice, Inbred ICR
- Mice, Transgenic
- Microscopy, Electron, Scanning
- Mutation
- Nerve Tissue Proteins/chemistry
- Nerve Tissue Proteins/genetics
- Nerve Tissue Proteins/physiology
- Neuropeptides
- Nucleoside-Phosphate Kinase/chemistry
- Palate/embryology
- Phenotype
- Protein Binding
- Protein Structure, Tertiary
- Stem Cells/metabolism
- Time Factors
- Tumor Suppressor Proteins
- src Homology Domains
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Affiliation(s)
- G Caruana
- Program in Molecular Biology and Cancer, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada M5G 1X5.
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Dror Y, Leaker M, Caruana G, Bernstein A, Freedman MH. Mastocytosis cells bearing a c-kit activating point mutation are characterized by hypersensitivity to stem cell factor and increased apoptosis. Br J Haematol 2000; 108:729-36. [PMID: 10792276 DOI: 10.1046/j.1365-2141.2000.01935.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [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: 12/13/2022]
Abstract
Mastocytosis is characterized by abnormal infiltration of mast cells into various organs. An activating mutation in c-kit, involving an A --> T substitution at nucleotide 2648 has recently been described in some patients with mastocytosis. We describe a 12-year-old girl with this mutation in her bone marrow cells at diagnosis with a myelodysplastic syndrome (MDS) without evidence of mastocytosis, and then in peripheral blood mononuclear cells 1 year later after the emergence of mastocytosis. The role of the c-Kit receptor and its ligand stem cell factor (SCF) in the pathogenesis of the disease was analysed in marrow cell clonogenic assays. We show that the genetic abnormalities in the patient resulted in factor-independent growth and hypersensitivity of primitive progenitors to SCF, with increased production of mast cells. Increased apoptosis and cluster formation, consistent with the myelodysplastic nature of the disorder, accompanied accumulation of abnormal cells with increasing concentrations of SCF.
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Affiliation(s)
- Y Dror
- Division of Hematology/Oncology, Department of Pediatrics, Research Institute, The Hospital for Sick Children and the University of Toronto, Toronto, Canada.
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Abstract
Using an expression gene trapping strategy, we have identified and characterized two novel hematopoietic genes, Hzf and Hhl. Embryonic stem (ES) cells containing a gene trap vector insertion were cultured on OP9 stromal cells to induce hematopoietic differentiation and screened for lacZ reporter gene expression. Two ES clones displaying lacZ expression within hematopoietic cells in vitro were used to generate mice containing the gene trap integrations. Paralleling this in vitro expression pattern, both Hzf and Hhl were expressed in a tissue-specific manner during hematopoietic development in vivo. Hzf encodes a novel protein containing three C(2)H(2)-type zinc fingers predominantly expressed in megakaryocytes and CFU-GEMM. Hhl encodes a novel protein containing a putative phosphotyrosine binding (PTB) domain expressed in megakaryocytes, CFU-GEMM and BFU-E. These results demonstrate the utility of expression trapping to identify novel hematopoietic genes. Future studies of Hzf and Hhl should provide valuable information on the role these genes play during megakaryocytopoiesis.
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Affiliation(s)
- M Hidaka
- Program in Molecular Biology and Cancer, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, 600 University Avenue, Toronto, Canada
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Abstract
Alternate splicing of mRNA encoding c-KIT results in isoforms which differ in the presence or absence of four amino acids (GNNK) in the juxtamembrane region of the extracellular domain of the receptor. In this study we show that these isoforms of human c-KIT, expressed at similar levels in NIH3T3 cells, display differential effects on various attributes of transformation. The GNNK- isoform strongly promoted anchorage independent growth (colony formation in semi-solid medium), loss of contact inhibition (focus formation), and led to tumorigenicity in nude mice. In contrast, the GNNK+ isoform elicited colony formation but relatively poor focus formation and no tumorigenicity. Saturation binding analysis indicated that the isoforms do not differ significantly in their affinity for the KIT ligand, Steel Factor (SLF). Negligible ligand-independent receptor phosphorylation was observed in either case but, after ligand stimulation, the GNNK- isoform displayed more rapid and extensive tyrosine autophosphorylation and faster internalization. Both isoforms recruited the p85 subunit of phosphatidylinositol 3-kinase and led to similar phosphorylation of its downstream effector c-Akt, but the GNNK- isoform gave rise to more MAP kinase phosphorylation. Thus the c-KIT isoforms display different signalling characteristics and have different transforming activity in NIH3T3 cells.
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Affiliation(s)
- G Caruana
- Division of Haematology, Hanson Centre for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, SA 5000, Australia
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Stanford WL, Caruana G, Vallis KA, Inamdar M, Hidaka M, Bautch VL, Bernstein A. Expression trapping: identification of novel genes expressed in hematopoietic and endothelial lineages by gene trapping in ES cells. Blood 1998; 92:4622-31. [PMID: 9845528] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
We have developed a large-scale, expression-based gene trap strategy to perform genome-wide functional analysis of the murine hematopoietic and vascular systems. Using two different gene trap vectors, we have isolated embryonic stem (ES) cell clones containing lacZ reporter gene insertions in genes expressed in blood island and vascular cells, muscle, stromal cells, and unknown cell types. Of 79 clones demonstrating specific expression patterns, 49% and 16% were preferentially expressed in blood islands and/or the vasculature, respectively. The majority of ES clones that expressed lacZ in blood islands also expressed lacZ upon differentiation into hematopoietic cells on OP9 stromal layers. Importantly, the in vivo expression of the lacZ fusion products accurately recapitulated the observed in vitro expression patterns. Expression and sequence analysis of representative clones suggest that this approach will be useful for identifying and mutating novel genes expressed in the developing hematopoietic and vascular systems.
