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Vietri L, Cameli P, Perruzza M, Cekorja B, Bergantini L, d'Alessandro M, Refini RM, Pieroni M, Fossi A, Bennett D, Spalletti M, Mazzei MA, Sestini P, Rottoli P, Bargagli E. Pirfenidone in idiopathic pulmonary fibrosis: real-life experience in the referral centre of Siena. Ther Adv Respir Dis 2021; 14:1753466620906326. [PMID: 32066332 PMCID: PMC7029533 DOI: 10.1177/1753466620906326] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia and has a median survival after diagnosis of 2–5 years. Pirfenidone is the first approved antifibrotic drug for the treatment of IPF. Here we report the functional progress, side effects and survival data of a population of patients with IPF, diagnosed at our centre and treated with pirfenidone. Methods: We enrolled 91 patients with IPF (71 males) treated with pirfenidone. Clinical, survival and functional details were collected retrospectively at start of therapy and after 12, 24, 36 and 48 months of treatment. Lung function tests at least 12 months before starting therapy were available for 40 patients and were entered in the database, as well as side effects. Results: During the observation period (922 ± 529 days), 27 patients died, 5 patients underwent lung transplant and 10 patients interrupted therapy due to adverse events or IPF progression. The median survival was 1606 days. There was a significant reduction in disease progression rate, as measured by trend of forced vital capacity, after 1 year of therapy with respect to before treatment (p = 0.0085). Forced vital capacity reduction rate was progressively higher in the subsequent years of treatment. Treatment-related side effects were reported in 25 patients and were predominantly mild. Overall, four patients discontinued therapy due to severe photosensitivity. Conclusions: Our findings confirm the efficacy of pirfenidone in reducing functional progression of IPF and its excellent safety profile in a real-life setting. This study, designed on a long-term follow up, contributes to the growing evidence on safety, tolerability and efficacy of pirfenidone in IPF. The reviews of this paper are available via the supplemental material section.
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Affiliation(s)
- Lucia Vietri
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Paolo Cameli
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, Viale Bracci, Siena, 53100, Italy
| | - Marco Perruzza
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Behar Cekorja
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Laura Bergantini
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Miriana d'Alessandro
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Rosa Metella Refini
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Maria Pieroni
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Antonella Fossi
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - David Bennett
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Marco Spalletti
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Medical and Surgical Sciences and Neurosciences, Diagnostic Imaging Unit, University of Siena, AOUS, Siena, Italy
| | - Piersante Sestini
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Paola Rottoli
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
| | - Elena Bargagli
- Department of Medical and Surgical Sciences and Neurosciences, Respiratory Disease and Lung Transplant Unit, University of Siena, AOUS, Siena, Italy
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Sposato B, Croci L, Di Tomassi M, Puttini C, Olivieri C, Alessandri M, Ronchi MC, Donati E, Garcea A, Brazzi A, Migliorini MG, Chigiotti S, Nikiforakis N, Carli T, Canneti E, Strambio F, Cellini C, Nardangeli C, Allegri MP, Bianchi F, Bettini C, Perruzza M, Lanzarone N, Valentini L, Orselli P, Solari M, Cardaci S, Nofri M, Angeli G, Mangani F, Aloia E, Lanari A, Corridi M, Spargi G, Perrella A, Nencioni C. Spontaneous abdominal bleeding associated with SARS-CoV-2 infection: causality or coincidence? Acta Biomed 2021; 92:e2021199. [PMID: 33988163 PMCID: PMC8182584 DOI: 10.23750/abm.v92i2.10142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Accepted: 03/29/2021] [Indexed: 01/27/2023]
Abstract
Authors present 6 cases of abdominal bleeding associated with COVID-19, representing 1.35% of all hospitalized COVID-19 patients and hypothesize that there could be, although not very frequently, a relationship between SARS-CoV2 and bleeding. They excluded a side effect of the low molecular weight heparin therapy that all patients underwent during the course of the disease or other possible causes. Alterations of the coagulation state or a weakness of the vascular wall due toa presumed endotheliitis SARS-CoV-2 infection induced, are hypothesized by the authors. Investigation and follow-up for possible hemorrhagic problems in patients with COVID-19 is recommended. In particular, clinicians should be vigilant about retroperitoneal hemorrhage in COVID-19 patients. In addition to the fact that these patients are being treated with anticoagulants, anemia and abdominal pain are the signs that should lead us to suspect this type of haemorrhage. More studies are needed to understand if COVID-19 can be directly associated with bleeding. (www.actabiomedica.it)
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Affiliation(s)
- Bruno Sposato
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Experimental Medicine and Systems, "PhD program" Department of Systems Medicine University of Rome "Tor Vergata".
