1
|
Sgalla G, Leone PM, Gualano G, Simonetti J, Comes A, Verdirosi D, Di Gennaro F, Larici AR, Ianniello S, Cicchetti G, Fusco N, Pani M, Palmieri F, Richeldi L. A randomized trial of pamrevlumab in patients with COVID-19 pneumonia. Respirology 2023; 28:954-957. [PMID: 37605035 DOI: 10.1111/resp.14575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Affiliation(s)
- Giacomo Sgalla
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Paolo Maria Leone
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gina Gualano
- UOC Malattie Infettive dell'Apparato Respiratorio, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Jacopo Simonetti
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessia Comes
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Diana Verdirosi
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Di Gennaro
- UOC Malattie Infettive dell'Apparato Respiratorio, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Anna Rita Larici
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefania Ianniello
- UOSD Diagnostica per Immagini nelle Malattie Infettive, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Giuseppe Cicchetti
- Dipartimento Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Nicoletta Fusco
- UOSD Diagnostica per Immagini nelle Malattie Infettive, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Marcello Pani
- UOC Farmacia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Fabrizio Palmieri
- UOC Malattie Infettive dell'Apparato Respiratorio, Istituto Nazionale per le Malattie Infettive "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - Luca Richeldi
- UOC Pneumologia, Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
2
|
Tosato M, Calvani R, Picca A, Ciciarello F, Galluzzo V, Coelho-Júnior HJ, Di Giorgio A, Di Mario C, Gervasoni J, Gremese E, Leone PM, Nesci A, Paglionico AM, Santoliquido A, Santoro L, Santucci L, Tolusso B, Urbani A, Marini F, Marzetti E, Landi F. Effects of l-Arginine Plus Vitamin C Supplementation on Physical Performance, Endothelial Function, and Persistent Fatigue in Adults with Long COVID: A Single-Blind Randomized Controlled Trial. Nutrients 2022; 14:nu14234984. [PMID: 36501014 PMCID: PMC9738241 DOI: 10.3390/nu14234984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/25/2022] Open
Abstract
Long COVID, a condition characterized by symptom and/or sign persistence following an acute COVID-19 episode, is associated with reduced physical performance and endothelial dysfunction. Supplementation of l-arginine may improve endothelial and muscle function by stimulating nitric oxide synthesis. A single-blind randomized, placebo-controlled trial was conducted in adults aged between 20 and 60 years with persistent fatigue attending a post-acute COVID-19 outpatient clinic. Participants were randomized 1:1 to receive twice-daily orally either a combination of 1.66 g l-arginine plus 500 mg liposomal vitamin C or a placebo for 28 days. The primary outcome was the distance walked on the 6 min walk test. Secondary outcomes were handgrip strength, flow-mediated dilation, and fatigue persistence. Fifty participants were randomized to receive either l-arginine plus vitamin C or a placebo. Forty-six participants (median (interquartile range) age 51 (14), 30 [65%] women), 23 per group, received the intervention to which they were allocated and completed the study. At 28 days, l-arginine plus vitamin C increased the 6 min walk distance (+30 (40.5) m; placebo: +0 (75) m, p = 0.001) and induced a greater improvement in handgrip strength (+3.4 (7.5) kg) compared with the placebo (+1 (6.6) kg, p = 0.03). The flow-mediated dilation was greater in the active group than in the placebo (14.3% (7.3) vs. 9.4% (5.8), p = 0.03). At 28 days, fatigue was reported by two participants in the active group (8.7%) and 21 in the placebo group (80.1%; p < 0.0001). l-arginine plus vitamin C supplementation improved walking performance, muscle strength, endothelial function, and fatigue in adults with long COVID. This supplement may, therefore, be considered to restore physical performance and relieve persistent symptoms in this patient population.
