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Michetti L, Maffina F, Ravasio R, Barcella V, Radaelli M, Chiudinelli L, Sessa M, Alessio MG. Free light chains as a reliable biomarker of intrathecal synthesis in the diagnosis of CNS inflammatory diseases. J Neuroimmunol 2023; 379:578091. [PMID: 37210840 DOI: 10.1016/j.jneuroim.2023.578091] [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: 09/13/2022] [Revised: 02/20/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To address the diagnostic performances of cerebrospinal fluid (CSF) free light chains (FLC) measurements compared to oligoclonal bands (OCB) to support multiple sclerosis (MS) diagnosis. RESULTS kFLC index showed the highest diagnostic accuracy to detect MS patients with the highest AUC compared to OCB, IgG index, IF kFLC R, kFLC H, λFLC index and IF λFLC. CONCLUSIONS FLC indices are biomarkers of intrathecal Immunoglobulin synthesis and central nervous system (CNS) inflammation. kFLC index can discriminate between MS and other CNS inflammatory disorders, while λFLC index is less informative for MS but can play a role to support the diagnosis of other inflammatory CNS disorders.
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Affiliation(s)
- Laura Michetti
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy.
| | - Francesca Maffina
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Rudi Ravasio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Valeria Barcella
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | | | - Maria Sessa
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Maria Grazia Alessio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
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2
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Infantino M, Manfredi M, Alessio MG, Previtali G, Grossi V, Benucci M, Faraone A, Fortini A, Grifoni E, Masotti L, Russo E, Amedei A, FitzGerald E, Albesa R, Norman GL, Mahler M. Clinical utility of circulating calprotectin to assist prediction and monitoring of COVID-19 severity: An Italian study. J Med Virol 2022; 94:5758-5765. [PMID: 35941084 PMCID: PMC9538954 DOI: 10.1002/jmv.28056] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 07/23/2022] [Accepted: 08/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Calprotectin (S100A8/A9) has been identified as a biomarker that can aid in predicting the severity of disease in COVID-19 patients. This study aims to evaluate the correlation between levels of circulating calprotectin (cCP) and the severity of COVID-19. METHODS Sera from 245 COVID-19 patients and 110 apparently healthy individuals were tested for calprotectin levels using a chemiluminescent immunoassay (Inova Diagnostics). Intensive care unit (ICU) admission and type of respiratory support administered were used as indicators of disease severity, and their correlation with calprotectin levels was assessed. RESULTS Samples from patients in the ICU had a median calprotectin concentration of 11.6 µg/ml as compared to 3.5 µg/ml from COVID-19 patients who were not in the ICU. The median calprotectin concentration in a cohort of healthy individuals collected before the COVID-19 pandemic was 3.0 µg/ml (95% CI: 2.820-2.969 µg/ml). Patients requiring a Venturi mask, continuous positive airway pressure, or orotracheal intubation all had significantly higher values of calprotectin than controls, with the increase of cCP levels proportional to the increasing need of respiratory support. CONCLUSION Calprotectin levels in serum correlate well with disease severity and represent a promising serological biomarker for the risk assessment of COVID-19 patients.
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Affiliation(s)
- Maria Infantino
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | | | - Giulia Previtali
- Department of Laboratory MedicineASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Valentina Grossi
- Immunology and Allergology Laboratory UnitSan Giovanni di Dio HospitalFlorenceItaly
| | | | - Antonio Faraone
- Department of Internal MedicineSan Giovanni Di Dio HospitalFlorenceItaly
| | - Alberto Fortini
- Department of Internal MedicineSan Giovanni Di Dio HospitalFlorenceItaly
| | - Elisa Grifoni
- Internal Medicine IISan Giuseppe HospitalEmpoliItaly
| | - Luca Masotti
- Internal Medicine IISan Giuseppe HospitalEmpoliItaly
| | - Edda Russo
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Amedeo Amedei
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Emily FitzGerald
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Roger Albesa
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Gary L. Norman
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
| | - Michael Mahler
- Headquarters & Technology Center Autoimmunity, WerfenSan DiegoCaliforniaUSA
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3
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Seghezzi M, Previtali G, Moioli V, Alessio MG, Guerra G, Buoro S. Performance evaluation of automated cell counts compared with reference methods for body fluid analysis. Diagnosis (Berl) 2021; 9:369-378. [PMID: 34599561 DOI: 10.1515/dx-2021-0088] [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: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cellular analysis of body fluids (BFs) can assist clinicians for the diagnosis of many medical conditions. The aim of this work is the evaluation of the analytical performance of the UF-5000 body fluid mode (UF-BF) analyzer compared to the gold standard method (optical microscopy, OM) and to XN-1000 (XN-BF), another analyzer produced by the same manufacturer (Sysmex) and with a similar technology for BF analysis. METHODS One hundred BF samples collected in K3EDTA tubes were analyzed by UF-BF, XN-BF and OM. The agreement was evaluated using Passing and Bablok regression and Bland-Altman plot analysis. The receiver operating characteristic (ROC) curves were selected for evaluating the diagnostic agreement between OM classification and UF-BF parameters. RESULTS Comparison between UF-BF and OM, in all BF types, showed Passing and Bablok's slope comprised between 0.99 (polymorphonuclear cells count, PMN-BF) and 1.39 (mononuclear cells count, MN-BF), the intercepts ranged between 26.47 (PMN-BF parameter) and 226.80 (white blood cell count). Bland-Altman bias was comprised between 7.3% (total cell count, TC-BF) and 52.9% (MN-BF). Comparison between UF-BF and XN-BF in all BF showed slopes ranged between 1.07 (TC-BF and PMN-BF) and 1.16 (MN-BF), intercepts ranged between 8.30 (PMN) and 64.78 (WBC-BF). Bland-Altman bias ranged between 5.8 (TC-BF) and 21.1% (MN-BF). The ROC curve analysis showed an area under the curve ranged between 0.9664 and 1.000. CONCLUSIONS UF-BF shows very good performance for the differential counts of cells in ascitic, pleural and synovial fluids and therefore it is useful to screen and count cells in this type of BF.
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Affiliation(s)
- Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Giovanni Guerra
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sabrina Buoro
- Regional Reference Center for the Quality of Laboratory Medicine Services, Milan, Italy
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4
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McConnell MJ, Kawaguchi N, Kondo R, Sonzogni A, Licini L, Valle C, Bonaffini PA, Sironi S, Alessio MG, Previtali G, Seghezzi M, Zhang X, Lee AI, Pine AB, Chun HJ, Zhang X, Fernandez-Hernando C, Qing H, Wang A, Price C, Sun Z, Utsumi T, Hwa J, Strazzabosco M, Iwakiri Y. Liver injury in COVID-19 and IL-6 trans-signaling-induced endotheliopathy. J Hepatol 2021; 75:647-658. [PMID: 33991637 PMCID: PMC8285256 DOI: 10.1016/j.jhep.2021.04.050] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS COVID-19 is associated with liver injury and elevated interleukin-6 (IL-6). We hypothesized that IL-6 trans-signaling in liver sinusoidal endothelial cells (LSECs) leads to endotheliopathy (a proinflammatory and procoagulant state) and liver injury in COVID-19. METHODS Coagulopathy, endotheliopathy, and alanine aminotransferase (ALT) were retrospectively analyzed in a subset (n = 68), followed by a larger cohort (n = 3,780) of patients with COVID-19. Liver histology from 43 patients with COVID-19 was analyzed for endotheliopathy and its relationship to liver injury. Primary human LSECs were used to establish the IL-6 trans-signaling mechanism. RESULTS Factor VIII, fibrinogen, D-dimer, von Willebrand factor (vWF) activity/antigen (biomarkers of coagulopathy/endotheliopathy) were significantly elevated in patients with COVID-19 and liver injury (elevated ALT). IL-6 positively correlated with vWF antigen (p = 0.02), factor VIII activity (p = 0.02), and D-dimer (p <0.0001). On liver histology, patients with COVID-19 and elevated ALT had significantly increased vWF and platelet staining, supporting a link between liver injury, coagulopathy, and endotheliopathy. Intralobular neutrophils positively correlated with platelet (p <0.0001) and vWF (p <0.01) staining, and IL-6 levels positively correlated with vWF staining (p <0.01). IL-6 trans-signaling leads to increased expression of procoagulant (factor VIII, vWF) and proinflammatory factors, increased cell surface vWF (p <0.01), and increased platelet attachment in LSECs. These effects were blocked by soluble glycoprotein 130 (IL-6 trans-signaling inhibitor), the JAK inhibitor ruxolitinib, and STAT1/3 small-interfering RNA knockdown. Hepatocyte fibrinogen expression was increased by the supernatant of LSECs subjected to IL-6 trans-signaling. CONCLUSION IL-6 trans-signaling drives the coagulopathy and hepatic endotheliopathy associated with COVID-19 and could be a possible mechanism behind liver injury in these patients. LAY SUMMARY Patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection often have liver injury, but why this occurs remains unknown. High levels of interleukin-6 (IL-6) and its circulating receptor, which form a complex to induce inflammatory signals, have been observed in patients with COVID-19. This paper demonstrates that the IL-6 signaling complex causes harmful changes to liver sinusoidal endothelial cells and may promote blood clotting and contribute to liver injury.
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Affiliation(s)
- Matthew J McConnell
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Nao Kawaguchi
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Reiichiro Kondo
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA; Department of Pathology, Kurume University School of Medicine, Kurume, Japan
| | - Aurelio Sonzogni
- Department of Pathology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lisa Licini
- Department of Pathology, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Clarissa Valle
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy; Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Monza, Italy
| | - Pietro A Bonaffini
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy; Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Monza, Italy
| | - Sandro Sironi
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy; Post Graduate School of Diagnostic Radiology, University of Milano-Bicocca, Monza, Italy
| | | | - Giulia Previtali
- Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Seghezzi
- Department of Laboratory Medicine, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Xuchen Zhang
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Alexander B Pine
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Hyung J Chun
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Xinbo Zhang
- Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Carlos Fernandez-Hernando
- Department of Pathology, Yale University School of Medicine, New Haven, CT 06520, USA; Department of Comparative Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Hua Qing
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Andrew Wang
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Christina Price
- Section of Rheumatology, Allergy & Immunology, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Zhaoli Sun
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Teruo Utsumi
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - John Hwa
- Section of Cardiology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520, USA
| | - Mario Strazzabosco
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA
| | - Yasuko Iwakiri
- Section of Digestive Diseases, Department of Internal Medicine, Yale School of Medicine, New Haven, CT 06520, USA.
