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Vellucci L, Ciccarelli M, Buonaguro EF, Fornaro M, D’Urso G, De Simone G, Iasevoli F, Barone A, de Bartolomeis A. The Neurobiological Underpinnings of Obsessive-Compulsive Symptoms in Psychosis, Translational Issues for Treatment-Resistant Schizophrenia. Biomolecules 2023; 13:1220. [PMID: 37627285 PMCID: PMC10452784 DOI: 10.3390/biom13081220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 07/24/2023] [Accepted: 07/31/2023] [Indexed: 08/27/2023] Open
Abstract
Almost 25% of schizophrenia patients suffer from obsessive-compulsive symptoms (OCS) considered a transdiagnostic clinical continuum. The presence of symptoms pertaining to both schizophrenia and obsessive-compulsive disorder (OCD) may complicate pharmacological treatment and could contribute to lack or poor response to the therapy. Despite the clinical relevance, no reviews have been recently published on the possible neurobiological underpinnings of this comorbidity, which is still unclear. An integrative view exploring this topic should take into account the following aspects: (i) the implication for glutamate, dopamine, and serotonin neurotransmission as demonstrated by genetic findings; (ii) the growing neuroimaging evidence of the common brain regions and dysfunctional circuits involved in both diseases; (iii) the pharmacological modulation of dopaminergic, serotoninergic, and glutamatergic systems as current therapeutic strategies in schizophrenia OCS; (iv) the recent discovery of midbrain dopamine neurons and dopamine D1- and D2-like receptors as orchestrating hubs in repetitive and psychotic behaviors; (v) the contribution of N-methyl-D-aspartate receptor subunits to both psychosis and OCD neurobiology. Finally, we discuss the potential role of the postsynaptic density as a structural and functional hub for multiple molecular signaling both in schizophrenia and OCD pathophysiology.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry University Medical School of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy
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De Simone G, Mazza B, Vellucci L, Barone A, Ciccarelli M, de Bartolomeis A. Schizophrenia Synaptic Pathology and Antipsychotic Treatment in the Framework of Oxidative and Mitochondrial Dysfunction: Translational Highlights for the Clinics and Treatment. Antioxidants (Basel) 2023; 12:antiox12040975. [PMID: 37107350 PMCID: PMC10135787 DOI: 10.3390/antiox12040975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
Schizophrenia is a worldwide mental illness characterized by alterations at dopaminergic and glutamatergic synapses resulting in global dysconnectivity within and between brain networks. Impairments in inflammatory processes, mitochondrial functions, energy expenditure, and oxidative stress have been extensively associated with schizophrenia pathophysiology. Antipsychotics, the mainstay of schizophrenia pharmacological treatment and all sharing the common feature of dopamine D2 receptor occupancy, may affect antioxidant pathways as well as mitochondrial protein levels and gene expression. Here, we systematically reviewed the available evidence on antioxidants' mechanisms in antipsychotic action and the impact of first- and second-generation compounds on mitochondrial functions and oxidative stress. We further focused on clinical trials addressing the efficacy and tolerability of antioxidants as an augmentation strategy of antipsychotic treatment. EMBASE, Scopus, and Medline/PubMed databases were interrogated. The selection process was conducted in respect of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. Several mitochondrial proteins involved in cell viability, energy metabolism, and regulation of oxidative systems were reported to be significantly modified by antipsychotic treatment with differences between first- and second-generation drugs. Finally, antioxidants may affect cognitive and psychotic symptoms in patients with schizophrenia, and although the evidence is only preliminary, the results indicate that further studies are warranted.
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Affiliation(s)
- Giuseppe De Simone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Benedetta Mazza
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences, and Dentistry, University Medical School of Naples "Federico II", Via Pansini 5, 80131 Naples, Italy
- UNESCO Chair on Health Education and Sustainable Development, University of Naples "Federico II", 80131 Naples, Italy
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de Bartolomeis A, Ciccarelli M, De Simone G, Mazza B, Barone A, Vellucci L. Canonical and Non-Canonical Antipsychotics' Dopamine-Related Mechanisms of Present and Next Generation Molecules: A Systematic Review on Translational Highlights for Treatment Response and Treatment-Resistant Schizophrenia. Int J Mol Sci 2023; 24:ijms24065945. [PMID: 36983018 PMCID: PMC10051989 DOI: 10.3390/ijms24065945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
Schizophrenia is a severe psychiatric illness affecting almost 25 million people worldwide and is conceptualized as a disorder of synaptic plasticity and brain connectivity. Antipsychotics are the primary pharmacological treatment after more than sixty years after their introduction in therapy. Two findings hold true for all presently available antipsychotics. First, all antipsychotics occupy the dopamine D2 receptor (D2R) as an antagonist or partial agonist, even if with different affinity; second, D2R occupancy is the necessary and probably the sufficient mechanism for antipsychotic effect despite the complexity of antipsychotics' receptor profile. D2R occupancy is followed by coincident or divergent intracellular mechanisms, implying the contribution of cAMP regulation, β-arrestin recruitment, and phospholipase A activation, to quote some of the mechanisms considered canonical. However, in recent years, novel mechanisms related to dopamine function beyond or together with D2R occupancy have emerged. Among these potentially non-canonical mechanisms, the role of Na2+ channels at the dopamine at the presynaptic site, dopamine transporter (DAT) involvement as the main regulator of dopamine concentration at synaptic clefts, and the putative role of antipsychotics as chaperones for intracellular D2R sequestration, should be included. These mechanisms expand the fundamental role of dopamine in schizophrenia therapy and may have relevance to considering putatively new strategies for treatment-resistant schizophrenia (TRS), an extremely severe condition epidemiologically relevant and affecting almost 30% of schizophrenia patients. Here, we performed a critical evaluation of the role of antipsychotics in synaptic plasticity, focusing on their canonical and non-canonical mechanisms of action relevant to the treatment of schizophrenia and their subsequent implication for the pathophysiology and potential therapy of TRS.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
| | - Mariateresa Ciccarelli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
| | - Giuseppe De Simone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
| | - Benedetta Mazza
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Department of Neuroscience, Reproductive Sciences and Dentistry, University Medical School of Naples "Federico II", 80131 Naples, Italy