Collapse
Affiliation(s)
- Matteo Tosato
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Riccardo Calvani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Correspondence: ; Tel.: +39-(06)-3015-5559
| | - Anna Picca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
| | | | - Vincenzo Galluzzo
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Hélio José Coelho-Júnior
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Angela Di Giorgio
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Clara Di Mario
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Jacopo Gervasoni
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Elisa Gremese
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Paolo Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Nesci
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | | | - Angelo Santoliquido
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Santoro
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Lavinia Santucci
- Metabolomics Research Core Facility, Gemelli Science and Technology Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Barbara Tolusso
- Immunology Core Facility, Gemelli Science Technological Park (GSTeP), Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Andrea Urbani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Biochemistry and Clinical Biochemistry, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Federico Marini
- Department of Chemistry, Sapienza University of Rome, 00185 Rome, Italy
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
- Department of Geriatrics and Orthopedics, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| |
Collapse
|
3
|
Leone PM, Siciliano M, Simonetti J, Lopez A, Zaman T, Varone F, Richeldi L. Ventilatory Support in Patients with COVID-19. Adv Exp Med Biol 2021; 1318:469-483. [PMID: 33973195 DOI: 10.1007/978-3-030-63761-3_27] [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: 01/08/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused the novel coronavirus disease 2019 (COVID-19) pandemic, which spread throughout the world. Acute hypoxemic respiratory failure is the most dangerous complication of COVID-19 pneumonia. To date, no specific therapeutic drugs or vaccines have been proven efficacious. Ventilatory support is still a significant challenge for physicians facing COVID-19. The mechanisms underlying hypoxemia in those patients are not fully understood, but a new physiopathology model has been proposed. Oxygen therapy should be delivered to patients with mild to moderate hypoxemia. More severe patients could benefit from other treatments (high-flow nasal cannula, noninvasive ventilation or intubation, and invasive ventilation). Given the rapid evolution of COVID-19, there has been a paucity of the high-quality data that typically inform clinical practice guidelines from professional societies, and a worldwide consensus is still lacking. This chapter aims to illustrate the potentials of ventilatory support as therapeutic options for adult and pediatric patients affected by COVID-19 pneumonia.
Collapse
Affiliation(s)
- Paolo Maria Leone
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy.
- Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Matteo Siciliano
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Jacopo Simonetti
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelena Lopez
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Tanzira Zaman
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Francesco Varone
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
4
|
Leone PM, Richeldi L. Interstitial lung abnormalities a risk factor for rheumatoid arthritis interstitial lung disease progression: what's new. Breathe (Sheff) 2020; 16:200223. [PMID: 33664837 PMCID: PMC7910034 DOI: 10.1183/20734735.0223-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Rheumatoid arthritis (RA) is a connective tissue disease in which pulmonary involvement is common [4]. Individuals with RA-ILD show a poor prognosis [5], worse than RA patients without ILD. An important prognostic factor in RA-ILD is the radiological pattern, with a usual interstitial pneumonia pattern identified as independent predictor of mortality [6]. However, we are dealing with the tip of an iceberg, since there are still several undiagnosed cases of pulmonary involvement, due to their pauci-symptomatic nature. ILAs, according to previous studies, seem to be present in the 20–60% of RA patients [4, 7, 8]. ILA/ILD extension and subpleural ILA localisation are risk factors for disease progression in RA subjects. A semiquantitative method to assess ILA/ILD extent and to measure the fibrotic burden is feasible to accurately determine ILA progression.https://bit.ly/3mmMJk2
Collapse
|
5
|
Leone PM, Richeldi L. Current Diagnosis and Management of Hypersensitivity Pneumonitis. Tuberc Respir Dis (Seoul) 2020; 83:122-131. [PMID: 32185914 PMCID: PMC7105432 DOI: 10.4046/trd.2020.0012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/21/2022] Open
Abstract
Hypersensitivity Pneumonitis (HP) one of the most common interstitial lung diseases (ILDs) is characterized by exposure to an inhaled inciting antigen that leads to a host immunologic reaction determining interstitial inflammation and architectural distortion. The underlying pathogenetic mechanisms are unclear. The absence of international shared diagnostic guidelines and the lack of a "gold-standard" test for HP combined with the presence of several clinical and radiologic overlapping features makes it particularly challenging to differentiate HP from other ILDs, also in expert contests. Radiology is playing a more crucial role in this process; recently the headcheese sign was recognized as a more specific for chronic-HP than the extensive mosaic attenuation. Several classification proposals and diagnostic models have been advanced by different groups, with no prospective validation. Therapeutic options for HP have been limited to antigen avoidance and immunosuppressant drugs over the last decades. Several questions about this condition remain unanswered and there is a need for more studies.