| | - Leonardo Croci
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Elisa Donati
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | | | | | - Tiziana Carli
- UOC Malattie Infettive, Ospedale Misericordia di Grosseto.
| | | | | | | | - Claudia Nardangeli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | | | - Francesco Bianchi
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Claudio Bettini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy; Cardiothoracic and Vascular Department, University Hospital of Pisa, Pisa, Italy.
| | - Marco Perruzza
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Nicola Lanzarone
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Lucia Valentini
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Paolo Orselli
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Solari
- Cardiology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Salvatore Cardaci
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marco Nofri
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Giorgia Angeli
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Francesca Mangani
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Elio Aloia
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Alessandro Lanari
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Marta Corridi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Genni Spargi
- Intensive Care Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Antonio Perrella
- Pneumology Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
| | - Cesira Nencioni
- Infectious Disease Department, USL SUDEST, Toscana, Misericordia Hospital, Grosseto, Italy.
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Bergantini L, d'Alessandro M, Cameli P, Bono C, Perruzza M, Biagini M, Pini L, Bigliazzi C, Sestini P, Dotta F, Bargagli E. Regulatory T cell monitoring in severe eosinophilic asthma patients treated with mepolizumab. Scand J Immunol 2021; 94:e13031. [PMID: 33606277 DOI: 10.1111/sji.13031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 02/08/2021] [Accepted: 02/15/2021] [Indexed: 12/14/2022]
Abstract
Severe eosinophilic asthma (SEA) has been associated with T-helper type 2 (Th2) inflammatory response. A good understanding of T cell functions in asthma is important for therapy, especially in the choice of biological treatments for severe cases. Mepolizumab, an IL-5 antagonist, is indicated for the treatment of severe asthma. Regulatory T cells (Tregs) suppress inflammation by secreting cytokines that inhibit Th2 cell proliferation. We investigated peripheral Treg, CD4, CD8, CD19 and NK cell percentages and their relationship to clinical and functional parameters, including peripheral eosinophils, before and after anti-IL5 treatment. Subjects were 14 adult SEA patients (9 male, 54.1 ± 11.6 years), treated with mepolizumab, and 10 controls. T cells (CD4 and CD8), CD19, NK and Tregs were evaluated by flow cytometry. Comparison of lung function parameters before and after treatment with mepolizumab (T0 and T1) showed an increase in FEV1, FEV1/FVC ratio and a reduction in blood eosinophil percentages. CD8 and CD16/56+ CD3+ were significantly higher in SEA patients than controls (P = .04 and P = .03, respectively). A decrease in CD45+, CD8 + and CD16/56+ CD3+ cell percentages was observed between T0 and T1 (P = .02, P = .04, P = .03, respectively). A significant increase in Treg percentages (P = .0001) was recorded between T0 and T1. Mepolizumab therapy was found to modulate immune response, restoring immune balance in patients with SEA.