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Barone A, De Simone G, Ciccarelli M, Buonaguro EF, Tomasetti C, Eramo A, Vellucci L, de Bartolomeis A. A Postsynaptic Density Immediate Early Gene-Based Connectome Analysis of Acute NMDAR Blockade and Reversal Effect of Antipsychotic Administration. Int J Mol Sci 2023; 24:ijms24054372. [PMID: 36901803 PMCID: PMC10002165 DOI: 10.3390/ijms24054372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/20/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
Although antipsychotics' mechanisms of action have been thoroughly investigated, they have not been fully elucidated at the network level. We tested the hypothesis that acute pre-treatment with ketamine (KET) and administration of asenapine (ASE) would modulate the functional connectivity of brain areas relevant to the pathophysiology of schizophrenia, based on transcript levels of Homer1a, an immediate early gene encoding a key molecule of the dendritic spine. Sprague-Dawley rats (n = 20) were assigned to KET (30 mg/kg) or vehicle (VEH). Each pre-treatment group (n = 10) was randomly split into two arms, receiving ASE (0.3 mg/kg), or VEH. Homer1a mRNA levels were evaluated by in situ hybridization in 33 regions of interest (ROIs). We computed all possible pairwise Pearson correlations and generated a network for each treatment group. Acute KET challenge was associated with negative correlations between the medial portion of cingulate cortex/indusium griseum and other ROIs, not detectable in other treatment groups. KET/ASE group showed significantly higher inter-correlations between medial cingulate cortex/indusium griseum and lateral putamen, the upper lip of the primary somatosensory cortex, septal area nuclei, and claustrum, in comparison to the KET/VEH network. ASE exposure was associated with changes in subcortical-cortical connectivity and an increase in centrality measures of the cingulate cortex and lateral septal nuclei. In conclusion, ASE was found to finely regulate brain connectivity by modelling the synaptic architecture and restoring a functional pattern of interregional co-activation.
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Affiliation(s)
- Annarita Barone
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | - Giuseppe De Simone
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | - Mariateresa Ciccarelli
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | - Carmine Tomasetti
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | | | - Licia Vellucci
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
| | - Andrea de Bartolomeis
- Laboratory of Translational and Molecular Psychiatry, Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Odontostomatology, University Medical School of Naples “Federico II”, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-7463673; Fax: +39-081-7462644
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Barone A, Billeci M, D'Amore S, De Prisco M, De Simone G, Ermini E, Freda V, Iannotta F, Luciani A, Pistone L, Rifici LM, Saia VM, Spennato G, Subosco F, Vellucci L, D'Urso G, Galletta D, Fornaro M, Iasevoli F, de Bartolomeis A. The effects of sustained COVID-19 emergency and restrictions on the mental health of subjects with serious mental illness: A prospective study. J Community Psychol 2023; 51:154-167. [PMID: 35615854 PMCID: PMC9347680 DOI: 10.1002/jcop.22886] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 05/16/2023]
Abstract
Few longitudinal studies have so far investigated the impact of sustained COVID-19 among people with pre-existing psychiatric disorders. We conducted a prospective study involving people with serious mental illness (n = 114) and healthy controls (n = 41) to assess changes in the Perceived Stress Scale, Generalized Anxiety Disorder Scale, Patient Health Questionnaire, and Specific Psychotic Experiences Questionnaire scores 18 months after the COVID-19 pandemic outset. Subjects underwent interviews with a mental health professional in April 2020 and at the end of the local third wave (October 2021). A significant increase in perceived stress was found in healthy controls, especially females. Psychiatric patients showed a significant worsening of anxiety symptoms compared to baseline records (t = -2.3, p = 0.036). Patients who rejected vaccination had significantly higher paranoia scores compared to those willing to get vaccinated (U = 649.5, z = -2.02, p = 0.04). These findings indicate that COVID-19's sustained emergency may cause enduring consequences on mental health, soliciting further investigations.
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Affiliation(s)
- Annarita Barone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Martina Billeci
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Sofia D'Amore
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Michele De Prisco
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giuseppe De Simone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Eleonora Ermini
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Vittorio Freda
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Federica Iannotta
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Adalgisa Luciani
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Luca Pistone
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Lorenza M. Rifici
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Viviana M. Saia
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giancarlo Spennato
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Francesco Subosco
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Licia Vellucci
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Giordano D'Urso
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Diana Galletta
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Michele Fornaro
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, School of MedicineUniversity of Naples “Federico II”NaplesItaly
- UNESCO Chair on Health Education & Sustainable Development at University of Naples “Federico II”School of MedicineNaplesItaly
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de Bartolomeis A, De Simone G, Ciccarelli M, Castiello A, Mazza B, Vellucci L, Barone A. Antipsychotics-Induced Changes in Synaptic Architecture and Functional Connectivity: Translational Implications for Treatment Response and Resistance. Biomedicines 2022; 10:biomedicines10123183. [PMID: 36551939 PMCID: PMC9776416 DOI: 10.3390/biomedicines10123183] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/14/2022] Open
Abstract
Schizophrenia is a severe mental illness characterized by alterations in processes that regulate both synaptic plasticity and functional connectivity between brain regions. Antipsychotics are the cornerstone of schizophrenia pharmacological treatment and, beyond occupying dopamine D2 receptors, can affect multiple molecular targets, pre- and postsynaptic sites, as well as intracellular effectors. Multiple lines of evidence point to the involvement of antipsychotics in sculpting synaptic architecture and remodeling the neuronal functional unit. Furthermore, there is an increasing awareness that antipsychotics with different receptor profiles could yield different interregional patterns of co-activation. In the present systematic review, we explored the fundamental changes that occur under antipsychotics' administration, the molecular underpinning, and the consequences in both acute and chronic paradigms. In addition, we investigated the relationship between synaptic plasticity and functional connectivity and systematized evidence on different topographical patterns of activation induced by typical and atypical antipsychotics.