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5
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Kondo R, Kawaguchi N, McConnell MJ, Sonzogni A, Licini L, Valle C, Bonaffini PA, Sironi S, Alessio MG, Previtali G, Seghezzi M, Zhang X, Sun Z, Utsumi T, Strazzabosco M, Iwakiri Y. Pathological characteristics of liver sinusoidal thrombosis in COVID-19 patients: A series of 43 cases. Hepatol Res 2021; 51:1000-1006. [PMID: 34260803 PMCID: PMC8444906 DOI: 10.1111/hepr.13696] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/06/2021] [Accepted: 06/29/2021] [Indexed: 02/05/2023]
Abstract
AIM Coronavirus disease (COVID-19) is characterized by pneumonia with secondary damage to multiple organs including the liver. Liver injury (elevated alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) often correlates with disease severity in COVID-19 patients. The aim of this study is to identify pathological microthrombi in COVID-19 patient livers by correlating their morphology with liver injury, and examine hyperfibrinogenemia and von Willebrand factor (vWF) as mechanisms of their formation. METHODS Forty-three post-mortem liver biopsy samples from COVID-19 patients were obtained from Papa Giovanni XXIII Hospital in Bergamo, Italy. Three morphological features of microthrombosis (sinusoidal erythrocyte aggregation [SEA], platelet microthrombi [PMT], and fibrous thrombi) were evaluated. RESULTS We found liver sinusoidal microthrombosis in 23 COVID-19 patients (53%) was associated with a higher serum ALT and AST level compared to those without (ALT: 10-fold, p = 0.04; AST: 11-fold, p = 0.08). Of 43 livers, PMT and SEA were observed in 14 (33%) and 19 (44%) cases, respectively. Fibrous thrombi were not observed. Platelet microthrombi were associated with increased ALT (p < 0.01), whereas SEA was not (p = 0.73). In COVID-19 livers, strong vWF staining in liver sinusoidal endothelial cells was associated with significantly increased platelet adhesion (1.7-fold, p = 0.0016), compared to those with weak sinusoidal vWF (2-fold, p < 0.0001). Sinusoidal erythrocyte aggregation in 19 (83%) liver samples was mainly seen in zone 2. Livers with SEA had significantly higher fibrinogen (1.6-fold, p = 0.031) compared to those without SEA in COVID-19 patients. CONCLUSIONS Liver PMT is a pathologically important thrombosis associated with liver injury in COVID-19, while SEA is a unique morphological feature of COVID-19 patient livers. Sinusoidal vWF and hyperfibrinogenemia could contribute to PMT and SEA formation.
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Affiliation(s)
- Reiichiro Kondo
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA,Department of PathologyKurume University School of MedicineKurumeFukuokaJapan
| | - Nao Kawaguchi
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Matthew J. McConnell
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Aurelio Sonzogni
- Department of PathologyASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Lisa Licini
- Department of PathologyASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Clarissa Valle
- Department of RadiologyASST Papa Giovanni XXIII HospitalBergamoItaly,Post Graduate School of Diagnostic RadiologyUniversity of Milano‐BicoccaMonzaItaly
| | - Pietro A. Bonaffini
- Department of RadiologyASST Papa Giovanni XXIII HospitalBergamoItaly,Post Graduate School of Diagnostic RadiologyUniversity of Milano‐BicoccaMonzaItaly
| | - Sandro Sironi
- Department of RadiologyASST Papa Giovanni XXIII HospitalBergamoItaly,Post Graduate School of Diagnostic RadiologyUniversity of Milano‐BicoccaMonzaItaly
| | | | - Giulia Previtali
- Department of Laboratory MedicineASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Michela Seghezzi
- Department of Laboratory MedicineASST Papa Giovanni XXIII HospitalBergamoItaly
| | - Xuchen Zhang
- Department of PathologyYale University School of MedicineNew HavenConnecticutUSA
| | - Zhaoli Sun
- Department of SurgeryJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Teruo Utsumi
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Mario Strazzabosco
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA
| | - Yasuko Iwakiri
- Department of Internal MedicineSection of Digestive DiseasesYale University School of MedicineNew HavenConnecticutUSA
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6
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Infantino M, Merone M, Manfredi M, Grossi V, Landini A, Alessio MG, Previtali G, Trevisan MT, Porcelli B, Fabris M, Macchia D, Villalta D, Cinquanta L, D'Antoni F, Iannello G, Soda P, Bizzaro N. Positive tissue transglutaminase antibodies with negative endomysial antibodies: Unresolved issues in diagnosing celiac disease. J Immunol Methods 2020; 489:112910. [PMID: 33166550 DOI: 10.1016/j.jim.2020.112910] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 10/14/2020] [Accepted: 11/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The serological screening for celiac disease (CD) is currently based on the detection of anti-transglutaminase (tTG) IgA antibodies, subsequently confirmed by positive endomysial antibodies (EMA). When an anti-tTG IgA positive/EMA IgA negative result occurs, it can be due either to the lower sensitivity of the EMA test or to the lower specificity of the anti-tTG test. This study aimed at verifying how variation in analytical specificity among different anti-tTG methods could account for this discrepancy. METHODS A total of 130 consecutive anti-tTG IgA positive/EMA negative samples were collected from the local screening routine and tested using five anti-tTG IgA commercial assays: two chemiluminescence methods, one fluoroimmunoenzymatic method, one immunoenzymatic method and one multiplex flow immunoassay method. RESULTS Twenty three/130 (17.7%) patients were diagnosed with CD. In the other 107 cases a diagnosis of CD was not confirmed. The overall agreement among the five anti-tTG methods ranged from 28.5% to 77.7%. CD condition was more likely linked to the positivity of more than one anti-tTG IgA assay (monopositive = 2.5%, positive with ≥ three methods = 29.5%; p = 0.0004), but it was not related to anti-tTG IgA antibody levels (either positive or borderline; p = 0.5). CONCLUSIONS Patients with positive anti-tTG/negative EMA have a low probability of being affected by CD. Given the high variability among methods to measure anti-tTG IgA antibodies, anti-tTG-positive/EMA-negative result must be considered with extreme caution. It is advisable that the laboratory report comments on any discordant results, suggesting to consider the data in the proper clinical context and to refer the patient to a CD reference center for prolonged follow up.
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Affiliation(s)
- Maria Infantino
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Azienda USL. Centro Firenze, Toscana, Italy.
| | - Mario Merone
- Unità di Sistemi di elaborazione e Bioinformatica, Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico, Roma, Italy
| | - Mariangela Manfredi
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Azienda USL. Centro Firenze, Toscana, Italy
| | - Valentina Grossi
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Azienda USL. Centro Firenze, Toscana, Italy
| | - Alessandra Landini
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Azienda USL. Centro Firenze, Toscana, Italy
| | | | - Giulia Previtali
- Laboratorio Analisi Chimico Cliniche, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Teresa Trevisan
- Laboratorio Analisi Chimico Cliniche e Microbiologiche, UOA di Laboratorio, Ospedale G. Fracastoro, Verona, Italy
| | - Brunetta Porcelli
- Dipartimento Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - Martina Fabris
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Donatella Macchia
- SOS Allergologia Immunologia Clinica, Ospedale S. Giovanni di Dio, Azienda USL, Centro Firenze, Toscana, Italy
| | - Danilo Villalta
- SSD di Allergologia e Immunologia Clinica, Presidio Ospedaliero S. Maria degli Angeli, Pordenone, Italy
| | | | - Federico D'Antoni
- Unità di Sistemi di elaborazione e Bioinformatica, Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico, Roma, Italy
| | - Giulio Iannello
- Unità di Sistemi di elaborazione e Bioinformatica, Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico, Roma, Italy
| | - Paolo Soda
- Unità di Sistemi di elaborazione e Bioinformatica, Facoltà Dipartimentale di Ingegneria, Università Campus Bio-Medico, Roma, Italy
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo - Azienda Sanitaria Universitaria Integrata di Udine, Italy
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7
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Sonzogni A, Previtali G, Seghezzi M, Grazia Alessio M, Gianatti A, Licini L, Morotti D, Zerbi P, Carsana L, Rossi R, Lauri E, Pellegrinelli A, Nebuloni M. Liver histopathology in severe COVID 19 respiratory failure is suggestive of vascular alterations. Liver Int 2020; 40:2110-2116. [PMID: 32654359 PMCID: PMC7404964 DOI: 10.1111/liv.14601] [Citation(s) in RCA: 189] [Impact Index Per Article: 47.3] [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: 04/15/2020] [Revised: 07/03/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
SARS2-CoV-2 breakout in Italy caused a huge number of severely ill patients with a serious increase in mortality. Although lungs seem to be the main target of the infection, very few information are available about liver involvement, possibly evocating a systemic disease. Post-mortem wedge liver biopsies from 48 patients died from severe pulmonary COVID-19 disease with respiratory failure were collected from two main hospitals in northern Italy. No patient had clinical symptoms of liver disease or signs of liver failure before and during hospitalization; for each of them liver function tests were available. All liver samples showed minimal inflammation features. Histological pictures compatible with vascular alterations were observed, characterized by increase in number of portal vein branches associated with lumen massive dilatation, partial or complete luminal thrombosis of portal and sinusoidal vessels, fibrosis of portal tract, focally markedly enlarged and fibrotic. SARS-CoV-2 was found in 15 of 22 samples tested by in situ hybridization method. Our preliminary results confirm the clinical impression that liver failure is not a main concern and this organ is not the target of significant inflammatory damage. Histopathological findings are highly suggestive for marked derangement of intrahepatic blood vessel network secondary to systemic changes induced by virus that could target not only lung parenchyma but also cardiovascular system, coagulation cascade and endothelial layer of blood vessels. It still remains unclear if the mentioned changes are directly related to virus infection or if SARS-CoV-2 triggers a series of reactions leading to striking vascular alterations.
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Affiliation(s)
| | - Giulia Previtali
- Department of Laboratory MedicinePapa Giovanni XXIII HospitalBergamoItaly
| | - Michela Seghezzi
- Department of Laboratory MedicinePapa Giovanni XXIII HospitalBergamoItaly
| | | | - Andrea Gianatti
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Lisa Licini
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Denise Morotti
- Department of PathologyPapa Giovanni XXIII HospitalBergamoItaly
| | - Pietro Zerbi
- Department of PathologyLuigi Sacco HospitalMilanoItaly,Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | - Luca Carsana
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | - Roberta Rossi
- Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
| | | | | | - Manuela Nebuloni
- Department of PathologyLuigi Sacco HospitalMilanoItaly,Department of Biomedical and Clinical SciencesUniversity of MilanMilanoItaly
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8
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Previtali G, Seghezzi M, Moioli V, Sonzogni A, Cerutti L, Marozzi R, Ravasio R, Gianatti A, Guerra G, Alessio MG. The pathogenesis of thromboembolic disease in covid-19 patients: Could be a catastrophic antiphospholipid syndrome? Thromb Res 2020; 194:192-194. [PMID: 32788116 PMCID: PMC7319923 DOI: 10.1016/j.thromres.2020.06.042] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Giulia Previtali
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy.
| | - Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Aurelio Sonzogni
- Pathological Anatomy, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Lorenzo Cerutti
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Roberto Marozzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Rudi Ravasio
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Andrea Gianatti
- Pathological Anatomy, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giovanni Guerra
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
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9
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Infantino M, Carbone T, Manfredi M, Grossi V, Antico A, Panozzo MP, Brusca I, Alessio MG, Previtali G, Platzgummer S, Cinquanta L, Paura G, Deleonardi G, Trevisan MT, Radice A, Castiglione C, Imbastaro T, Fabris M, Pesce G, Porcelli B, Terzuoli L, Sorrentino MC, Tampoia M, Abbracciavento L, Villalta D, Conte M, Barberio G, Gallo N, Benucci M, Bizzaro N. A new diagnostic algorithm for pattern-oriented autoantibody testing according to the ICAP nomenclature: A pilot study. Autoimmun Rev 2020; 19:102588. [PMID: 32540447 DOI: 10.1016/j.autrev.2020.102588] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
The commercial tests currently available as second-level tests to detect ANA sub-specificities are generally used independently from the ANA immunofluorescence (IIF) pattern. The aim of this study was to evaluate the efficacy of the use of a customizable pattern-oriented antigenic panel by immunoblot (IB) using the International Consensus on ANA Patterns (ICAP) classification scheme, in order to introduce a novel and updated autoimmune diagnostic flowchart. 710 sera referred for routine ANA testing were selected on the basis of the ANA pattern according to the ICAP nomenclature (nuclear speckled AC-2,4,5; nucleolar AC-8,9,10,29; cytoplasmic speckled AC-18,19,20) and on an IIF titer ≥1:320. They were then assayed by three experimental IB assays using a panel of selected antigens. ICAP-oriented IB detected 515 antibody reactivities vs. 457 of traditional anti-ENA in the nuclear speckled pattern group, 108 vs. 28 in the nucleolar pattern group, and 43 vs. 34 in the cytoplasmic speckled pattern. This pilot study may lead the way for a new approach introducing an ICAP pattern-oriented follow up testing as a valid alternative to the existing standard panels, thus enabling more patients with autoimmune rheumatic disease to be accurately diagnosed.