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Affiliation(s)
- Laura Bergantini
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Miriana d'Alessandro
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Paolo Cameli
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Clara Bono
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Marco Perruzza
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Marco Biagini
- U.O.S.D. Pneumologia Territoriale e rete respiratoria, USL Toscana Sud Est, Arezzo, Italy
| | - Laura Pini
- Respiratory Medicine Unit, Department of Experimental and Clinical Sciences, University of Brescia, Brescia, Italy
| | - Caterina Bigliazzi
- Respiratory Diseases Section, Azienda ospedaliero universitaria senese, Le Scotte Hospital, Brescia, 53100, Siena, Italy
| | - Piersante Sestini
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
| | - Francesco Dotta
- Diabetes Unit, Department of Medicine, Surgery and Neurosciences, University of Siena and Fondazione Umberto Di Mario ONLUS, Toscana Life Science Park, Siena, Italy
| | - Elena Bargagli
- Department of Medical Sciences, Surgery and Neuroscience, Respiratory Disease and Lung Transplant Unit, Siena University, Siena, Italy
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Bergantini L, Cameli P, d'Alessandro M, Vietri L, Perruzza M, Pieroni M, Lanzarone N, Refini RM, Fossi A, Bargagli E. Regulatory T Cells in Severe Persistent Asthma in the Era of Monoclonal Antibodies Target Therapies. Inflammation 2021; 43:393-400. [PMID: 31853715 DOI: 10.1007/s10753-019-01157-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Asthma is an immunoinflammatory disease characterized by bronchial hyper-reactivity to different external stimuli. New monoclonal target treatments have been developed, but few studies have investigated the role of regulatory T cells in severe asthma and the modulatory effect of biological therapy on regulatory T cell functions. Their dysfunction may contribute to the development and exacerbation of asthma. Here we review the recent literature on the potential immunological role of regulatory T cells in the pathogenesis of severe asthma. The analysis of the role of regulatory T cells was performed in terms of functions and their possible interactions with mechanisms of action of the novel treatment for severe asthma. In an era of biological therapies for severe asthma, little data is available on the potential effects of what could be a new therapy: monoclonal antibody targeting of regulatory T cell numbers and functions.
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Affiliation(s)
- L Bergantini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy.
| | - P Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - M d'Alessandro
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - L Vietri
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - M Perruzza
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - M Pieroni
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - N Lanzarone
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - R M Refini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - A Fossi
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
| | - E Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases and Lung Transplantation Section, University of Siena, Viale Bracci, 1, 53100, Siena, Italy
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Landi C, Cameli P, Vantaggiato L, Bergantini L, d'Alessandro M, Perruzza M, Carleo A, Shaba E, Di Giuseppe F, Angelucci S, Bargagli E, Bini L. Ceruloplasmin and oxidative stress in severe eosinophilic asthma patients treated with Mepolizumab and Benralizumab. Biochim Biophys Acta Proteins Proteom 2020; 1869:140563. [PMID: 33176218 DOI: 10.1016/j.bbapap.2020.140563] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/16/2020] [Accepted: 11/05/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Severe eosinophilic asthma has been associated with Th2 airway inflammation and elevated proinflammatory cytokines and chemokines, such as IL-5. Precision therapies have recently been shown to improve asthma symptoms with a steroid-sparing effect. Two such therapies, Benralizumab and Mepolizumab, humanized IgG antibodies directed against the IL-5 receptor and IL-5, have been approved for severe eosinophilic asthma. METHODS Here we used a differential proteomic approach to analyse serum from patients with severe eosinophilic asthma treated with Benralizumab and Mepolizumab in a search for differential molecular modifications responsible of their effects. Enrichment analysis of differential proteins was performed for the two treatments. RESULTS AND DISCUSSION After one month of Benralizumab treatment we detected up-regulation of certain protein species of the antioxidant ceruloplasmin. To investigate oxidative stress, we performed redox proteomics which detected lower oxidative burst after one month of Benralizumab treatment than in the pre-treatment phase or after one month of Mepolizumab therapy.