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de Bartolomeis A, Ciccarelli M, Vellucci L, Fornaro M, Iasevoli F, Barone A. Update on novel antipsychotics and pharmacological strategies for treatment resistant schizophrenia. Expert Opin Pharmacother 2022; 23:2035-2052. [DOI: 10.1080/14656566.2022.2145884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Mariateresa Ciccarelli
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Licia Vellucci
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Michele Fornaro
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
| | - Annarita Barone
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Dentistry, University of Naples “Federico II”, Naples, Italy
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de Bartolomeis A, Barone A, Vellucci L, Mazza B, Austin MC, Iasevoli F, Ciccarelli M. Linking Inflammation, Aberrant Glutamate-Dopamine Interaction, and Post-synaptic Changes: Translational Relevance for Schizophrenia and Antipsychotic Treatment: a Systematic Review. Mol Neurobiol 2022; 59:6460-6501. [PMID: 35963926 PMCID: PMC9463235 DOI: 10.1007/s12035-022-02976-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022]
Abstract
Evidence from clinical, preclinical, and post-mortem studies supports the inflammatory/immune hypothesis of schizophrenia pathogenesis. Less evident is the link between the inflammatory background and two well-recognized functional and structural findings of schizophrenia pathophysiology: the dopamine-glutamate aberrant interaction and the alteration of dendritic spines architecture, both believed to be the “quantal” elements of cortical-subcortical dysfunctional network. In this systematic review, we tried to capture the major findings linking inflammation, aberrant glutamate-dopamine interaction, and post-synaptic changes under a direct and inverse translational perspective, a paramount picture that at present is lacking. The inflammatory effects on dopaminergic function appear to be bidirectional: the inflammation influences dopamine release, and dopamine acts as a regulator of discrete inflammatory processes involved in schizophrenia such as dysregulated interleukin and kynurenine pathways. Furthermore, the link between inflammation and glutamate is strongly supported by clinical studies aimed at exploring overactive microglia in schizophrenia patients and maternal immune activation models, indicating impaired glutamate regulation and reduced N-methyl-D-aspartate receptor (NMDAR) function. In addition, an inflammatory/immune-induced alteration of post-synaptic density scaffold proteins, crucial for downstream NMDAR signaling and synaptic efficacy, has been demonstrated. According to these findings, a significant increase in plasma inflammatory markers has been found in schizophrenia patients compared to healthy controls, associated with reduced cortical integrity and functional connectivity, relevant to the cognitive deficit of schizophrenia. Finally, the link between altered inflammatory/immune responses raises relevant questions regarding potential new therapeutic strategies specifically for those forms of schizophrenia that are resistant to canonical antipsychotics or unresponsive to clozapine.
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Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy. .,Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy.
| | - Annarita Barone
- Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy.,Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy
| | - Licia Vellucci
- Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy.,Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy
| | - Benedetta Mazza
- Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy
| | - Mark C Austin
- Clinical Psychopharmacology Program, College of Pharmacy, Idaho State University (ISU), Pocatello, ID, USA
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy.,Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy
| | - Mariateresa Ciccarelli
- Laboratory of Molecular and Translational Psychiatry, University School of Medicine of Naples Federico II, Naples, Italy.,Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Naples Federico II, Naples, Italy
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de Bartolomeis A, Vellucci L, Barone A, Manchia M, De Luca V, Iasevoli F, Correll CU. Clozapine's multiple cellular mechanisms: What do we know after more than fifty years? A systematic review and critical assessment of translational mechanisms relevant for innovative strategies in treatment-resistant schizophrenia. Pharmacol Ther 2022; 236:108236. [PMID: 35764175 DOI: 10.1016/j.pharmthera.2022.108236] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 12/21/2022]
Abstract
Almost fifty years after its first introduction into clinical care, clozapine remains the only evidence-based pharmacological option for treatment-resistant schizophrenia (TRS), which affects approximately 30% of patients with schizophrenia. Despite the long-time experience with clozapine, the specific mechanism of action (MOA) responsible for its superior efficacy among antipsychotics is still elusive, both at the receptor and intracellular signaling level. This systematic review is aimed at critically assessing the role and specific relevance of clozapine's multimodal actions, dissecting those mechanisms that under a translational perspective could shed light on molecular targets worth to be considered for further innovative antipsychotic development. In vivo and in vitro preclinical findings, supported by innovative techniques and methods, together with pharmacogenomic and in vivo functional studies, point to multiple and possibly overlapping MOAs. To better explore this crucial issue, the specific affinity for 5-HT2R, D1R, α2c, and muscarinic receptors, the relatively low occupancy at dopamine D2R, the interaction with receptor dimers, as well as the potential confounder effects resulting in biased ligand action, and lastly, the role of the moiety responsible for lipophilic and alkaline features of clozapine are highlighted. Finally, the role of transcription and protein changes at the synaptic level, and the possibility that clozapine can directly impact synaptic architecture are addressed. Although clozapine's exact MOAs that contribute to its unique efficacy and some of its severe adverse effects have not been fully understood, relevant information can be gleaned from recent mechanistic understandings that may help design much needed additional therapeutic strategies for TRS.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy.