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Affiliation(s)
- Maria Infantino
- Laboratorio Immunologia Allergologia, Ospedale San Giovanni di Dio, Firenze, Italy.
| | - Teresa Carbone
- IReL, Istituto Reumatologico Lucano, Ospedale San Carlo, Potenza, Italy
| | - Mariangela Manfredi
- Laboratorio Immunologia Allergologia, Ospedale San Giovanni di Dio, Firenze, Italy
| | - Valentina Grossi
- Laboratorio Immunologia Allergologia, Ospedale San Giovanni di Dio, Firenze, Italy
| | | | | | - Ignazio Brusca
- Patologia Clinica, Ospedale Buccheri La Ferla FBF, Palermo, Italy
| | | | - Giulia Previtali
- Laboratorio Analisi Chimico Cliniche, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Luigi Cinquanta
- Laboratorio centralizzato (HUB) SDN Spa, Gruppo SYNLAB, Pagani, SA, Italy
| | - Giusy Paura
- Autoimmmunologia e allergologia diagnostica di laboratorio, OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gaia Deleonardi
- Laboratorio Unico Metropolitano, Ospedale Maggiore, Bologna, Italy
| | | | - Antonella Radice
- UOC Microbiologia e Virologia, Presidio Ospedaliero San Carlo Borromeo, Milano, Italy
| | | | | | - Martina Fabris
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Giampaola Pesce
- Laboratorio Diagnostico di Autoimmunologia IRCCS Ospedale Policlinico San Martino Genova Dipartimento di Medicina Interna e specialità mediche (DIMI), Università di Genova, Genova, Italy
| | - Brunetta Porcelli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria alle Scotte, AOU Senese, Siena, Italy
| | - Lucia Terzuoli
- UOC Laboratorio Patologia Clinica, Policlinico S. Maria alle Scotte, AOU Senese, Siena, Italy
| | - Maria Concetta Sorrentino
- Dipartimento di Medicina di Laboratorio e Biotecnologie avanzate, Laboratorio di Patologia Clinica, Microbiologia e Virologia, Palermo, Italy
| | - Marilina Tampoia
- Laboratorio di Autoimmunologia, UOC di Patologia Clinica Universitaria, Bari, Italy
| | | | - Danilo Villalta
- SSD di Allergologia e Immunologia clinica, Presidio Ospedaliero S. Maria degli Angeli, Pordenone, Italy
| | - Mariaelisabetta Conte
- SSD di Allergologia e Immunologia clinica, Presidio Ospedaliero S. Maria degli Angeli, Pordenone, Italy
| | - Giuseppina Barberio
- U.O.C. Medicina di Laboratorio Azienda ULSS n2 Marca trevigiana, Treviso, Italy
| | - Nicoletta Gallo
- Dipartimento di Medicina di Laboratorio, Azienda Universitaria di Padova, Padova, Italy
| | | | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo, Italy
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10
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Villalta D, Seaman A, Tiongson M, Warren C, Bentow C, Bizzaro N, Alessio MG, Porcelli B, Norman GL, Mahler M. Evaluation of a novel extended automated particle-based multi-analyte assay for the detection of autoantibodies in the diagnosis of primary biliary cholangitis. Clin Chem Lab Med 2020; 58:1499-1507. [PMID: 32286240 DOI: 10.1515/cclm-2020-0122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 10/23/2019] [Accepted: 03/10/2020] [Indexed: 02/07/2023]
Abstract
Background Anti-mitochondrial autoantibodies (AMA) detected by indirect immunofluorescence (IIF) on rodent tissues are the diagnostic marker of primary biliary cholangitis (PBC). However, up to 15% of patients with PBC are AMA-negative by IIF. In the effort to close the serological gap and improve the diagnostic sensitivity of PBC testing, recently, novel autoantibodies specific for PBC, such as kelch-like 12 (KLHL12, KLp epitope) and hexokinase 1 (HK1) have been described. In this study, we evaluated the autoantibody profile in a large cohort of PBC patients and in patients with other liver disease, including anti-HK1 and anti-KLp autoantibodies. Methods Sera of 194 PBC patients (126 AMA-IIF-positive and 68 AMA-IIF-negative) and 138 disease controls were tested for a panel of PBC-specific antibodies (MIT3, sp100, gp210, HK1, KLp) using a new automated particle-based multi-analyte technology (PMAT) assay on the Aptiva instrument (Inova). Results Selecting a cutoff yielding a specificity of >95% for all the markers, the sensitivity for anti-MIT3, anti-sp100, anti-gp210, anti-HK1 and anti-KLp in the PBC AMA-IIF-negative cohort was 20.6%, 16.2%, 23.5%, 22.0%, 17.6 and 13.2%, respectively. Six out of the 68 (8.8%) AMA-IIF negative sera were positive for anti-HK1 or anti-KLp alone. Using these new markers in addition to anti-MIT3, anti-sp100 and anti-gp210, the overall sensitivity in this cohort of AMA-IIF-negative patients increased from 53% to 61.8%, reducing the serological gap in AMA-negative PBC patients. Conclusions PBC antibody profiling, made possible by the new Aptiva-PMAT technology, allows recognition of a higher number of AMA-negative PBC patients than conventional immunoassays and may represent a useful tool to evaluate the prognostic significance of autoantibody association in PBC patients.
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Affiliation(s)
- Danilo Villalta
- Immunologia e Allergologia, Ospedale S. Maria degli Angeli, Pordenone, Italy
| | - Andrea Seaman
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | | | - Charles Warren
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | - Chelsea Bentow
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | - Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale S. Antonio, Tolmezzo (UD), via M.L. King 25, 30027 San Donà di Piave (Venice), Italy
| | - Maria Grazia Alessio
- Dipartimento di Patologia Clinica, Laboratorio Analisi, AO Papa Giovanni XXIII, Bergamo, Italy
| | - Brunetta Porcelli
- Dipartimento di Biotecnologie Mediche, Università di Siena, Policlinico Le Scotte, Siena, Italy
| | - Gary L Norman
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | - Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
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11
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Seghezzi M, Moioli V, Previtali G, Manenti B, Lopez RS, Kono M, Tirloni E, Alessio MG, Buoro S. Preliminary evaluation of a new flow cytometry method for the routine hematology workflow. Clin Chem Lab Med 2019; 57:1608-1622. [PMID: 31556506 DOI: 10.1515/cclm-2018-1356] [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: 12/20/2018] [Accepted: 03/10/2019] [Indexed: 11/15/2022]
Abstract
Background In a generalist laboratory, the integration of the data obtained from hematology analyzers (HAs) with those from multiparametric flow cytometry (FMC) could increase the specificity and sensitivity of first level screening to identify the pathological samples. The aim of this study was to perform a preliminary evaluation of a new simple hybrid method (HM). The method was obtained by integration between HAs reagents into FCM, with a basic monoclonal antibodies panel for the leukocytes differential count. Methods Eighty-one peripheral blood samples, collected in K3EDTA tubes, were analyzed by XN-module, and CyFlow Space System, using both standard MoAbs and HM method analysis, and with the optical microscopy (OM). Within-run imprecision was carried out using normal samples, the carryover was evaluated, data comparison was performed with Passing-Bablok regression and Bland-Altman plots. Results The within-run imprecision of HM methods ranged between 1.4% for neutrophils (NE) and 10.1% for monocytes (MO) always equal or lower to the OM. The comparison between HM methods vs. OM shows Passing-Bablok regression slopes comprised between 0.83 for lymphocyte (LY) and 1.14 for MO, whilst the intercepts ranged between -0.18 for NE and 0.25 for LY. Bland-Altman relative bias was comprised between -12.43% for NE, and 19.77% for eosinophils. In all 11 pathological samples the agreement between the methods was 100%. Conclusions The new hybrid method generates a leukocytes differential count suitable for routine clinical use and it is also useful for identifying morphological abnormalities with a reduction in cost and improvement of screening for first level hematology workflow.
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Affiliation(s)
- Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Mari Kono
- Scientific Affairs, Sysmex Corporation, Kobe, Japan
| | - Ezio Tirloni
- Product and Application, Sysmex Partec Italia, Milano, Italy
| | | | - Sabrina Buoro
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy, Phone: (+039) 0352674550, Fax: (+039) 0352674939
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12
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Podestà MA, Gennarini A, Portalupi V, Rota S, Alessio MG, Remuzzi G, Ruggenenti P. Accelerating the Depletion of Circulating Anti-Phospholipase A2 Receptor Antibodies in Patients with Severe Membranous Nephropathy: Preliminary Findings with Double Filtration Plasmapheresis and Ofatumumab. Nephron Clin Pract 2019; 144:30-35. [PMID: 31336376 DOI: 10.1159/000501858] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 06/29/2019] [Indexed: 11/19/2022] Open
Abstract
Patients with membranous nephropathy (MN) and persistent nephrotic syndrome (NS) are at increased risk of -progression to end-stage renal disease. The discovery of -autoantibodies against the podocyte-expressed M-type phospholipase A2 receptor (PLA2R) provided a clear pathophysiological rationale for interventions targeting the B-cell lineage to prevent antibody production and subepithelial immune-complex deposition. The anti-CD20 monoclonal antibodies, rituximab and ofatumumab, are safe and achieve remission of NS in approximately two-thirds of patients with MN. In patients with PLA2R-related MN, remission can be predicted by anti-PLA2R antibody depletion, and faster depletion is associated with earlier reduction of proteinuria and improved nephroprotection. Selective apheresis methods, such as double-filtration plasmapheresis (DFPP), may accelerate the clearance of autoreactive antibodies and at the same time avoid the side effects of plasma-exchange. In this preliminary, explorative, proof-of-concept study, we observed that in patients with PLA2R-related MN, NS and high antibody levels, ofatumumab-induced B-cell depletion followed by DFPP accelerated anti-PLA2R depletion compared to anti-CD20 monotherapy. This therapeutic regimen was safe and well tolerated. These observations may provide the background for controlled trials aimed at formally testing whether the addition of DFPP to anti-CD20 therapy could offer a novel therapeutic option, especially for patients with more severe MN.