Collapse
Affiliation(s)
- Paolo Maria Leone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
6
|
Macagno F, Leone PM, Richeldi L. Managing patients with interstitial lung disease: Two more pieces of the puzzle. Respirology 2017; 22:1481-1482. [PMID: 28980371 DOI: 10.1111/resp.13195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 12/24/2022]
Affiliation(s)
- Francesco Macagno
- Catholic University of the Sacred Heart, Division of Pulmonary Medicine, A. Gemelli University Hospital, Rome, Italy
| | - Paolo Maria Leone
- Catholic University of the Sacred Heart, Division of Pulmonary Medicine, A. Gemelli University Hospital, Rome, Italy
| | - Luca Richeldi
- Catholic University of the Sacred Heart, Division of Pulmonary Medicine, A. Gemelli University Hospital, Rome, Italy
| |
Collapse
|
7
|
Varone F, Montemurro G, Macagno F, Calvello M, Conte E, Intini E, Iovene B, Leone PM, Mari PV, Richeldi L. Investigational drugs for idiopathic pulmonary fibrosis. Expert Opin Investig Drugs 2017; 26:1019-1031. [PMID: 28777013 DOI: 10.1080/13543784.2017.1364361] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION IPF is a specific form of chronic fibrosing interstitial pneumonia of unknown cause, characterized by progressive worsening in lung function and an unfavorable prognosis. Current concepts on IPF pathogenesis are based on a dysregulated wound healing response, leading to an over production of extracellular matrix. Based on recent research however, several other mechanisms are now proposed as potential targets for novel therapeutic strategies. Areas covered: This review analyzes the current investigational strategies targeting extracellular matrix deposition, tyrosine-kinase antagonism, immune and autoimmune response, and cell-based therapy. A description of the pathogenic rationale implied in each novel therapeutic approach is summarized. Expert opinion: New IPF drugs are being evaluated in the context of phase 1 and 2 clinical trials. Nevertheless, many drugs that have shown efficacy in preclinical studies, failed to exhibit the same positive effect when translated to humans. A possible explanation for these failures might be related to the known limitations of animal models of the disease. The recent development of 3D systems composed of cells from individual patients that recreate an ex-vivo model of IPF, could lead to significant improvements in disease pathogenesis and treatment. New drugs could be tested on more genuine models and clinicians could tailor therapy based on patient's response.
Collapse
Affiliation(s)
- Francesco Varone
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Giuliano Montemurro
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Francesco Macagno
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Mariarosaria Calvello
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Emanuele Conte
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Enrica Intini
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Bruno Iovene
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Paolo Maria Leone
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Pier-Valerio Mari
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| | - Luca Richeldi
- a Unità Operativa Complessa di Pneumologia , Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli , Rome , Italy
| |
Collapse
|
8
|
Macagno F, Varone F, Leone PM, Mari PV, Panico L, Berardini L, Richeldi L. New treatment directions for IPF: current status of ongoing and upcoming clinical trials. Expert Rev Respir Med 2017; 11:533-548. [DOI: 10.1080/17476348.2017.1335601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Francesco Macagno
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Francesco Varone
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Paolo Maria Leone
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Pier-Valerio Mari
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Loredana Panico
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Ludovica Berardini
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Luca Richeldi
- Università Cattolica del Sacro Cuore, Unità Operativa Complessa di Pneumologia, Fondazione Policlinico A. Gemelli, Rome, Italy
- Academic Unit of Clinical and Experimental Sciences, NIHR Southampton Respiratory Biomedical Research Unit, University Hospital Southampton, Southampton, UK
| |
Collapse
|
9
|
Molfino A, Formiconi A, Leone PM, Rossi Fanelli F, Muscaritoli M. Towards improved awareness and earlier diagnosis of early onset colorectal neoplasms. Intern Emerg Med 2014; 9:615-6. [PMID: 24986080 DOI: 10.1007/s11739-014-1101-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/23/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Alessio Molfino
- Department of Clinical Medicine, Sapienza University of Rome, Viale dell'Università 37, 00185, Rome, Italy
| | | | | | | | | |
Collapse
|