| | - Licia Vellucci
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy; Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Felice Iasevoli
- Section of Psychiatry, Laboratory of Translational and Molecular Psychiatry and Unit of Treatment Resistant Psychosis, Department of Neuroscience, Reproductive Science and Dentistry, University Medical School of Naples "Federico II", Naples, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY, USA; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, NY, USA; Charité Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Berlin, Germany
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de Bartolomeis A, Vellucci L, Austin MC, De Simone G, Barone A. Rational and Translational Implications of D-Amino Acids for Treatment-Resistant Schizophrenia: From Neurobiology to the Clinics. Biomolecules 2022; 12:biom12070909. [PMID: 35883465 PMCID: PMC9312470 DOI: 10.3390/biom12070909] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/25/2022] [Accepted: 06/26/2022] [Indexed: 12/13/2022] Open
Abstract
Schizophrenia has been conceptualized as a neurodevelopmental disorder with synaptic alterations and aberrant cortical–subcortical connections. Antipsychotics are the mainstay of schizophrenia treatment and nearly all share the common feature of dopamine D2 receptor occupancy, whereas glutamatergic abnormalities are not targeted by the presently available therapies. D-amino acids, acting as N-methyl-D-aspartate receptor (NMDAR) modulators, have emerged in the last few years as a potential augmentation strategy in those cases of schizophrenia that do not respond well to antipsychotics, a condition defined as treatment-resistant schizophrenia (TRS), affecting almost 30–40% of patients, and characterized by serious cognitive deficits and functional impairment. In the present systematic review, we address with a direct and reverse translational perspective the efficacy of D-amino acids, including D-serine, D-aspartate, and D-alanine, in poor responders. The impact of these molecules on the synaptic architecture is also considered in the light of dendritic spine changes reported in schizophrenia and antipsychotics’ effect on postsynaptic density proteins. Moreover, we describe compounds targeting D-amino acid oxidase and D-aspartate oxidase enzymes. Finally, other drugs acting at NMDAR and proxy of D-amino acids function, such as D-cycloserine, sarcosine, and glycine, are considered in the light of the clinical burden of TRS, together with other emerging molecules.
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Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (L.V.); (G.D.S.); (A.B.)
- Correspondence: ; Tel.: +39-081-7463673 or +39-081-7463884 or +39-3662745592; Fax: +39-081-7462644
| | - Licia Vellucci
- Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (L.V.); (G.D.S.); (A.B.)
| | - Mark C. Austin
- Clinical Psychopharmacology Program, College of Pharmacy, Idaho State University, Pocatello, ID 83209, USA;
| | - Giuseppe De Simone
- Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (L.V.); (G.D.S.); (A.B.)
| | - Annarita Barone
- Laboratory of Translational and Molecular Psychiatry and Unit of Treatment-Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, 80131 Naples, Italy; (L.V.); (G.D.S.); (A.B.)
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11
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de Bartolomeis A, Barone A, Buonaguro EF, Tomasetti C, Vellucci L, Iasevoli F. The Homer1 family of proteins at the crossroad of dopamine-glutamate signaling: An emerging molecular "Lego" in the pathophysiology of psychiatric disorders. A systematic review and translational insight. Neurosci Biobehav Rev 2022; 136:104596. [PMID: 35248676 DOI: 10.1016/j.neubiorev.2022.104596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/24/2022] [Accepted: 02/27/2022] [Indexed: 12/17/2022]
Abstract
Once considered only scaffolding proteins at glutamatergic postsynaptic density (PSD), Homer1 proteins are increasingly emerging as multimodal adaptors that integrate different signal transduction pathways within PSD, involved in motor and cognitive functions, with putative implications in psychiatric disorders. Regulation of type I metabotropic glutamate receptor trafficking, modulation of calcium signaling, tuning of long-term potentiation, organization of dendritic spines' growth, as well as meta- and homeostatic plasticity control are only a few of the multiple endocellular and synaptic functions that have been linked to Homer1. Findings from preclinical studies, as well as genetic studies conducted in humans, suggest that both constitutive (Homer1b/c) and inducible (Homer1a) isoforms of Homer1 play a role in the neurobiology of several psychiatric disorders, including psychosis, mood disorders, neurodevelopmental disorders, and addiction. On this background, Homer1 has been proposed as a putative novel target in psychopharmacological treatments. The aim of this review is to summarize and systematize the growing body of evidence on Homer proteins, highlighting the role of Homer1 in the pathophysiology and therapy of mental diseases.
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Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy.
| | - Annarita Barone
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | - Carmine Tomasetti
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | - Licia Vellucci
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
| | - Felice Iasevoli
- Laboratory of Translational and Molecular Psychiatry and Section of Psychiatry, Department of Neuroscience, University School of Medicine "Federico II", Naples, Italy
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12
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Barone A, Signoriello S, Latte G, Vellucci L, Giordano G, Avagliano C, Buonaguro EF, Marmo F, Tomasetti C, Iasevoli F, de Bartolomeis A. Modulation of glutamatergic functional connectivity by a prototypical antipsychotic: Translational inference from a postsynaptic density immediate-early gene-based network analysis. Behav Brain Res 2021; 404:113160. [PMID: 33577880 DOI: 10.1016/j.bbr.2021.113160] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although extensively studied, the effect of antipsychotics is not completely understood at a network level. We tested the hypothesis that acute administration of haloperidol would modulate functional connectivity of brain regions relevant to schizophrenia pathophysiology. To assess putative changes in brain network properties and regional interactivity, we studied the expression of Homer1a, an Immediate Early Gene (IEG) demonstrated to be induced by antipsychotic administration and coding for a protein involved in glutamatergic synapses remodeling. METHODS Sprague-Dawley rats (n = 26) assigned to vehicle (VEH; NaCl 0.9%) or haloperidol (HAL; 0.8 mg/kg) were included in the network analysis. Homer1a mRNA induction was evaluated by in situ hybridization. Signal intensity analysis was performed in 33 Regions of Interest (ROIs) in the cortex, the caudate putamen, and the nucleus accumbens. A signal correlation analysis was performed, computing all possible pairwise Pearson correlations among ROIs in the two groups. Two networks were generated for HAL and VEH groups, and their properties and topography were explored. RESULTS VEH and HAL networks showed qualitative differences in global efficiency and clustering coefficient. The HAL network showed enhanced interactivity between cortical and striatal regions, and within caudate putamen subdivisions. On the other hand, it exhibited reduced inter-correlations between cingulate cortex and anterior insula and caudate putamen and nucleus accumbens. Moreover, haloperidol was able to modulate centrality of crucial functional hubs. These preclinical results corroborate and expand the clinical evidence that antipsychotics may modulate specific brain network properties and disease-related circuits' interactivity.