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Affiliation(s)
- W L Stanford
- Program in Molecular Biology and Cancer, Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
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Caruana G, Cambareri AC, Gonda TJ, Ashman LK. Transformation of NIH3T3 fibroblasts by the c-Kit receptor tyrosine kinase: effect of receptor density and ligand-requirement. Oncogene 1998; 16:179-90. [PMID: 9464535 DOI: 10.1038/sj.onc.1201494] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [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: 02/06/2023]
Abstract
Ectopic expression of the normal murine receptor tyrosine kinase, c-Kit, in NIH3T3 cells induced many phenotypic changes characteristic of transformation including anchorage-independent growth, focus formation and tumorigenicity in nude mice. Although transformation was largely dependent on the presence of recombinant murine Steel Factor (SLF), the ligand to the c-Kit receptor, anchorage independent growth did occur at a low frequency in the absence of added factor, and this could not be inhibited by neutralising antibodies or by SLF anti-sense mRNA. Clones from factor-independent colonies in semi-solid agar displayed a narrow range of c-Kit surface protein levels (4.3-6.4 x 10(4) receptors/cell) which was relatively high compared with the pool from which they were derived. Analysis of a larger series of random clones derived from adherent cultures expressing different levels of c-Kit demonstrated a positive correlation between SLF-dependent, anchorage-independent growth and c-Kit protein and mRNA expression levels (respectively, Rs = 0.58, P < 0.01; and Rs = 0.53, P < 0.01) with consistent colony formation observed with clones having > 2.5 x 10(4) receptors/cell. Interestingly, two of the three clones expressing the highest levels of c-Kit protein and mRNA produced few or no colonies in the presence or absence of SLF. Sequential overexpression of human c-KIT in NIH3T3 cells using a dihydrofolate reductase (DHFR)-encoding vector and gene co-amplification through methotrexate selection, which resulted in pools expressing up to 1.5 x 10(5) receptors/cell, confirmed that high receptor densities resulted in a decrease in colony numbers. Thus, analysis of clonal and selected populations has indicated that an optimal level of c-Kit is required for transformation of NIH3T3 cells in the presence of SLF, and that some ligand-independent transformation occurs.
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Affiliation(s)
- G Caruana
- Division of Haematology, Hanson Centre for Cancer Research, Institute of Medical and Veterinary Science, Adelaide, SA, Australia
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Caruana G, Ashman LK, Fujita J, Gonda TJ. Responses of the murine myeloid cell line FDC-P1 to soluble and membrane-bound forms of steel factor (SLF). Exp Hematol 1993; 21:761-8. [PMID: 7684700] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Cells of the murine interleukin-3 (IL-3) or granulocyte-macrophage colony-stimulating factor (GM-CSF) factor-dependent line, FDC-P1, express the tyrosine kinase receptor, c-kit. The ligand for c-kit, steel factor (SLF), encoded by the steel (Sl) locus, is produced as both membrane-bound and soluble forms by fibroblastoid cells. Fibroblasts derived from normal (+/+) WCB6F1 mice are known to produce both forms of SLF and were able to support FDC-P1 cells in a contact-dependent manner in the presence of neutralizing anti-GM-CSF antiserum. In contrast, Sl/Sld mutant fibroblasts, which produce only a soluble form of SLF, were incapable of supporting FDC-P1 cells in the presence of GM-CSF antiserum. These results suggested that FDC-P1 cells were being supported on fibroblast layers by membrane-bound SLF. Attempts to grow FDC-P1 cells in high levels of soluble recombinant SLF to mimic the SLF-dependent response seen in co-culture experiments showed that cells which had been previously grown in GM-CSF or IL-3 were minimally responsive to SLF at concentrations up to 100 ng/mL. Although these cultures were not supported by SLF alone, the cells showed synergistic proliferative responses to SLF combined with suboptimal levels of GM-CSF or IL-3. FDC-P1 cells could, however, be adapted to grow in SLF alone by gradual substitution of SLF for GM-CSF over a period of 3 weeks. These cells showed 5.6- to 8.4-fold and 2.5-fold higher levels of c-kit mRNA than cells grown in GM-CSF or IL-3, respectively. Downregulation of surface c-kit protein was also seen in FDC-P1 cells grown in GM-CSF or IL-3 compared with cells grown in SLF. Although FDC-P1 cells propagated in SLF were more responsive to SLF, they were still able to proliferate as well in GM-CSF and IL-3 as the cells originally grown in the latter factors. Thus, functional downregulation of c-kit by GM-CSF and IL-3 was unidirectional.
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Affiliation(s)
- G Caruana
- Leukaemia Research Unit, Hanson Centre for Cancer Research, Adelaide, South Australia
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