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Affiliation(s)
- Claudia Landi
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Siena, Italy; UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Paolo Cameli
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Lorenza Vantaggiato
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Siena, Italy
| | - Laura Bergantini
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Marco Perruzza
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Alfonso Carleo
- Department of Pulmonology, Hannover Medical School, Hannover, Germany
| | - Enxhi Shaba
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Siena, Italy
| | - Fabrizio Di Giuseppe
- Dept. Medical, Oral & Biotechnological Sciences, Dentistry and Biotechnology, and Proteomics Unit, Centre of Advanced Studies and Technoloy, "G. d'Annunzio", University of Chieti-Pescara, Italy
| | - Stefania Angelucci
- Dept. Medical, Oral & Biotechnological Sciences, Dentistry and Biotechnology, and Proteomics Unit, Centre of Advanced Studies and Technoloy, "G. d'Annunzio", University of Chieti-Pescara, Italy
| | - Elena Bargagli
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy.
| | - Luca Bini
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Siena, Italy
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Cameli P, Perruzza M, Salvini M, Fui A, Cekorja B, Refini RM, Sestini P, Bargagli E. Omalizumab treatment in Samter's triad: case series and review of the literature. Eur Rev Med Pharmacol Sci 2020; 23:8124-8129. [PMID: 31599440 DOI: 10.26355/eurrev_201909_19031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Samter's triad is the combination of asthma, aspirin sensitization, and nasal polyposis. Few data are available on the use of omalizumab in this disease. The study aimed to describe the impact of omalizumab on clinical and functional parameters and the quality of life of a series of patients with Samter's triad. Moreover, we aimed to provide a review of the literature on this topic. PATIENTS AND METHODS We retrospectively described four patients with Samter's triad undergoing omalizumab therapy. Clinical, functional, and immunological data of these patients were collected at baseline and follow-up. RESULTS Reduction of asthma exacerbations and salbutamol rescue therapy were observed in all patients after anti-IgE treatment together with an improvement in the quality of life. A significant improvement in FEV1, FVC, and FEF25-75 was observed. No major side-effects were observed. A total of 14 studies regarding omalizumab in aspirin-exacerbated respiratory diseases were included in the review, comprising 78 patients. All studies reported a good efficacy in improving asthma control; restoration of aspirin tolerance was repeatedly reported. CONCLUSIONS The results of our case series and review of the literature suggest that omalizumab effectively improves asthma control, lung function tests, and quality of life in patients with Samter's triad.
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Affiliation(s)
- P Cameli
- Respiratory Diseases and Lung Transplantation Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy.
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Vantaggiato L, Perruzza M, Refini RM, Bergantini L, d'Alessandro M, Cameli P, Perruzza D, Bini L, Bargagli E, Landi C. Mepolizumab and Benralizumab in Severe Eosinophilic Asthma: Preliminary Results of a Proteomic Study. Lung 2020; 198:761-765. [PMID: 32691140 DOI: 10.1007/s00408-020-00379-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/07/2020] [Indexed: 01/01/2023]
Abstract
Benralizumab and mepolizumab are new therapies for severe eosinophilic asthma. They are both humanized IgG antibodies, targeting the IL-5 receptor and IL-5, respectively, suppressing the corresponding pathways. No specific biomarkers have been proposed to evaluate treatment response to benralizumab or mepolizumab. The aim of this proteomic study was to compare serum protein profiles of patients with severe eosinophilic asthma before and after anti-IL5 or anti-IL5R therapies. Proteomic analysis highlighted 22 differently abundant spots. Among the proteins identified, CAYP1, A1AT and A2M expression was significantly modified in both groups of patients after therapies while ceruloplasmin showed a significant modification in the group of benralizumab treatment. These differentially expressed proteins could be potential biomarkers of response to mepolizumab and benralizumab treatments and need further evaluation.