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Affiliation(s)
- Annarita Barone
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Simona Signoriello
- Medical Statistics Unit, University of Campania "Luigi Vanvitelli", 80138, Naples, Italy
| | - Gianmarco Latte
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Licia Vellucci
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Giuseppe Giordano
- Department of Social and Political Studies, University of Salerno, 84084, Fisciano, SA, Italy
| | - Camilla Avagliano
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Elisabetta F Buonaguro
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Federica Marmo
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Carmine Tomasetti
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Felice Iasevoli
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy
| | - Andrea de Bartolomeis
- Laboratory of Molecular and Translational Psychiatry and Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science, and Odontostomatology, University of Naples Federico II, 80131, Napoli, Italy.
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13
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Iasevoli F, Barone A, Buonaguro EF, Vellucci L, de Bartolomeis A. Safety and tolerability of antipsychotic agents in neurodevelopmental disorders: a systematic review. Expert Opin Drug Saf 2020; 19:1419-1444. [DOI: 10.1080/14740338.2020.1820985] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Felice Iasevoli
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Annarita Barone
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Elisabetta Filomena Buonaguro
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Licia Vellucci
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Andrea de Bartolomeis
- Section of Psychiatry, Department of Neuroscience, School of Medicine, University of Naples Federico II, Naples, Italy
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14
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de Bartolomeis A, Manchia M, Marmo F, Vellucci L, Iasevoli F, Barone A. Glycine Signaling in the Framework of Dopamine-Glutamate Interaction and Postsynaptic Density. Implications for Treatment-Resistant Schizophrenia. Front Psychiatry 2020; 11:369. [PMID: 32477178 PMCID: PMC7240307 DOI: 10.3389/fpsyt.2020.00369] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 04/14/2020] [Indexed: 12/14/2022] Open
Abstract
Treatment-resistant schizophrenia (TRS) or suboptimal response to antipsychotics affects almost 30% of schizophrenia (SCZ) patients, and it is a relevant clinical issue with significant impact on the functional outcome and on the global burden of disease. Among putative novel treatments, glycine-centered therapeutics (i.e. sarcosine, glycine itself, D-Serine, and bitopertin) have been proposed, based on a strong preclinical rationale with, however, mixed clinical results. Therefore, a better appraisal of glycine interaction with the other major players of SCZ pathophysiology and specifically in the framework of dopamine - glutamate interactions is warranted. New methodological approaches at cutting edge of technology and drug discovery have been applied to study the role of glycine in glutamate signaling, both at presynaptic and post-synaptic level and have been instrumental for unveiling the role of glycine in dopamine-glutamate interaction. Glycine is a non-essential amino acid that plays a critical role in both inhibitory and excitatory neurotransmission. In caudal areas of central nervous system (CNS), such as spinal cord and brainstem, glycine acts as a powerful inhibitory neurotransmitter through binding to its receptor, i.e. the Glycine Receptor (GlyR). However, glycine also works as a co-agonist of the N-Methyl-D-Aspartate receptor (NMDAR) in excitatory glutamatergic neurotransmission. Glycine concentration in the synaptic cleft is finely tuned by glycine transporters, i.e. GlyT1 and GlyT2, that regulate the neurotransmitter's reuptake, with the first considered a highly potential target for psychosis therapy. Reciprocal regulation of dopamine and glycine in forebrain, glycine modulation of glutamate, glycine signaling interaction with postsynaptic density proteins at glutamatergic synapse, and human genetics of glycinergic pathways in SCZ are tackled in order to highlight the exploitation of this neurotransmitters and related molecules in SCZ and TRS.
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Affiliation(s)
- Andrea de Bartolomeis
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Mirko Manchia
- Section of Psychiatry, Department of Medical Science and Public Health, University of Cagliari, Cagliari, Italy.,Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Federica Marmo
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Licia Vellucci
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Felice Iasevoli
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
| | - Annarita Barone
- Laboratory of Molecular Psychiatry and Translational Psychiatry, Unit of Treatment Resistant Psychosis, Section of Psychiatry, Department of Neuroscience, Reproductive Science and Odontostomatology, University School of Medicine of Napoli Federico II, Naples, Italy
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15
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Cerasoli B, Canevelli M, Vellucci L, Rossi PD, Bruno G, Cesari M. Adopting a Diary to Support an Ecological Assessment of Neuropsychiatric Symptoms of Dementia. J Nutr Health Aging 2019; 23:614-616. [PMID: 31367724 DOI: 10.1007/s12603-019-1209-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Neuropsychiatric symptoms (NPS) are one of the most challenging issues in the management and care of people with dementia. Their accurate assessment is thus crucial for properly approaching subjects with cognitive disorders in the clinical setting. In parallel, the correct evaluation of NPS is also particularly relevant in the research field where they serve as critical indicators for measuring the efficacy of interventions against cognitive disorders. However, the study of NPS is extremely challenging given their extreme inter- and intra-individual variability. Moreover, the available assessment tools are often inadequate to fully capture their complexity and phenotypic expression. Based on these considerations, novel modalities for the assessment and measurement of NPS may be important to identify and develop. In this regard, a promising alternative (or, at least, a complementary aid) to traditional scales and questionnaires might be constituted by diaries. In the present article, we discuss the potential advantages and implications that may result from the adoption of this kind of instruments for the ecological assessment of NPS in subjects with dementia.