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Affiliation(s)
- Manuel Alfredo Podestà
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,Unit of Nephrology and Dialysis, Department of Medicine, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Alessia Gennarini
- Unit of Nephrology and Dialysis, Department of Medicine, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Portalupi
- Unit of Nephrology and Dialysis, Department of Medicine, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Stefano Rota
- Unit of Nephrology and Dialysis, Department of Medicine, Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Maria Grazia Alessio
- Clinical Chemistry Laboratory, Department of Laboratory Medicine Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
| | - Giuseppe Remuzzi
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy, .,L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy,
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Bergamo, Italy.,L. Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
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13
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Infantino M, Tampoia M, Fabris M, Alessio MG, Previtali G, Pesce G, Deleonardi G, Porcelli B, Musso M, Grossi V, Benucci M, Manfredi M, Bizzaro N. Combining immunofluorescence with immunoblot assay improves the specificity of autoantibody testing for myositis. Rheumatology (Oxford) 2019; 58:1239-1244. [DOI: 10.1093/rheumatology/key451] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Revised: 12/19/2018] [Indexed: 01/25/2023] Open
Affiliation(s)
- M Infantino
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Firenze, Azienda USL Toscana Centro, Italy
| | - M Tampoia
- Laboratorio di Patologia Clinica, Azienda Ospedaliera Universitaria, Policlinico di Bari, Bari, Italy
| | - M Fabris
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - M G Alessio
- Laboratorio Analisi Chimico Cliniche ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Previtali
- Laboratorio Analisi Chimico Cliniche ASST Papa Giovanni XXIII, Bergamo, Italy
| | - G Pesce
- Lab. Autoimmunologia e Coordinamento con la clinica, Di.M.I. Università degli Studi di Genova, Genova, Italy
| | - G Deleonardi
- Laboratorio Unico Metropolitano, AUSL Bologna, Bologna, Italy
| | - B Porcelli
- Dipartimento Biotecnologie Mediche, Università degli Studi di Siena, Siena, Italy
| | - M Musso
- Laboratorio Analisi ASO S.Croce e Carle, Cuneo, Italy
| | - V Grossi
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Firenze, Azienda USL Toscana Centro, Italy
| | - M Benucci
- Reumatologia, Ospedale S. Giovanni di Dio, Firenze, Azienda USL Toscana Centro, Italy
| | - M Manfredi
- Laboratorio Immunologia e Allergologia, Ospedale S. Giovanni di Dio, Firenze, Azienda USL Toscana Centro, Italy
| | - N Bizzaro
- Laboratorio di Patologia Clinica, Ospedale San Antonio, Tolmezzo, Italy, Italy
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14
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Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Caleffi A, Gambaro G, Secchiero S, Pieretti B, Ottomano C, Liverani A, Drago C, Balboni F, Epifani MG, Saccani G, DI Rienzo G, Valverde S, Ravasio R, Brunori G, Gesualdo L. [PHYSICAL, CHEMICAL AND MORPHOLOGICAL URINE EXAMINATION: RECOMMENDATIONS FOR THE POST ANALYTICAL PHASE FROM THE INTERDISCIPLINARY URINALYSIS GROUP (GIAU)]. G Ital Nefrol 2018; 35:35-6-2018-4. [PMID: 30550034] [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] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
With these recommendations the Interdisciplinary Urinalysis Group (GIAU) aims to stimulate the following aspects : improvement and standardization of the post analytical approach to physical, chemical and morphological urine examination (ECMU); emphasize the value added to ECMU by selection of clinically significant parameters, indication of analytical methods, of units of measurement, of reference values; improvement of interpretation of dip stick urinalysis with particular regard to the reconsideration of the diagnostic significance of the evaluated parameters together with an increasing awareness of the limits of sensitivity and specificity of this analytical method. Accompanied by the skills to propose and carry out in-depth investigations with analytical methods that are more sensitive and specific;increase the awareness of the importance of professional skills in the field of urinary morphology and their relationships with the clinicians. through the introduction, in the report, of descriptive and interpretative comments depending on the type of request, the complexity of the laboratory, the competence of the pathologist;implement a policy of evaluation of the analytical quality by using, in addition to traditional internal and external controls, a program for the evaluation of morphological competence. The hope is to revalue the enormous potential diagnostic of ECMU, implementing a urinalysis on personalized diagnostic needs that each patient brings with it.
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Affiliation(s)
- Fabio Manoni
- Dipartimento dei Servizi di Diagnosi e Cura Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, PD
| | - Gianluca Gessoni
- Servizio di Medicina di Laboratorio, Ospedale Madonna della Navicella, Chioggia, VE
| | - Giovanni Battista Fogazzi
- Laboratorio Clinico e di Ricerca sul Sedimento Urinario U.O. Di Nefrologia e Dialisi Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milano
| | - Maria Grazia Alessio
- Laboratorio Analisi Chimico Cliniche. ASST Papa Giovanni XXIII Piazza OMS Bergamo
| | - Alberta Caleffi
- U.O Diagnostica Ematochimica, Dipartimento Diagnostico, Azienda Ospedaliero-Universitaria Parma
| | - Giovanni Gambaro
- Cattedra di Nefrologia-Divisione di Nefrologia e Dialisi, Fondazione Policlinico A. Gemelli, Università Cattolica del Sacro Cuore, Roma
| | - Sandra Secchiero
- Centro di Ricerca Biomedica, U.O.C. Medicina di Laboratorio Azienda Ospedaliera-Università, Padova
| | | | | | - Anna Liverani
- Dipartimento dei Servizi di Diagnosi e Cura Ospedali Riuniti Padova Sud Madre Teresa di Calcutta, Monselice, PD
| | - Cettina Drago
- Laboratorio di Analisi Cliniche e Microbiologiche del Centro Cuore Morgagni in Pedara
| | | | - Maria Grazia Epifani
- Centro di Ricerca Biomedica, U.O.C. Medicina di Laboratorio Azienda Ospedaliera-Università, Padova
| | | | | | - Sara Valverde
- Servizio di Medicina di Laboratorio, Ospedale Madonna della Navicella, Chioggia VE
| | - Rudi Ravasio
- Laboratorio Analisi Chimico Cliniche. ASST Papa Giovanni XXIII Piazza OMS Bergamo
| | | | - Loreto Gesualdo
- Cattedra Nefrologia Università degli Studi di Bari-Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari
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15
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Bagnasco M, Saverino D, Pupo F, Marchiano M, Alessio MG, Schlumberger W, Antico A, Pesce G, Bizzaro N. Estimate of the Prevalence of Anti-Gastric Parietal Cell Autoantibodies in Healthy Individuals Is Method Dependent. Am J Clin Pathol 2018; 150:285-292. [PMID: 30007281 DOI: 10.1093/ajcp/aqy061] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Anti-parietal cell antibodies (APCA) are a serologic marker of autoimmune gastritis. Their prevalence in healthy individuals is not well defined. METHODS We evaluated APCA prevalence in 515 healthy blood-donors by rat/primate tissue indirect immunofluorescence (IIF), enzyme-linked immunosorbent assay (ELISA), and immunoblot. RESULTS Fifty-three of 515 (10.3%) subjects were positive for APCA by at least one method: 18 only by ELISA, 10 by rodent tissue IIF, and one by primate tissue IIF; 18 were positive by ELISA and primate tissue IIF, and one by ELISA and rodent tissue IIF. Two were positive by both IIF methods, and three were triple positive. APCA positivity was confirmed by immunoblot in 100% of ELISA positive, in 95.8% of positive primate tissue IIF, and in 50% of positive rat tissue IIF. CONCLUSIONS A great discrepancy in APCA prevalence detected by different methods in this cohort was apparent. Thus, the results on APCA prevalence in healthy individuals are likely method-dependent.
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Affiliation(s)
- Marcello Bagnasco
- Dipartimento di Medicina Interna, University of Genoa, Genoa, Italy
- Laboratory of Autoimmunology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Daniele Saverino
- Dipartimento di Medicina Sperimentale, University of Genoa, Genoa, Italy
- Laboratory of Autoimmunology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Pupo
- Dipartimento di Medicina Interna, University of Genoa, Genoa, Italy
- Laboratory of Autoimmunology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Manuela Marchiano
- Dipartimento di Medicina Interna, University of Genoa, Genoa, Italy
- Laboratory of Autoimmunology, Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Antonio Antico
- Laboratory of Clinical Pathology, Civic Hospital, Santorso, Italy
| | - Giampaola Pesce
- Dipartimento di Medicina Interna, University of Genoa, Genoa, Italy
- Laboratory of Autoimmunology, Ospedale Policlinico San Martino, Genoa, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Italy
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16
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Donati MB, Falanga A, Consonni R, Alessio MG, Bassan R, Buelli M, Borin L, Catani LG, Pogliani E, Gugliotta L, Masera G, Barbui T. Cancer Procoagulant in Acute Non Lymphoid Leukemia: Relationship of Enzyme Detection to Disease Activity. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1647145] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryBlast cell extracts from patients with acute non lymphoid leukemia (ANLL) express cancer procoagulant (cp). Thii factor X (FX) activator is distinct from tissue factor (TF) in that it does not require factor VII (FVII) to trigger blood coagulation, it acts as a cysteine proteinase and is not present in normal mononuclear cells. Tb assess whether there is any relationship between the presence of CP and the status of the disease, ANLL patients have been studied at diagnosis, during remission, at relapse. The procoagulant activity in either the presence or absence of F VII and sensitivity to cysteine proteinaie inhibitors were tested on cell extracts. Immunoreactivity was explored with an anti-cP polyclonal antibody. Data obtained in gL newlydiagnosed ANLL patients (subtypes M1 to M5, EAB classification) confirmed the presence of cp in M1- to M4 groups (mean + sE Fvll-independent activity: M1 = 2.1 ± 0.7 unit/mg; M2 = 5.7 ± 1.7 unit/mg; M3 = 31.5 ± 8 unit/mg M4 = 1.6 ± 1.2 unit/mg; CP was absent in the M5 type. In eight patients analy zedin a subsequent phase of partial remission, specific activity had dropped from 26.9 ± 7.8 to 10.5 ± 4.0 unit/mg. Activiiy was virtually absent (0−0.05 unit/mg) in the bone marrow of 37 patients studied at complete remission. Bone marrow samples from six subjects tested at different intervals after complete remission were repeatedly negative for CP but became positive 2 to 5 months before relapse. Upon relapse, the FVII indbpendent activity rose to 24.2 ± 8.2 unit/mg.These results suggest that CP activity may be closely associated with the presence of myeloid malignant cells in the bone marrow, a finding of potential relevance not only to the coagulation disorders of acute leukemia, but also to the early deteition of blast cells in ANLL.