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Affiliation(s)
- Lorenza Vantaggiato
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy
| | - Marco Perruzza
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Rosa Metella Refini
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Laura Bergantini
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Paolo Cameli
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Davide Perruzza
- Unit of Basic and Applied Biosciences, University of Teramo, Via Balzarini 1, 64100, Teramo, Italy
| | - Luca Bini
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy
| | - Elena Bargagli
- UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy
| | - Claudia Landi
- Functional Proteomics Lab, Department of Life Sciences, University of Siena, Via Aldo Moro 2, 53100, Siena, Italy. .,UOC Respiratory Diseases and Lung Transplantation, Department Internal and Specialist Medicine, University of Siena, Siena, Italy.
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Cameli P, Bergantini L, d'Alessandro M, Perruzza M, Cekorja B, Perillo F, Massa E, Ruzza A, Fossi A, Beltrami V, Sestini P, Bargagli E. A Comprehensive Evaluation of Mepolizumab Effectiveness in a Real-Life Setting. Int Arch Allergy Immunol 2020; 181:606-612. [PMID: 32516771 DOI: 10.1159/000507996] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Interleukin-5 (IL-5) is the principal cytokine regulating eosinophil growth, differentiation, activation, and expression. It is a specific target of mepolizumab, an anti-IL-5 monoclonal antibody used in the treatment of severe eosinophilic asthma. This new drug can improve symptoms, reduce asthma exacerbations and steroid use. Few data are available on its efficacy for nasal symptoms. OBJECTIVE To describe the all-round clinical impact of mepolizumab in a real-life setting, evaluating the efficacy and safety of the drug in severe eosinophilic asthma patients. POPULATION AND METHODS We retrospectively collected the clinical and functional data on 27 patients (16 males) affected with severe eosinophilic asthma, diagnosed at the Siena Regional Referral Centre and monitored for 6 months. Clinical, immunological, and functional data at baseline and follow-up were entered in a database together with comorbidities, number of exacerbations, steroid treatment, multiple-flow exhaled nitric oxide, and validated questionnaires. RESULTS A significant reduction in asthma exacerbations was observed in all patients after 6 months of the biological therapy (p = 0.0009), and 4/6 patients discontinued chronic oral steroids. A significant improvement in ACT, FEV1, SNOT22, and alveolar nitric oxide was observed after 1 month of mepolizumab (p = 0.003, p = 0.007, p = 0.047, and p = 0.019, respectively) and maintained after 6 months of treatment. After 6 months, FeNO 50 was reduced as well (p = 0.030). Mepolizumab was very well tolerated, and no major side effects were observed. CONCLUSIONS Our study suggests that mepolizumab is effective in improving control of asthma, lung function parameters, exhaled biomarkers, and nasal symptoms in patients with severe eosinophilic asthma.
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Affiliation(s)
- Paolo Cameli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy,
| | - Laura Bergantini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Miriana d'Alessandro
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Marco Perruzza
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Behar Cekorja
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Felice Perillo
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Evaluna Massa
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Annamaria Ruzza
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Antonella Fossi
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Valerio Beltrami
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Piersante Sestini
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
| | - Elena Bargagli
- Department of Medicine, Surgery and Neurosciences, Respiratory Diseases Unit, University of Siena, Siena, Italy
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9
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Perruzza M, Fusha E, Cameli P, Capecchi PL, Selvi E, Gentili F, Mazzei MA, Aversa S, Spina D, Di Lucia D, Sestini P, Luzzi L, Bargagli E. Pleuroparenchymal fibroelastosis (PPFE) associated with giant cell arteritis: A coincidence or a novel phenotype? Respir Med Case Rep 2019; 27:100843. [PMID: 31024793 PMCID: PMC6476809 DOI: 10.1016/j.rmcr.2019.100843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/12/2019] [Accepted: 04/12/2019] [Indexed: 11/16/2022] Open
Abstract
Pleuroparenchymal fibroelastosis (PPFE) is a rare interstitial lung disease characterized by the fibrotic thickening of subpleural and parenchymal areas of the upper lobes. It may be both idiopathic or secondary to infections, interstitial lung diseases and/or drug exposure. Often PPFE patients report recurrent lower respiratory tract infections, suggesting that repeated inflammatory alterations induced by pulmonary infections may contribute to the development/progression of PPFE. Here, we report for the first time the case of a patient affected by Giant cell Arteritis with histologically proven PPFE. The lung involvement in GCA is rare and interstitial lung diseases are usually reported as an uncommon clinical manifestation of GCA. Our patient is probably the first case presenting PPFE associated with GCA and we wonder if this is a real associative disease or a coincidence perhaps, secondary to drug effects.