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Affiliation(s)
- B Cerasoli
- Marco Canevelli, Department of Human Neuroscience, "Sapienza" University of Rome, Viale dell'Università 30, 00185 Rome, Italy, Tel/fax +39 (0)6 49914604;
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Lanini S, Capobianchi MR, Pompa MG, Vellucci L. Authors’ reply: Measles on the cruise ship: links with virus spreading into an emergency department in Southern Italy. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.19.20803] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S Lanini
- National Institute for Infectious Diseases (INMI) ‘Lazzaro Spallanzani’ Rome, Italy
| | - M R Capobianchi
- Ministry of Health, Directorate General for Prevention, Rome, Italy
| | - M G Pompa
- Ministry of Health, Directorate General for Prevention, Rome, Italy
| | - L Vellucci
- Ministry of Health, Directorate General for Prevention, Rome, Italy
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17
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Lanini S, Capobianchi MR, Derrough T, Severi E, Vellucci L, Pompa MG. Author’s reply: Measles on a cruise ship - links with the outbreak in the Philippines. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.15.20773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- S Lanini
- National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani” Rome, Italy
| | - M R Capobianchi
- National Institute for Infectious Diseases (INMI) “Lazzaro Spallanzani” Rome, Italy
| | - T Derrough
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - E Severi
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - L Vellucci
- Ministry of Health, Directorate General for Prevention, Rome, Italy
| | - M G Pompa
- Ministry of Health, Directorate General for Prevention, Rome, Italy
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18
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Lanini S, Capobianchi MR, Puro V, Filia A, Del Manso M, Karki T, Nicoletti L, Magurano F, Derrough T, Severi E, Bonfigli S, Lauria F, Ippolito G, Vellucci L, Pompa MG. Measles outbreak on a cruise ship in the western Mediterranean, February 2014, preliminary report. ACTA ACUST UNITED AC 2014; 19. [PMID: 24650863 DOI: 10.2807/1560-7917.es2014.19.10.20735] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A measles outbreak occurred in February 2014 on a ship cruising the western Mediterranean Sea. Overall 27 cases were reported: 21 crew members, four passengers.For two cases the status crew or passenger was unknown. Genotype B3 was identified. Because of different nationalities of cases and persons on board,the event qualified as a cross-border health threat. The Italian Ministry of Health coordinated rapid response.Alerts were posted through the Early Warning and Response System.
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Affiliation(s)
- S Lanini
- National Institute for Infectious Diseases (INMI) Lazzaro Spallanzani Rome, Italy
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Rizzo C, Rota MC, Bella A, Giannitelli S, De Santis S, Nacca G, Pompa MG, Vellucci L, Salmaso S, Declich S. Response to the 2009 influenza A(H1N1) pandemic in Italy. Euro Surveill 2010; 15. [DOI: 10.2807/ese.15.49.19744-en] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- C Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - M C Rota
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - A Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - S Giannitelli
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - S De Santis
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - G Nacca
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - M G Pompa
- Department of Prevention and Communication, Ministry of Health, Rome, Italy
| | - L Vellucci
- Department of Prevention and Communication, Ministry of Health, Rome, Italy
| | - S Salmaso
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
| | - S Declich
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità (ISS, National Institute of Health), Rome, Italy
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Rizzo C, Declich S, Bella A, Caporali MG, Lana S, Pompa MG, Vellucci L, Salmaso S. Enhanced epidemiological surveillance of influenza A(H1N1)v in Italy. ACTA ACUST UNITED AC 2009; 14. [PMID: 19589331 DOI: 10.2807/ese.14.27.19266-en] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
As of 7 July 2009, a total of 158 laboratory-confirmed cases of influenza A(H1N1)v were reported in Italy, from half of the 21 Italian regions. To date all cases have had symptoms consistent with seasonal influenza and no severe or fatal cases have been reported. An active surveillance of cases has been set up in Italy in order to undertake appropriate measures to slow down the spread of the new virus. This report describes the routine and enhanced surveillance currently ongoing in Italy.
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Affiliation(s)
- C Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Instituto Superiore di Sanita (National Institute of Health), Rome, Italy.
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21
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Ciofi Degli Atti ML, Salmaso S, Vellucci L. New measles epidemic in southern Italy: 1217 cases reported to sentinel surveillance, January-May 2003. ACTA ACUST UNITED AC 2003. [DOI: 10.2807/esw.07.27.02253-en] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In January 2003, data from the Sorveglianza Pediatri
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Affiliation(s)
- M L Ciofi Degli Atti
- National Centre for Epidemiology Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - S Salmaso
- Istituto Superiore di Sanità, Rome, Italy
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22
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Patti AM, Santi AL, Fiore L, Vellucci L, De Stefano D, Bellelli E, Barbuti S, Fara GM. Environmental surveillance of poliovirus in Italy: pilot study. Ann Ig 2003; 15:97-105. [PMID: 12838824] [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: 03/03/2023]
Abstract
A pilot study on environmental surveillance of poliovirus included one hundred ninety-six samples (drinking water, surface water, seawater and sewage), collected between 1996 and 1998 in different regions of Italy. Samples were screened for the presence of poliovirus and other enteric viruses. Twelve polioviruses, 35 non polio enteroviruses (NPE) and 51 enteric non entero (NE) viruses were isolated. All poliovirus isolates, namely four type 1, four type 2 and four type 3, were characterised as Sabin-like strains. Thirty-one Coxsackie B and 4 Echo viruses were also detected. The presence of Sabin-like polioviruses in the environment is not unexpected since immunization with only oral poliovirus vaccine was performed in Italy until May 1999, when a sequential schedule consisting of two doses of inactivated polio vaccine (IPV) and two of oral polio vaccine (OPV) was adopted; in July 2002 a schedule consisting of four doses of IPV was adopted. Although this is only a pilot study and the number of samples analysed is limited, so far data from this study so far supports once again evidence of lack of circulating wild poliovirus and is in line with results from AFP surveillance in Italy and stool survey on healthy children.