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Affiliation(s)
- M B Donati
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - A Falanga
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - R Consonni
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - M G Alessio
- Recipient of a fellowship of the “Associ azioneltaliana per la Ricerca sul Cancro”
| | - R Bassan
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - M Buelli
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - L Borin
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - L G Catani
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - E Pogliani
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - L Gugliotta
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - G Masera
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
| | - T Barbui
- The Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro; Divisione di Ematologia, Ospedali Riuniti, Bergamo; Dipartimenti di Medicina J ai peaiatria, Universitd di Milano, Ospedale S. Gerardo, Monza; and Divisione di Ematologia, Ospedale S. Orsola, dologna, Italy
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Bizzaro N, Brusca I, Previtali G, Alessio MG, Daves M, Platzgummer S, Cinquanta L, Paura G, Infantino M, Manfredi M, Faricelli R, Bassetti D, Musso M, Deleonardi G, Trevisan MT, Radice A, Liguori M, Imbastaro T, Pesente F, Fabris M, Tonutti E. The association of solid-phase assays to immunofluorescence increases the diagnostic accuracy for ANA screening in patients with autoimmune rheumatic diseases. Autoimmun Rev 2018; 17:541-547. [PMID: 29631063 DOI: 10.1016/j.autrev.2017.12.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 12/08/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale S. Antonio, Tolmezzo, Italy.
| | - Ignazio Brusca
- Patologia Clinica, Ospedale Buccheri La Ferla FBF, Palermo, Italy
| | - Giulia Previtali
- Laboratorio Analisi Chimico Cliniche, ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Massimo Daves
- Laboratorio Centrale, Ospedale Civile, Merano, Italy
| | | | - Luigi Cinquanta
- Autoimmunologia e Allergologia Diagnostica di Laboratorio, OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Giusy Paura
- Autoimmunologia e Allergologia Diagnostica di Laboratorio, OORR San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Maria Infantino
- Laboratorio Immunologia Allergologia, Azienda Usl Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | - Mariangela Manfredi
- Laboratorio Immunologia Allergologia, Azienda Usl Toscana Centro, Ospedale San Giovanni di Dio, Florence, Italy
| | | | | | - Maura Musso
- Laboratorio Analisi, Ospedale S.Croce e Carle, Cuneo, Italy
| | - Gaia Deleonardi
- Laboratorio Unico Metropolitano, Ospedale Maggiore, Bologna, Italy
| | | | - Antonella Radice
- UOC Microbiologia e Virologia, Presidio Ospedaliero San Carlo Borromeo, Milan, Italy
| | - Marco Liguori
- Laboratorio Analisi, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | | | - Fiorenza Pesente
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Martina Fabris
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
| | - Elio Tonutti
- SOC Istituto di Patologia Clinica, Azienda Sanitaria Universitaria Integrata, Udine, Italy
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18
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Bizzaro N, Bagnasco M, Tozzoli R, Brusca I, Cinquanta L, Tampoia M, Deleonardi G, Antico A, Pesce G, Alessio MG, Liguori M, Bassetti D, Villalta D. Choosing Wisely in autoimmunologia: le 5 Proposte del Gruppo di Studio in Autoimmunologia della SIPMeL. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s13631-018-0181-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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19
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Seghezzi M, Manenti B, Previtali G, Alessio MG, Dominoni P, Buoro S. Preliminary evaluation of UF-5000 Body Fluid Mode for automated cerebrospinal fluid cell counting. Clin Chim Acta 2017; 473:133-138. [DOI: 10.1016/j.cca.2017.08.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/22/2017] [Accepted: 08/22/2017] [Indexed: 11/16/2022]
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20
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Previtali G, Ravasio R, Seghezzi M, Buoro S, Alessio MG. Performance evaluation of the new fully automated urine particle analyser UF-5000 compared to the reference method of the Fuchs-Rosenthal chamber. Clin Chim Acta 2017; 472:123-130. [PMID: 28760666 DOI: 10.1016/j.cca.2017.07.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 07/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND UF-5000 is the new fully automated urine particle analyser. We validated its performance. METHODS 736 urines were analysed and results were compared by two pathologists on uncentrifuged samples, using Fuchs-Rosenthal chamber. RESULTS AUC of ROC curve ranged between 0.86 and 0.99. Sensitivity was >0.90 for all the elements and similar for RBC and yeasts. Specificity ranged between 0.74 and 0.89 for total cast, epithelial/non-squamous/renal-tubular cells and RBC. For all the other parameters specificity was >0.90. Comparison with Fuchs-Rosenthal chamber was very good for all the parameters; r ranged between 0.52 and 0.99 except for pathological cast because of the lack of the pathological samples in medium and higher ranges. Linearity performance (R2) was 1.00, 1.00 and 0.99 respectively for RBC, WBC and epithelial cells (EC). No carry-over was observed. The within-run imprecision was 25.42%,13.81%,1.36% for RBC; 37.50%,10.16%,1.41% for WBC and 35.25%, 17.85%,6.30% for EC at low, near the cut off level and high concentrations, respectively. The between-run imprecision was 6.90%,1.60% for RBC, 4.10%,1.90% for WBC and 7.60%,7.30% for EC, using low and high positive quality controls, respectively. CONCLUSION UF-5000 is an analyser of great interest to detect urine particle related to pathological process of kidney and urinary tract.
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Affiliation(s)
- Giulia Previtali
- Clinical Chemistry Laboratory, Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy.
| | - Rudi Ravasio
- Clinical Chemistry Laboratory, Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy
| | - Michela Seghezzi
- Clinical Chemistry Laboratory, Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy
| | - Sabrina Buoro
- Clinical Chemistry Laboratory, Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy
| | - Maria Grazia Alessio
- Clinical Chemistry Laboratory, Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS 1, Bergamo, Italy
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21
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Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Caleffi A, Gambaro G, Epifani MG, Pieretti B, Perego A, Ottomano C, Saccani G, Valverde S, Secchiero S. [Physical, chemical and morphological urine examination guidelines for the Analytical Phase from the Intersociety Urinalysis Group]. G Ital Nefrol 2016; 33:gin/33.6.15. [PMID: 28134409] [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: 06/06/2023]
Abstract
With these guidelines the Intersociety Urinalysis Group (GIAU) aims to stimulate the following aspects: Improvement and standardization of the analytical approach to physical, chemical and morphological urine examination (ECMU). Improvement of the chemical analysis of urine with particular regard to the reconsideration of the diagnostic significance of the parameters that are traditionally evaluated in dipstick analysis together with an increasing awareness of the limits of sensitivity and specificity of this analytical method. Increase the awareness of the importance of professional skills in the field of urinary morphology and the relationship with the clinicians. Implement a policy of evaluation of the analytical quality by using, in addition to traditional internal and external controls, a program for the evaluation of morphological competence. Stimulate the diagnostics industry to focus research efforts and development methodology and instrumental catering on the needs of clinical diagnosis. The hope is to revalue the enormous diagnostic potential of 'ECMU, implementing a urinalysis on personalized diagnostic needs for each patient. Emphasize the value added to ECMU by automated analyzers for the study of the morphology of the corpuscular fraction urine. The hope is to revalue the enormous potential diagnostic of 'ECMU, implementing a urinalysis on personalized diagnostic needs that each patient brings with it.
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22
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Manoni F, Gessoni G, Fogazzi GB, Alessio MG, Caleffi A, Gambaro G, Epifani MG, Pieretti B, Perego A, Ottomano C, Saccani G, Valverde S, Secchiero S. Esame fisico, chimico e morfologico delle urine: proposta di linee guida per la fase analitica del Gruppo Intersocietario Analisi delle Urine (GIAU). ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s13631-016-0127-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Villalta D, Sorrentino MC, Girolami E, Tampoia M, Alessio MG, Brusca I, Daves M, Porcelli B, Barberio G, Bizzaro N. Autoantibody profiling of patients with primary biliary cirrhosis using a multiplexed line-blot assay. Clin Chim Acta 2015; 438:135-8. [DOI: 10.1016/j.cca.2014.08.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/18/2022]
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Saverino D, Pesce G, Antola P, Porcelli B, Brusca I, Villalta D, Tampoia M, Tozzoli R, Tonutti E, Alessio MG, Bagnasco M, Bizzaro N. High levels of soluble CTLA-4 are present in anti-mitochondrial antibody positive, but not in antibody negative patients with primary biliary cirrhosis. PLoS One 2014; 9:e112509. [PMID: 25383768 PMCID: PMC4226553 DOI: 10.1371/journal.pone.0112509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 01/16/2014] [Accepted: 10/19/2014] [Indexed: 12/15/2022] Open
Abstract
Primary biliary cirrhosis (PBC) is a chronic autoimmune cholestatic liver disease frequently characterized by anti-mitochondrial autoantibodies (AMA). A minority of patients are AMA-negative. Cytotoxic-T-Lymphocyte-Antigen-4 (CTLA-4) is a surface molecule expressed on activated T-cells delivering a critical negative immunoregulatory signal. A soluble form of CTLA-4 (sCTLA-4) has been detected at high concentrations in several autoimmune diseases, and its possible functional meaning has been suggested. We aimed to evaluate sCTLA-4 concentration in sera of patients with PBC and to correlate it to immunological abnormalities associated with the disease. Blood samples were collected from 82 PBC-patients diagnosed according to international criteria (44 AMA-positive/MIT3-positive and 38 AMA-negative-MIT3-negative), and 65 controls. sCTLA-4 levels were evaluated by ELISA and Western blot. Increased sCTLA-4 concentrations were found in all AMA-positive PBC-patients, but in none of the AMA-negative ones, nor in normal controls or in controls with unrelated liver diseases. sCTLA-4 presence was associated with autoantibodies against MIT3, but not with nuclear autoantibodies (sp100, gp210). This is the first study to demonstrate that levels of sCTLA-4 are elevated in sera of PBC patients. However, they are clearly restricted to patients with AMA positivity, suggesting an immunological difference with respect to AMA-negative ones.
