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Guia Margherita Matronola

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Messina A, Caporale M, Calabrò L, Lionetti G, Bono D, Matronola GM, Brunati A, Frassanito L, Morenghi E, Antonelli M, Chew MS, Cecconi M. Reliability of pulse pressure and stroke volume variation in assessing fluid responsiveness in the operating room: a metanalysis and a metaregression. Crit Care 2023;27:431. [PMID: 37940953 PMCID: PMC10631038 DOI: 10.1186/s13054-023-04706-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/23/2023] [Indexed: 11/10/2023] Open

Abstract

BACKGROUND

Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia.

METHODS

Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables.

RESULTS

We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position.

CONCLUSION

The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability.

TRIAL REGISTRATION

PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.

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Affiliation(s)

Antonio Messina Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
Mariagiovanna Caporale Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Lorenzo Calabrò Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Giulia Lionetti Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Daniele Bono Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Guia Margherita Matronola Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Andrea Brunati Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Luciano Frassanito Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Emanuela Morenghi Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
Massimo Antonelli Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
Michelle S Chew Department of Anaesthesia and Intensive Care, Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
Maurizio Cecconi Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy

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Cappadona C, Paraboschi EM, Ziliotto N, Bottaro S, Rimoldi V, Gerussi A, Azimonti A, Brenna D, Brunati A, Cameroni C, Campanaro G, Carloni F, Cavadini G, Ciravegna M, Composto A, Converso G, Corbella P, D’Eugenio D, Dal Rì G, Di Giorgio SM, Grondelli MC, Guerrera L, Laffoucriere G, Lando B, Lopedote L, Maizza B, Marconi E, Mariola C, Matronola GM, Menga LM, Montorsi G, Papatolo A, Patti R, Profeta L, Rebasti V, Smidili A, Tarchi SM, Tartaglia FC, Tettamanzi G, Tinelli E, Stuani R, Bolchini C, Pattini L, Invernizzi P, Degenhardt F, Franke A, Duga S, Asselta R. MEDTEC Students against Coronavirus: Investigating the Role of Hemostatic Genes in the Predisposition to COVID-19 Severity. J Pers Med 2021;11:jpm11111166. [PMID: 34834519 PMCID: PMC8622845 DOI: 10.3390/jpm11111166] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 10/14/2021] [Revised: 11/04/2021] [Accepted: 11/06/2021] [Indexed: 12/23/2022] Open

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the etiologic agent of the coronavirus disease 2019 (COVID-19) pandemic. Besides virus intrinsic characteristics, the host genetic makeup is predicted to account for the extreme clinical heterogeneity of the disease, which is characterized, among other manifestations, by a derangement of hemostasis associated with thromboembolic events. To date, large-scale studies confirmed that genetic predisposition plays a role in COVID-19 severity, pinpointing several susceptibility genes, often characterized by immunologic functions. With these premises, we performed an association study of common variants in 32 hemostatic genes with COVID-19 severity. We investigated 49,845 single-nucleotide polymorphism in a cohort of 332 Italian severe COVID-19 patients and 1668 controls from the general population. The study was conducted engaging a class of students attending the second year of the MEDTEC school (a six-year program, held in collaboration between Humanitas University and the Politecnico of Milan, allowing students to gain an MD in Medicine and a Bachelor’s Degree in Biomedical Engineering). Thanks to their willingness to participate in the fight against the pandemic, we evidenced several suggestive hits (p < 0.001), involving the PROC, MTHFR, MTR, ADAMTS13, and THBS2 genes (top signal in PROC: chr2:127192625:G:A, OR = 2.23, 95%CI = 1.50–3.34, p = 8.77 × 10⁻⁵). The top signals in PROC, MTHFR, MTR, ADAMTS13 were instrumental for the construction of a polygenic risk score, whose distribution was significantly different between cases and controls (p = 1.62 × 10⁻⁸ for difference in median levels). Finally, a meta-analysis performed using data from the Regeneron database confirmed the contribution of the MTHFR variant chr1:11753033:G:A to the predisposition to severe COVID-19 (pooled OR = 1.21, 95%CI = 1.09–1.33, p = 4.34 × 10⁻¹⁴ in the weighted analysis).

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Affiliation(s)

Claudio Cappadona Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Elvezia Maria Paraboschi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.) Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
Nicole Ziliotto Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Sandro Bottaro Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.) Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
Valeria Rimoldi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Alessio Gerussi Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (A.G.); (P.I.) European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, 20900 Monza, Italy
Andrea Azimonti Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Daniele Brenna Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Andrea Brunati Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Charlotte Cameroni Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Giovanni Campanaro Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Francesca Carloni Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Giacomo Cavadini Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Martina Ciravegna Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Antonio Composto Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Giuseppe Converso Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Pierluigi Corbella Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Davide D’Eugenio Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Giovanna Dal Rì Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Sofia Maria Di Giorgio Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Maria Chiara Grondelli Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Lorenza Guerrera Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Georges Laffoucriere Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Beatrice Lando Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Leandro Lopedote Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Benedetta Maizza Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Elettra Marconi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Carlotta Mariola Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Guia Margherita Matronola Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Luca Maria Menga Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Giulia Montorsi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Antonio Papatolo Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Riccardo Patti Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Lorenzo Profeta Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Vera Rebasti Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Alice Smidili Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Sofia Maria Tarchi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Francesco Carlo Tartaglia Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Gaia Tettamanzi Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Elena Tinelli Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Riccardo Stuani Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.)
Cristiana Bolchini Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (C.B.); (L.P.)
Linda Pattini Department of Electronics, Information and Bioengineering, Politecnico di Milano, 20133 Milan, Italy; (C.B.); (L.P.)
Pietro Invernizzi Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, 20900 Monza, Italy; (A.G.); (P.I.) European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, 20900 Monza, Italy
Frauke Degenhardt Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (F.D.); (A.F.)
Andre Franke Institute of Clinical Molecular Biology, Christian-Albrechts-University Kiel, 24105 Kiel, Germany; (F.D.); (A.F.) University Hospital Schleswig-Holstein (UKSH), 24105 Kiel, Germany
Stefano Duga Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.) Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy
Rosanna Asselta Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Italy; (C.C.); (E.M.P.); (N.Z.); (S.B.); (V.R.); (A.A.); (D.B.); (A.B.); (C.C.); (G.C.); (F.C.); (G.C.); (M.C.); (A.C.); (G.C.); (P.C.); (D.D.); (G.D.R.); (S.M.D.G.); (M.C.G.); (L.G.); (G.L.); (B.L.); (L.L.); (B.M.); (E.M.); (C.M.); (G.M.M.); (L.M.M.); (G.M.); (A.P.); (R.P.); (L.P.); (V.R.); (A.S.); (S.M.T.); (F.C.T.); (G.T.); (E.T.); (R.S.); (S.D.) Humanitas Clinical and Research Center, IRCCS, Via Manzoni 56, 20089 Rozzano, Italy Correspondence:

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