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Affiliation(s)
- A M Patti
- Department of Public Health Sciences, University La Sapienza, Rome.
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Prato R, Labianca M, Calvario A, Bozzi A, Rizzo C, Fiore L, Vellucci L, Buttinelli G, Donati V, Lopalco PL, Germinario C. [Evaluation of the Surveillance System of Acute Flaccid Paralysis in Puglia: 5 years of work]. Ann Ig 2002; 14:487-94. [PMID: 12638352] [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: 03/01/2023]
Abstract
Surveillance of acute flaccid paralysis (AFP) is the milestone to monitor the progress toward poliomyelitis eradication aim, fixed by WHA in 1988. Active AFP surveillance started in Apulia in 1997; this work evaluates five-year period activities. In this period, the total number of cases notified was 48, 7 of which were resident out of Apulia. Twenty-five were males and 23 females; the age ranged between 1 month and 15 years. Any collected serum specimens showed protective antibody levels against polioviruses. Polioviruses type 1 and type 2 Sabin-like were isolated from stool samples collected from two AFP patients. AFP surveillance targets improved in the years, with only exception, in 2001, of second serum specimen collected within 14 days because of children were discharged earlier form the hospitals. Apulia experience demonstrates the achievement of good levels of AFP surveillance targets. System sensitivity has been optimal in 2001 with a number of notified cases threefold the expected value and adequate specimen sampling (80%). Additional involved hospitals and availability of increased and dedicated human resources contributed to this outcome. The effort to achieve WHO targets for AFP surveillance needs to be maintained in next years until global certification of eradication will be declared.
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Affiliation(s)
- R Prato
- Osservatorio Epidemiologico, Regione Puglia
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24
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Caraffa De Stefano D, Vellucci L. [Recent recommendations of the National Committee on Vaccines regarding polio immunization]. Ann Ig 2002; 14:81-4. [PMID: 12389296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- D Caraffa De Stefano
- Ministero della Salute, Direzione Generale della Prevenzione, Ufficio III Malattie Infettive e Profilassi Internazionale, Osservatorio Epidemiologico Nazionale, Roma
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25
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Patti AM, Santi AL, Vulcano A, Casagni L, Lamberti A, De Stefano Caraffa D, Vellucci L, Fiore L, Fara GM. Surveillance of poliomyelitis in Italy: immunity status of population against polio and environmental circulation of Poliovirus. General illustration of the results. Ann Ig 2002; 14:1-57. [PMID: 12389292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- A M Patti
- Department of Public Health Sciences, University La Sapienza of Rome
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26
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Caraffa De Stefano D, Vellucci L. [Proposal for the recommendation of the anti-varicella vaccination in Italy]. Ann Ig 2002; 14:67-8. [PMID: 12389308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- D Caraffa De Stefano
- Ministero della Salute, Direzione Generale della Prevenzione, Ufficio III Malattie Infettive e Profilassi Internazionale, Osservatorio Epidemiologico Nazionale, Roma
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27
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Vellucci L. [Surveillance of poliomyelitis in Italy within the WHO/Europe project of polio eradication]. Ann Ig 2002; 14:65-71. [PMID: 12389294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- L Vellucci
- Ministero della Salute, Direzione Generale della Prevenzione, Ufficio III Malattie Infettive e Profilassi Internazionale, Osservatorio Epidemiologico Nazionale, Roma
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28
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Vellucci L. [Immunization coverage for measles, mumps and rubella in Italy: many shadows, few lights]. Ann Ig 2002; 14:51-6. [PMID: 12389424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/26/2023]
Affiliation(s)
- L Vellucci
- Ministero della Salute, Direzione Generale della Prevenzione, Ufficio III Malattie Infettive e Profilassi Internazionale, Osservatorio Epidemiologico Nazionale, Roma.
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29
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Abstract
Surveillance of acute flaccid paralysis (AFP) is the golden strategy recommended by the WHO to verify the condition of polio eradication in a country. Because of the difficulty to detect all of the expected AFP cases and to reach the target incidence of 1/100,000 requested by WHO, the surveillance of enteroviruses in the population has been adopted by several countries as an important additional method to verify the absence of wild-poliovirus circulation. To complete the results of AFP surveillance set up in Italy in 1996, we have conducted a wild poliovirus surveillance by examining stool samples from 1551 healthy children aged less than 5 years, collected during the period January 1997 to January 1998. The children were from three cities (Parma, Rome and Bari) located in northern, central and southern Italy. Thirty-nine polioviruses, 72 non-polio enteroviruses and 50 enteric, nonentero (NE), viruses were isolated from stool specimens. Polioviruses identified were nine type 1, seven type 2 and twenty-three type 3. Characterization of isolates by both antigenic and molecular methods showed that all polioviruses were of vaccine origin. As expected, most polioviruses, especially types 2 and 3, presented retromutations known to be associated with loss of the Sabin attenuated phenotype. The results of this study support the data obtained from the active AFP surveillance conducted in Italy in the same period--on the absence of paralytic disease due to wild poliovirus--and altogether demonstrate the effectiveness of the vaccination program.