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Affiliation(s)
- Daniele Saverino
- Department of Experimental Medicine – Section of Human Anatomy, University of Genova, Genova, Italy
| | - Giampaola Pesce
- Autoimmunity Unit, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Princey Antola
- Autoimmunity Unit, Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Ignazio Brusca
- Department of Clinical Pathology, Buccheri La Ferla Hospital, Palermo, Italy
| | - Danilo Villalta
- Allergology and Clinical Immunology, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Marilina Tampoia
- Laboratory of Clinical Pathology, University Hospital, Bari, Italy
| | - Renato Tozzoli
- Clinical Pathology, Department of Laboratory Medicine, S. Maria degli Angeli Hospital, Pordenone, Italy
| | - Elio Tonutti
- Immunopathology and Allergology Unit, S. Maria della Misericordia Hospital, Udine, Italy
| | - Maria Grazia Alessio
- Department of Laboratory Medicine, Biochemistry Laboratory, Riuniti Hospital, Bergamo, Italy
| | - Marcello Bagnasco
- Autoimmunity Unit, Department of Internal Medicine, University of Genova, Genova, Italy
| | - Nicola Bizzaro
- Laboratory of Clinical Pathology, San Antonio Hospital, Tolmezzo, Udine, Italy
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Villalta D, Girolami E, Alessio MG, Sorrentino MC, Tampoia M, Brusca I, Daves M, Porcelli B, Barberio G, Conte M, Pantarotto L, Bizzaro N. Autoantibody Profiling in a Cohort of Pediatric and Adult Patients With Autoimmune Hepatitis. J Clin Lab Anal 2014; 30:41-6. [PMID: 25242745 DOI: 10.1002/jcla.21813] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 05/28/2014] [Accepted: 08/25/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Autoimmune hepatitis (AIH) is a rare condition characterized by the presence of autoantibodies distinctive of type 1 AIH (AIH-1) and type 2 AIH (AIH-2). The aim of this study was to evaluate the autoantibody profile in a cohort of pediatric and adult AIH patients, using both indirect immunofluorescence (IIF) and a new multiplexed line-blot assay. METHODS Sera from 63 pediatric and 53 adult AIH patients were tested for antinuclear (ANA), antismooth muscle (SMA), anti-liver kidney microsome 1 (anti-LKM1), anti-liver cytosol 1 (anti-LC1) autoantibodies using IIF methods; for anti-LKM1, anti-LC1, and soluble liver antigen/liver-pancreas (anti-SLA/LP) autoantibodies using the line-blot; for anti-F-actin autoantibodies using IIF both on VSM47 cell-line and on rat intestinal epithelial cells. RESULTS AIH-1 was the most common type of AIH in the adult cohort (73.6%), while AIH-2 was the most common AIH in the pediatric cohort (61.9%). Both in adult and pediatric AIH-2 anti-LKM1 were the prevalent autoantibodies. In pediatric AIH-2 anti-LC1 autoantibodies were more frequent than in adult AIH-2 (59 vs. 28.6%), and in 35.9% of cases they were present alone. In 17 patients anti-LC1 autoantibodies were detected only with the line-blot assay. The levels of anti-LKM1 and of anti-LC1 were not different between adult and pediatric AIH, and the overall agreement between the results obtained with the two IIF methods for F-actin detection was 98.8% (CI 95%: 94.4-99.7%). CONCLUSIONS The line-blot assay showed a higher sensitivity than IIF for anti-LC1 detection. Anti-LKM1 and anti-LC1 autoantibody levels are not different in adults and children. An almost perfect agreement between the two IIF methods for anti-F-actin detection has been observed.
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Affiliation(s)
- Danilo Villalta
- Allergologia e Immunologia Clinica, A.O. "S. Maria degli Angeli", Pordenone, Italy
| | - Elia Girolami
- Dipartimento di Oncoematologia Pediatrica e Medicina Trasfusionale, Ospedale Bambino Gesù, Roma, Italy
| | | | | | - Marilina Tampoia
- Laboratorio di Patologia Clinica, Policlinico Consorziale di Bari, Italy
| | - Ignazio Brusca
- Patologia Clinica, Ospedale Buccheri La Ferla, Palermo, Italy
| | - Massimo Daves
- Laboratorio Centrale, Ospedale Civile, Merano (BZ), Italy
| | | | | | | | - Lisa Pantarotto
- Allergologia e Immunologia Clinica, A.O. "S. Maria degli Angeli", Pordenone, Italy
| | - Nicola Bizzaro
- Patologia Clinica, Ospedale Civile, Tolmezzo (UD), Italy
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Manoni F, Gessoni G, Alessio MG, Caleffi A, Saccani G, Epifani MG, Tinello A, Zorzan T, Valverde S, Caputo M, Lippi G. Gender's equality in evaluation of urine particles: Results of a multicenter study of the Italian Urinalysis Group. Clin Chim Acta 2014; 427:1-5. [DOI: 10.1016/j.cca.2013.09.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/15/2013] [Accepted: 09/15/2013] [Indexed: 11/24/2022]
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Manoni F, Gessoni G, Caleffi A, Alessio MG, Rosso R, Menozzi P, Tinello A, Valverde S, Azzarà G, Lippi G. Pediatric reference values for urine particle quantification by using automated flow cytometer: Results of a multicenter study of Italian urinalysis group. Clin Biochem 2013; 46:1820-4. [DOI: 10.1016/j.clinbiochem.2013.09.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2013] [Revised: 08/26/2013] [Accepted: 09/08/2013] [Indexed: 11/25/2022]
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Invernizzi P, Alessio MG, Smyk DS, Lleo A, Sonzogni A, Fabris L, Candusso M, Bogdanos DP, Iorio R, Torre G. Autoimmune hepatitis type 2 associated with an unexpected and transient presence of primary biliary cirrhosis-specific antimitochondrial antibodies: a case study and review of the literature. BMC Gastroenterol 2012; 12:92. [PMID: 22816667 PMCID: PMC3464927 DOI: 10.1186/1471-230x-12-92] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Accepted: 07/20/2012] [Indexed: 12/14/2022] Open
Abstract
Background Unlike other autoimmune liver diseases, primary biliary cirrhosis (PBC) has never been reported in early childhood, while type 2 autoimmune hepatitis (AIH) is eminently a paediatric disease. Case presentation We describe a case of type 2 AIH with serological positivity for PBC-specific anti-mitochondrial antibodies (AMA) in a 3-year old girl. We found this observation intriguing as AMA and indeed an overlap with PBC are virtually absent in Type 2 AIH, a pediatric form of AIH which is distinct precisely because it is characterized by pathognomonic anti-liver kidney microsomal type 1 (LKM-1) showing a remarkable antigen-specificity directed against cytochrome P4502D6. We also review the literature in relation to AMA positivity in paediatric age and adolescence. In our case, the presence of AIH-2-specific anti-LKM-1 and PBC-specific AMA was confirmed by indirect immunofluorescence (IIF), and immunoblotting and ELISA based on recombinant mitochondrial antigens. The clinical, laboratory and histological features of the child are given in detail. Interestingly the mother was AMA positive without other features of PBC. The child was successfully treated with immunosuppression and five years after the original diagnosis is on a low dose of prednisolone and azathioprine, with no signs of relapse. Anti-LKM-1 antibodies are still present in low titres. AMA were detectable for the first 4 years after the diagnosis and disappeared later. Conclusion This is the first case report in the literature of AIH type 2 with an unexpected PBC-specific AMA positivity in a young child. Response to immunosuppressive treatment was satisfactory and similar to that described in AIH. A review of published reports on AMA positivity in paediatric age shows that the antibody may arise in the context of immunodeficiency and is variably associated with liver damage.
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Affiliation(s)
- Pietro Invernizzi
- Center for Autoimmune Liver Diseases, Humanitas Clinical and Research Center, Via Manzoni 56, 20089, Rozzano(MI), Italy.
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Manoni F, Gessoni G, Alessio MG, Caleffi A, Saccani G, Silvestri MG, Poz D, Ercolin M, Tinello A, Valverde S, Ottomano C, Lippi G. Mid-stream vs. first-voided urine collection by using automated analyzers for particle examination in healthy subjects: an Italian multicenter study. Clin Chem Lab Med 2012; 50:679-84. [DOI: 10.1515/cclm.2011.823] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 11/14/2011] [Indexed: 11/15/2022]
Abstract
AbstractIn analogy with other areas of laboratory diagnostics, the pre-analytical phase is the leading source of variability also in urinalysis. We carried out a multicentric study for comparing results obtained from first-voided and mid-stream urine samples.Each of the six hospital-based clinical laboratories participating to this study recruited 50 healthy subjects among laboratory staff and/or their relatives. Two consecutive samples of the first morning micturition were collected by vacuum system, the first from the first-void and the second from the mid-stream. Routine urinalysis was performed using dip-stick automated analyzers for chemical examination and automated analyzers for formed particle examination (Sysmex UF-100, Sysmex UF-1000i and Iris iQ-200).Counts of epithelial cells (EC), erythrocytes (ERY) and leukocytes (LEU) but not for cylinders (CAS) were significantly higher in the first-voided samples. A significantly higher count of EC, ERY and LEU was also observed between females and males in first-voided samples, whereas no significant difference could be found in mid-stream samples. Health related analyzer specific upper reference limits (URL) were CAS≤1, EC≤5, ERY≤19, Leu≤13 for UF-100; CAS≤1, EC≤4, ERY≤15, Leu≤11 for UF-1000i; CAS≤1, EC≤4, ERY≤18, Leu≤10 for iQ200. The overall prevalence of subjects with cellular elements count exceeding URL was also higher in first-voided than in mid-stream samples.Mid-stream urine was confirmed as the most appropriate sample, since the presence of contaminating elements, such as bacteria, analytes and formed particles are minimized.
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Manoni F, Caleffi A, Gessoni G, Alessio MG, Lippi G, Valverde S, Ottomano C, Silvestri MG, Cappelletti P, Ercolin M, Schinella M, Saccani G. L’esame delle urine chimico morfologico e colturale: proposta di linee guida per una procedura standardizzata della fase preanalitica. ACTA ACUST UNITED AC 2011. [DOI: 10.1007/s13631-011-0005-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fabris M, De Vita S, Visentini D, Fabro C, Picierno A, Lerussi A, Villalta D, Alessio MG, Tampoia M, Tonutti E. B-lymphocyte stimulator and a proliferation-inducing ligand serum levels in IgA-deficient patients with and without celiac disease. Ann N Y Acad Sci 2009; 1173:268-73. [PMID: 19758161 DOI: 10.1111/j.1749-6632.2009.04628.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
IgA deficiency (IgAD) is the most common form of immunodeficiency and frequently associates with autoimmunity, especially with celiac disease (CD). The mechanisms underlying IgAD and the development of autoimmunity are still relatively unknown. Elevated B-lymphocyte stimulator (BLyS) and APRIL (a proliferation-inducing ligand) serum levels characterize several autoimmune diseases. We herein investigated BLyS and APRIL serum levels in IgAD patients with and without CD and compared these patients to CD patients with normal IgA and control patients (HBDs). Compared to HBDs, IgAD patients demonstrated a significant increase of BLyS (P < 0.0001) and APRIL (P = 0.003) levels, and no differences were seen between patients with or without CD. While BLyS appeared similarly overexpressed in IgAD and CD patients, APRIL was significantly increased only in IgAD patients. Because APRIL promotes IgA production, its overexpression may represent a physiological mechanism of compensation. BLyS upregulation may be involved in the increased risk of autoimmune disease development characterizing people carrying IgAD.
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Affiliation(s)
- Martina Fabris
- Clinic of Rheumatology, Azienda Ospedaliero-Universitaria of Udine, Udine, Italy.