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Affiliation(s)
- M Perruzza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Fusha
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Cameli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P L Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - E Selvi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - F Gentili
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - M A Mazzei
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - S Aversa
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Spina
- Pathology Section, Department of Human Pathology and Oncology, Siena University Hospital, Siena, Italy
| | - D Di Lucia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - P Sestini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
| | - L Luzzi
- Thoracic Surgery Unit, Department of Cardiothoracic and Vascular Surgery, Siena University Hospital, Italy
| | - E Bargagli
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Viale M. Bracci 16, 53100 Siena, Italy
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10
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Bargagli E, Di Masi M, Perruzza M, Vietri L, Bergantini L, Torricelli E, Biadene G, Fontana G, Lavorini F. The pathogenetic mechanisms of cough in idiopathic pulmonary fibrosis. Intern Emerg Med 2019; 14:39-43. [PMID: 30269188 DOI: 10.1007/s11739-018-1960-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/24/2018] [Indexed: 01/07/2023]
Abstract
Idiopathic pulmonary fibrosis is a peripheral subpleural interstitial lung disorder limited to the lung not involving the airways. It has a poor prognosis (survival less than 5 years) and commonly an interstitial pneumonia radiological pattern. Patients complain of a chronic dry cough in 80% of cases. A cough is often the first symptom of this rare disease, preceding dyspnea by years, and is associated with a poor prognosis, high dyspnea scores and low FVC percentages. The pathogenetic mechanisms leading to coughing in IPF are unclear. This review focuses on recent evidence of cough pathophysiology in this disease. Gastroesophageal reflux may promote coughing in IPF patients; bile salts and pepsin may be abundant in BAL of these patients, inducing overproduction of TGF-β by airway epithelial cells and mesenchymal transition with fibroblast recruitment/activation and extracellular matrix deposition. Patients have an enhanced cough reflex to capsaicin and substance P with respect to control subjects. Moreover, patients with the MUC5B polymorphism show more severe coughing as MUC5B encodes for the dominant mucin in the honeycomb cysts of IPF patients. Comorbidities, including asthma, gastroesophageal reflux, hypersensitivity pneumonitis, bronchiectasis, chronic obstructive pulmonary disease and emphysema, can induce coughing in IPF patients. There is no clear explanation of the causes of coughing in IPF. Further research into the pathophysiology of IPF and the pathogenetic mechanisms of coughing is necessary to improve survival and quality of life.
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Affiliation(s)
- Elena Bargagli
- Section of Respiratory Diseases and Lung Transplantation, Department of Clinical Medicine and Neurosciences, Siena University Hospital, Siena, Italy.
| | - Maria Di Masi
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Marco Perruzza
- Section of Respiratory Diseases and Lung Transplantation, Department of Clinical Medicine and Neurosciences, Siena University Hospital, Siena, Italy
| | - Lucia Vietri
- Section of Respiratory Diseases and Lung Transplantation, Department of Clinical Medicine and Neurosciences, Siena University Hospital, Siena, Italy
| | - Laura Bergantini
- Section of Respiratory Diseases and Lung Transplantation, Department of Clinical Medicine and Neurosciences, Siena University Hospital, Siena, Italy
| | - Elena Torricelli
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Giulia Biadene
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Giovanni Fontana
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Federico Lavorini
- Section of Respiratory Medicine, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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