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Affiliation(s)
- A M Patti
- Institute of Hygiene, University La Sapienza, Rome, Italy
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30
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Patti AM, Santi AL, Ciapetti C, Fiore L, Novello F, Vellucci L, De Stefano F, Fara GM. [Flaccid paralysis surveillance in the Latium Region]. Ann Ig 2000; 12:333-8. [PMID: 11140100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The goal of World Health Organization is to reach the global eradication of poliomyelitis during the first decade of the third millennium. To achieve the certification of the eradication of the disease the main strategy is the Acute Flaccid Paralysis (AFP) surveillance. In Italy the active AFP surveillance was performed at national level since 1997. In the Latium region the active surveillance was performed since January 1997 by the laboratory of virology of Institute of Hygiene G Sanarelli which established a regional hospital network. During the years of survey 7 cases were found in 1997 (0.87/100,000), 4 in 1998 (0.5/100,000), 2 in 1999 (0.25/100,000) and 2 in 2000. No wild polioviruses were detected.
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31
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Fiore L, Novello F, Simeoni P, Amato C, Buttinelli G, Fiore S, Vellucci L, De Stefano D, Grandolfo ME, Luzzi I. [Epidemiology of acute flaccid paralysis in Italy: 1996-98. Group for the Study of AFP]. Ann Ig 2000; 12:99-110. [PMID: 10863785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- L Fiore
- Lab. di Virologia, ISS, Roma
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Abstract
Though a relatively rare disease, botulism can be a serious problem of public health, particularly when connected with the consumption of industrial canned food; moreover, in the last years the shortage of botulism antitoxin has caused some concern in the Public Health Authorities. This work presents the results of a five-year surveillance of botulism in Italy, with the distribution of the cases by Regions (first level administrative units which, in Italy, have administrative and legislative competencies in the sanitary field) and by vehicle of transmission. All the relevant and confirmed botulism outbreaks that occurred in the period under consideration are described.
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Affiliation(s)
- S Squarcione
- Azienda Sanitaria Locale Roma F, Civitavecchia, Italy
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33
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Patti AM, Santi AL, Bellucci C, Ciapetti C, Fara GM, Germinario C, Calvario A, Lopalco PL, Barbuti S, Tanzi ML, Affanni P, Nieddu A, Bellelli E, Vellucci L, Caraffa De Stefano D. Serological survey on immunity status against polioviruses in Italian young adults and in immigrants. Ann Ig 1999; 11:353-9. [PMID: 10596422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- A M Patti
- Inst. of Hygiene, La Sapienza University, Rome, Italy
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34
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Fiore L, Novello F, Simeoni P, Amato C, Vellucci L, De Stefano D, Grandolfo ME, Luzzi I. Surveillance of acute flaccid paralysis in Italy: 1996-1997. AFP Study Group. Acute flaccid paralysis. Eur J Epidemiol 1999; 15:757-63. [PMID: 10555620 DOI: 10.1023/a:1007697421114] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/12/2022]
Abstract
The last case of poliomyelitis due to transmission of indigenous wild poliovirus occurred in Italy in 1982. To achieve the certification of the eradication of poliomyelitis in Italy, an active surveillance of acute flaccid paralysis (AFP) in the population aged less than 15 years was set up following the World Health Organization (WHO) guidelines. The survey started in 1996 with a pilot study involving 4 out of 21 regions, and was gradually extended to a national level in 1997. The two-year survey identified five patients with diagnosis of vaccine associated paralytic poliomyelitis (VAPP). Polioviruses type 2 and 3 Sabin-like were isolated and characterized in three of them. In the remaining two cases, samples were collected late after the onset of symptoms, and poliovirus could not be isolated. No wild polioviruses were detected during the survey. The rate of non-polio AFP found in Italy in 1997 was 0.61 cases per 100,000, which is lower than the level of 1.0 case per 100,000 considered as acceptable by the WHO. This was mainly due to the delay in organizing the hospital network and starting the active search of AFP cases in the largest and most densely populated regions. Therefore, the overall rate of AFP found in Italy underestimates the global effectiveness of the program, which however will be better evaluated in the next few years. This study is the first systematic attempt to determine the rate of AFP in Italy.
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Affiliation(s)
- L Fiore
- Laboratory of Virology, Istituto Superiore di Sanità, Rome, Italy.
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35
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36
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Squarcione S, Carbini R, D'Amato S, Vellucci L. [The peripheral offices of naval and aviation health administration]. Ann Ig 1994; 6:453-61. [PMID: 8611216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- S Squarcione
- Servizi Igiene Pubblica, Ministero della Sanità, Roma
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37
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Squarcione S, Vellucci L, Virtuani L, D'Amato S. [An increase in tetanus in Italy in 1991-1993]. Ann Ig 1993; 5:415-20. [PMID: 7521180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S Squarcione
- Ministero della Sanità, Servizi di Igiene Pubblica, Roma
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38
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Gianfaldoni R, D'Amato S, Vellucci L, Virtuani L, Squarcione S. [Quality control in the input of data relative to the infective disease notification system]. Ann Ig 1993; 5:381-8. [PMID: 7521176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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39
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Squarcione S, Vellucci L, Parisi P, D'Amato S, Serio G. Adverse reactions to vaccine: Italian cases in the quinquennium 1986-1990. Ann Ig 1993; 5:81-90. [PMID: 7510978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- S Squarcione
- Chair of Medical Statistics, School of Medicine, University of Bari
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40
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Squarcione S, Vellucci L, Parisi P, D'Amato S, Virtuani L. [Legionellosis: some epidemiological and preventive aspects]. Ann Ig 1991; 3:315-23. [PMID: 1726302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- S Squarcione
- Divisione Profilassi Malattie Infettive, Quarantenarie e Parassitarie, Roma
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41
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Franco E, Patti AM, Zaratti L, Cauletti M, Vellucci L, Panà A. [Sero-epidemiologic study of hepatitis A virus infection in childhood]. Nuovi Ann Ig Microbiol 1988; 39:103-7. [PMID: 2854235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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