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Villalta D, Alessio MG, Tampoia M, Tonutti E, Brusca I, Bagnasco M, Pesce G, Bizzaro N. Diagnostic accuracy of IgA anti-tissue transglutaminase antibody assays in celiac disease patients with selective IgA deficiency. Ann N Y Acad Sci 2007; 1109:212-20. [PMID: 17785308 DOI: 10.1196/annals.1398.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinical studies have estimated a 10- to 20-fold increased risk for celiac disease (CD) in patients with selective IgA deficiency (SIgAD). For this reason, screening for CD is mandatory in SIgAD patients, but it represents a special challenge since the specific IgA class antibodies against gliadin (AGA), endomysium (EMA), and tissue-transglutaminase (tTG) are not produced in patients with CD. IgG class counterparts of these antibodies may be informative; in particular IgG EMA has been demonstrated to be a valid marker for diagnosing CD in SIgAD cases, but it is not used much in clinical laboratories, because it is cumbersome and involves some technical difficulties. Even if it was widely used in clinical laboratories, the measuring of IgG AGA has shown a less-than-optimum diagnostic accuracy, so that now it tends to be substituted by tests for anti-tTG IgG, for which the few available studies have shown diagnostic performances superior to AGA. Since it is not known whether various available methods for measuring IgG anti-tTG antibodies offer similar diagnostic performances, we have compared the results obtained from nine second-generation commercial methods (D-tek, Phadia, Immco, Orgentec, Radim, Euroimmun, Inova, Aesku, Generic Assays), measuring IgG anti-tTG antibodies in 20 patients with CD and SIgAD and in 113 controls (9 patients with SIgAD without CD, 54 patients with chronic liver disease, and 50 healthy individuals). Diagnostic sensitivity, calculated by means of ROC plot analysis, ranged between 75% and 95%, and specificity ranged from 94% to 100%. In the same population, the diagnostic sensitivity and specificity of AGA IgG were 40% and 87%, respectively. Even though they perform differently, all IgG anti-tTG methods evaluated are reliable serological assays for the diagnosis of CD in SIgAD patients, with diagnostic accuracy superior to the AGA IgG method. The methods that use a mix of tTG and gliadin peptides as the antigenic preparation have a specificity slightly lower than that of the methods that use only tTG.
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Affiliation(s)
- D Villalta
- Immunologia Clinica e Virologia, A.O. S Maria degli Angeli, Via Montereale 24, 33170 Pordenone, Italy.
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Bizzaro N, Tonutti E, Visentini D, Alessio MG, Platzgummer S, Morozzi G, Antico A, Villalta D, Piller-Roner S, Vigevani E. Antibodies to the lens and cornea in anti-DFS70-positive subjects. Ann N Y Acad Sci 2007; 1107:174-83. [PMID: 17804545 DOI: 10.1196/annals.1381.019] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [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
Autoantibodies against DFS70 (dense fine speckles 70) antigen have recently been identified among antinuclear antibodies (ANA) in patients with various inflammatory diseases and in patients with different types of cancer. These antibodies are recognized using indirect immunofluorescence (IIF) on HEp-2 cells, by a fine speckled nuclear staining in interphase HEp-2 cells and a positive reaction in the chromosome region of mitotic cells. Given that the DFS70 protein is also known as the lens epithelium-derived growth factor, this study was performed with two objectives: (a) to assess the prevalence of these antibodies in patients sent for ANA testing and in 334 patients with different types of neoplasia and (b) to determine whether the lens tissue was a suitable substrate for the detection of antibodies specific to lens proteins. During routine workup for ANA detection by the IIF method, we found 172 DFS70-positive sera among 21,516 consecutive samples (prevalence, 0.8%). In the group of patients with neoplastic disease, 6 of 334 (1.8%) were anti-DFS70-positive. DFS70-positive sera were then assayed by the IIF method on cryostatic sections of mouse eye at a dilution of 1:40 with an anti-human IgG conjugate. Among the 172 DFS70-positive samples detected by the ANA screening, 32 (19%) were strongly reactive against the reticular fibers of the lens; 8 (5%) were positive only to the corneal epithelium (nuclear negative); 5 (3%) were positive both for the cornea and the lens fibers; 13 (7%) stained only the nuclei of lens and cornea cells, and 4 (2%) were positive against the ciliary muscle. Among the patients with neoplastic diseases, only one with lung cancer reacted weakly with the reticular fibers of the lens. Sera from 20 healthy blood donors were negative. In this preliminary study, we have shown that the prevalence of anti-DFS70 antibodies is much lower than previously reported, both in patients screened for ANA and in patients with cancer. We have also seen that some DFS70-positive sera have antibodies that recognize antigens of the lens. Further studies are needed to investigate the fine specificity and the possible significance of these new autoantibodies.
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Affiliation(s)
- Nicola Bizzaro
- Laboratorio di Patologia Clinica, Ospedale di Tolmezzo, Italy.
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Carroccio A, Brusca I, Iacono G, Alessio MG, Sonzogni A, Di Prima L, Barrale M, Ottomano C, Ambrosiano G, Teresi S, D'Angelo A, Pirrone G, Cefalù B, Scalici C, La Chiusa SM. IgA anti-actin antibodies ELISA in coeliac disease: a multicentre study. Dig Liver Dis 2007; 39:818-23. [PMID: 17652043 DOI: 10.1016/j.dld.2007.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 05/25/2007] [Accepted: 06/05/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies have demonstrated that serum anti-actin antibodies are a reliable marker of intestinal damage severity in coeliac disease. AIMS To validate in a multicentre study the clinical usefulness of serum IgA anti-actin antibody ELISA and its possible use in monitoring intestinal mucosa lesions during gluten-free diet. PATIENTS AND METHODS Four centres recruited 205 newly diagnosed coeliac disease patients with villous atrophy, 80 healthy controls and 81 "disease" controls. Twelve coeliac disease patients on gluten-free diet but with persistent symptoms underwent serum IgA anti-actin antibody assay and intestinal histology evaluation. IgA anti-actin antibody ELISA was performed with a commercial kit. All coeliac disease patients underwent intestinal histology study. RESULTS IgA anti-actin antibodies showed a sensitivity of 80% and a specificity of 85% in the diagnosis of coeliac disease patients with villous atrophy. The area under the receiving operator curve for anti-actin antibodies was 0.873 [95% C.I. 0.805-0.899]. Serum anti-actin antibodies values were significantly higher in coeliac disease patients than in healthy or "disease" controls (P<0.0001). Serum anti-actin antibodies were positive in 41 of the 60 coeliac disease patients with mild intestinal histology lesions (69%) and in 123 of the 145 with severe lesions (85.3%) (P<0.05). There was a significant inverse correlation between anti-actin antibody values and the villi/crypts ratio (r=-0.423; P<0.0001). In the 12 coeliac disease patients on gluten-free diet who underwent re-evaluation as they were persistently symptomatic, intestinal histology showed three cases with persistent villous atrophy: all of these were positive for serum anti-actin antibodies ELISA, whereas both serum anti-tTG and EmAs were negative. The other nine patients showed normal intestinal villi and were negative for serum anti-actin antibodies. CONCLUSIONS Anti-actin antibodies are a reliable marker of severe intestinal mucosa damage in coeliac disease patients and a simple ELISA technique offers an accurate method for their determination. These antibodies seem to be a very reliable marker of persistent intestinal damage in coeliac disease patients.
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Affiliation(s)
- A Carroccio
- Internal Medicine, University Hospital, Palermo, via del Vespro 141, 90127 Palermo, Italy.
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Villalta D, Alessio MG, Tampoia M, Tonutti E, Brusca I, Bagnasco M, Pesce G, Stella S, Bizzaro N. Testing for IgG class antibodies in celiac disease patients with selective IgA deficiency. A comparison of the diagnostic accuracy of 9 IgG anti-tissue transglutaminase, 1 IgG anti-gliadin and 1 IgG anti-deaminated gliadin peptide antibody assays. Clin Chim Acta 2007; 382:95-9. [PMID: 17490629 DOI: 10.1016/j.cca.2007.03.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2007] [Revised: 03/30/2007] [Accepted: 03/30/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND To evaluate the diagnostic characteristics of commercially available IgG anti-tTG assays in selective IgA deficiency (SIgAD), we tested different IgG anti-tTG methods and compared the results with those obtained from two other tests: one for IgG anti-gliadin (AGA) and one for IgG to deaminated gliadin peptides (DGP). METHODS 20 CD patients with SIgAD and 113 controls (9 patients with SIgAD without CD; 54 patients with chronic liver disease; 50 healthy subjects) were tested with 9 IgG anti-tTG assays (2 of which are enriched with gliadin peptides), one IgG AGA assay and one IgG anti-DGP assay. RESULTS Using optimal cutoffs as determined by ROC curves, the sensitivity of IgG anti-tTG methods ranged from 75% (1 kit) to 95% (7 kits) and the specificity from 94% (1 kit) to 100% (5 kits). Sensitivity and specificity were 40% and 87% for IgG AGA, and 80% and 98% for IgG anti-DGP, respectively. CONCLUSIONS All IgG anti-tTG methods evaluated are reliable serologic assays for the diagnosis of CD in patients with SIgAD and perform better than the gliadin-based assays used in this study. The tests containing both tTG and gliadinic peptides are burdened by a lower specificity than the anti-tTG assays.
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Affiliation(s)
- Danilo Villalta
- Immunologia Clinica e Virologia, AO S Maria degli Angeli, Via Montereale 24, Pordenone, Italy.
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Riva S, Sonzogni A, Bravi M, Bertani A, Alessio MG, Candusso M, Stroppa P, Melzi ML, Spada M, Gridelli B, Colledan M, Torre G. Late graft dysfunction and autoantibodies after liver transplantation in children: preliminary results of an Italian experience. Liver Transpl 2006; 12:573-7. [PMID: 16555335 DOI: 10.1002/lt.20673] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Late graft dysfunction (GD) associated with the development of autoantibodies is a common event after pediatric liver transplantation (OLTx) and can present in 2 clinicohistological subsets: de novo autoimmune hepatitis (DNAH) and early chronic rejection (ECR). Sixty out of 247 children developed autoantibodies after OLTx. GD was demonstrated in 22 (37%); based on histology, patients were divided in a DNAH and an ECR group. Portal/periportal inflammatory infiltrate with interface/lobular hepatitis was suggestive for DNAH. Pericentral hepatocytes confluent dropout with a variable degree of central vein endothelitis, but not with ductopenia (loss of >50% of interlobular bile ducts), was diagnosed as ECR. Nine patients had DNAH and 13 ECR. Five out of 9 in the DNAH group were on cyclosporin (CsA) and 4/9 were on tacrolimus (Tac). In the ECR group, 11 children were treated with CsA and 2 with Tac. All DNAH patients had normal liver function tests on steroids and azathioprine (AZA). Five patients with ECR recovered by increasing calcineurin inhibitors (CNIs) dosage, but in 8/13, including 7 switched from CsA to Tac, AZA and steroids were added to obtain remission of disease. Two patients developed late chronic rejection. DNAH and ECR associated with autoantibodies are forms of late GD after OLTx. DNAH improves after standard treatment of autoimmune hepatitis. ECR has a good response to increased doses of CNIs, although ductopenic chronic rejection may occur. In conclusion, the early differential diagnosis of these conditions and an appropriate treatment seem to allow good overall results reflected by a graft survival of more than 90%.
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Affiliation(s)
- Silvia Riva
- Pediatric Unit, Ospedali Riuniti, Bergamo, Italy [corrected]
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Petrini C, Alessio MG, Scapellato L, Brambilla S, Franzini C. Serum proteins by capillary zone electrophoresis: approaches to the definition of reference values. Clin Chem Lab Med 1999; 37:975-80. [PMID: 10616752 DOI: 10.1515/cclm.1999.144] [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: 11/15/2022]
Abstract
The Paragon CZE 2000 (Beckman Analytical, Milan, Italy) is an automatic dedicated capillary zone electrophoresis (CZE) system, producing a five-zone serum protein pattern with quantitative estimation of the zones. With the view of substituting this instrument for two previously used serum protein electrophoresis techniques, we planned to produce reference values for the "new" systems leading to compatible interpretation of the results. High resolution cellulose acetate electrophoresis with visual inspection and descriptive reporting (HR-CAE) and five-zone cellulose acetate electrophoresis with densitometry (CAE-D) were the previously used techniques. Serum samples (n = 167) giving "normal pattern" with HR-CAE were assayed with the CZE system, and the results were statistically assessed to yield 0.95 reference intervals. One thousand normal and pathological serum samples were then assayed with the CAE-D and the CZE techniques, and the regression equations of the CAE-D values over the CZE values for the five zones were used to transform the CAE-D reference limits into the CZE reference limits. The two sets of reference values thereby produced were in good agreement with each other and also with reference values previously reported for the CZE system. Thus, reference values for the CZE techniques permit interpretation of results coherent with the previously used techniques and reporting modes.
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Affiliation(s)
- C Petrini
- Laboratorio di Biochimica, Ospedale San Carlo, Milano, Italy
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Bani MR, Falanga A, Alessio MG, Radice E, Consonni R, Giavazzi R, Donati MB. Blood coagulation changes in nude mice bearing human colon carcinomas. Int J Cancer 1992; 50:75-9. [PMID: 1728616 DOI: 10.1002/ijc.2910500116] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
We studied several blood coagulation parameters and tumor tissue procoagulant activity (PCA) in nude mice bearing human colorectal carcinomas (HCC). In a control group of 51 tumor-free nude mice, platelet number was 1.2 +/- 0.03 x 10(6)/microliters, thrombotest activity 90% +/- 2.6 and fibrinogen 172 +/- 11 mg/dl. The same parameters were studied in nude mice (n = 71) bearing 7 different HCC lines subcutaneously (s.c.). The results did not significantly differ from those in control mice but there was broad variability among groups of mice injected with different HCC lines, ranging from 0.36 to 2.55 x 10(6)/microliters for platelets, from 100 to 28% for thrombotest activity and from 42 to 460 mg/dl for fibrinogen. The results were significantly (p less than 0.05) different from those in the tumor-free group when each group of HCC-bearing animals was analyzed individually. A malignant HCC line that grew in the liver of nude mice (n = 24) significantly (p less than 0.001) reduced thrombotest activity (58% +/- 5.9). The PCA of tissue extracts from tumors grown s.c. in nude mice was assayed. All the HCC xenografts expressed PCA which differed significantly for the various tumor lines (from 25.5 +/- 1.9 to 2.8 +/- 0.6 unit/mg in tumor tissue). Cancer procoagulant (CP), a cysteine proteinase with a direct factor-X-activating effect, was present in different amounts (84.7 +/- 4.3 to 59.5 +/- 9.0%) in the tumors. Our results indicates that the nude mouse is a suitable model for evaluating the hemostatic changes induced by human tumors and may represent a tool for investigating the underlying biochemical mechanisms.
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Affiliation(s)
- M R Bani
- Istituto di Ricerche Farmacologiche Mario Negri, Bergamo, Italy
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Donati MB, Falanga A, Consonni R, Alessio MG, Bassan R, Buelli M, Borin L, Catani L, Pogliani E, Gugliotta L. Cancer procoagulant in acute non lymphoid leukemia: relationship of enzyme detection to disease activity. Thromb Haemost 1990; 64:11-6. [PMID: 2274915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Blast cell extracts from patients with acute non lymphoid leukemia (ANLL) express cancer procoagulant (CP). This factor X (FX) activator is distinct from tissue factor (TF) in that it does not require factor VII (FVII) to trigger blood coagulation, it acts as a cysteine proteinase and is not present in normal mononuclear cells. To assess whether there is any relationship between the presence of CP and the status of the disease, ANLL patients have been studied at diagnosis, during remission, at relapse. The procoagulant activity in either the presence or absence of F VII and sensitivity to cysteine proteinase inhibitors were tested on cell extracts. Immunoreactivity was explored with an anti-CP polyclonal antibody. Data obtained in 91 newly-diagnosed ANLL patients (subtypes M1 to M5, FAB classification) confirmed the presence of CP in M1 to M4 groups (mean +/- SE FVII-independent activity: M1 = 2.1 +/- 0.7 unit/mg; M2 = 5.7 +/- 1.7 unit/mg; M3 = 31.5 +/- 8 unit/mg; M4 = 1.6 +/- 1.2 unit/mg); CP was absent in the M5 type. In eight patients analyzed in a subsequent phase of partial remission, specific activity had dropped from 26.9 +/- 7.8 to 10.5 +/- 4.0 unit/mg. Activity was virtually absent (0-0.05 unit/mg) in the bone marrow of 37 patients studied at complete remission. Bone marrow samples from six subjects tested at different intervals after complete remission were repeatedly negative for CP but became positive 2 to 5 months before relapse. Upon relapse, the FVII independent activity rose to 24.2 +/- 8.2 unit/mg.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M B Donati
- Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Italy
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Abstract
In a previous study we characterized cancer procoagulant (CP), a 68 kd cysteine proteinase which directly activates coagulation factor X in various subtypes (from M1 to M5) of acute non-lymphoblastic leukemia (ANLL). The aim of this study was to determine whether CP is also expressed by acute lymphoblastic leukemia (ALL) cells. Blasts from 25 ALL patients were extracted and tested for their procoagulant properties. 16 samples (64%) shortened the recalcification time of normal human plasma, and 9 (36%) did not. 8 of the 16 active samples showed properties compatible with CP, i.e. independence from factor VII in triggering blood coagulation and sensitivity to cysteine proteinase inhibitors. Selected samples also cross-reacted with a polyclonal antibody raised against purified CP. The specific activity of CP in ALL extracts was significantly lower than in most ANLL types previously studied (all but M4). These finding indicate that CP can be a property of the lymphoid phenotype although its expression may be lower than in the myeloid phenotype.
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Affiliation(s)
- M G Alessio
- Divisione di Ematologia, Ospedali Riuniti, Bergamo, Italy
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Roncaglioni MC, Falanga A, D'Alessandro AP, Alessio MG, Casali B, Donati MB. Evidence of a warfarin-sensitive cancer procoagulant in V2 carcinoma. Haematologica 1989; 74:143-7. [PMID: 2501168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Rabbit V2 carcinoma tissue is the tumor in which cancer procoagulant activity (CP) was first described, purified and identified as a cysteine proteinase able to activate F X directly. In the present study we show that CP of V2 carcinoma extracts is depressed in its biological activity (although the antigen is present) by warfarin treatment. The biochemical basis for this effect is offered by the identification of Vit.K-dependent gamma-carboxylase in the microsomal fraction of the tumor tissue. V2 carcinoma tissue had very low endogenous substrate(s) of tumor carboxylase in basal conditions but this increased threefold after warfarin. The accumulation of endogenous substrate(s) and the depression of the CP activity by warfarin raises the possibility that CP represents at least one of the substrates for gamma-glutamyl carboxylase in this experimental tumor tissue.
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Curatolo L, Alessio MG, Casali B, Falanga A, Donati MB, Semeraro N. Procoagulant activity of mouse transformed cells: different expression in freshly isolated or cultured cells. In Vitro Cell Dev Biol 1988; 24:1154-8. [PMID: 3209584 DOI: 10.1007/bf02624183] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study was originally designed to investigate whether there is any correlation between the type of procoagulant activity (PCA) and the tumorigenicity of transformed cells. The data obtained are relevant to this question and to defining the differences in the expression of cellular activities depending on the in vitro system used. PCA was measured and characterized in normal, immortalized, and tumorigenic mouse fibroblasts. In all the cell lines studied the activity was of tissue factor type, as established with functional, enzymatic, and immunochemical criteria. However, the PCA of cells freshly isolated from the tumors induced by tumorigenic cell lines was of cancer procoagulant type, i.e. a cysteine protease with direct factor X activator activity. The same cells, when cultured in vitro, expressed again PCA of tissue-factor type. These results suggest that either a tumor-host interaction is required for the expression of cancer procoagulant or the latter activity, produced by tumor cells under in vitro conditions, is destroyed or inactivated during the culture period. Our findings caution against defining the procoagulant activity of tumors based on experiments on cultured cells.
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Affiliation(s)
- L Curatolo
- Istituto di Ricerche Farmacologiche Mario Negri, Milano, Italy
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Grignani G, Falanga A, Pacchiarini L, Alessio MG, Zucchella M, Fratino P, Donati MB. Human breast and colon carcinomas express cysteine proteinase activities with pro-aggregating and pro-coagulant properties. Int J Cancer 1988; 42:554-7. [PMID: 3170028 DOI: 10.1002/ijc.2910420414] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
We have investigated concomitantly the pro-aggregating and pro-coagulant activities of 11 breast and 2 colon human carcinomas. Tumor tissues, obtained at surgery, were immediately processed to prepare tumor-cell suspensions for the study of aggregating activity and tissue extracts for the study of procoagulant capacity. Nine carcinomas (8 breast and 1 colon) possessed a high, dose-dependent platelet-aggregating activity, which was present in the cell-free supernatant and was inhibited by HgCl2 and iodoacetic acid, specific cysteine proteinase inhibitors, while apyrase and hirudin had no significant effect; in contrast, the other tumors did not aggregate platelets. All the tumor extracts tested from 12 carcinomas (11 breast and 1 colon) were able to activate blood coagulation in both the presence and the absence of F VII. The activity was inhibited by HgCl2 and iodoacetamide, while Con A was less effective. Therefore, these tumors do not aggregate platelets through the production of ADP or thrombin, nor promote blood coagulation through the production and release of tissue factor; a tumor-associated cysteine proteinase plays a major role in both pro-aggregating and pro-coagulant activities.
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Affiliation(s)
- G Grignani
- Department of Internal Medicine, University of Pavia, I.R.C.C.S. Policlinico S. Matteo, Italy
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Falanga A, Alessio MG, Donati MB, Barbui T. A new procoagulant in acute leukemia. Blood 1988; 71:870-5. [PMID: 3355894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
To verify whether cancer procoagulant (CP), a cysteine proteinase procoagulant distinct from tissue factor (TF), is associated with leukemic cells, we assayed the procoagulant activity of blast cell extracts from 26 patients with different cytological subtypes of acute nonlymphoid leukemia (ANLL) according to the French-American-British classification. All the samples except two shortened the recalcification time of normal human plasma, the effect being significantly greater in the M3 subgroup. The two criteria used to distinguish between CP and TF, independence from factor VII in initiating blood coagulation and sensitivity to cysteine-proteinase inhibitors, were positive in 19 samples from M1, M2, M3, and M4 cytological subtypes. None of the M5 samples fulfilled these criteria. In addition, M1, M2, M3, and M4 samples immunoreacted with an anti-CP goat polyclonal antibody on an Ouchterlony immunodiffusion plate. This study provides the first evidence for a procoagulant other than TF that is associated with leukemic cells.
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Affiliation(s)
- A Falanga
- Istituto di Ricerche Farmacologiche Mario Negri, Milano
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