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Genet G, Genet N, Paila U, Cain SR, Cwiek A, Chavkin NW, Serbulea V, Figueras A, Cerdà P, McDonnell SP, Sankaranarayanan D, Huba M, Nelson EA, Riera-Mestre A, Hirschi KK. Induced Endothelial Cell Cycle Arrest Prevents Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia. Circulation 2024; 149:944-962. [PMID: 38126211 PMCID: PMC10954087 DOI: 10.1161/circulationaha.122.062952] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/27/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Distinct endothelial cell cycle states (early G1 versus late G1) provide different "windows of opportunity" to enable the differential expression of genes that regulate venous versus arterial specification, respectively. Endothelial cell cycle control and arteriovenous identities are disrupted in vascular malformations including arteriovenous shunts, the hallmark of hereditary hemorrhagic telangiectasia (HHT). To date, the mechanistic link between endothelial cell cycle regulation and the development of arteriovenous malformations (AVMs) in HHT is not known. METHODS We used BMP (bone morphogenetic protein) 9/10 blocking antibodies and endothelial-specific deletion of activin A receptor like type 1 (Alk1) to induce HHT in Fucci (fluorescent ubiquitination-based cell cycle indicator) 2 mice to assess endothelial cell cycle states in AVMs. We also assessed the therapeutic potential of inducing endothelial cell cycle G1 state in HHT to prevent AVMs by repurposing the Food and Drug Administration-approved CDK (cyclin-dependent kinase) 4/6 inhibitor (CDK4/6i) palbociclib. RESULTS We found that endothelial cell cycle state and associated gene expressions are dysregulated during the pathogenesis of vascular malformations in HHT. We also showed that palbociclib treatment prevented AVM development induced by BMP9/10 inhibition and Alk1 genetic deletion. Mechanistically, endothelial cell late G1 state induced by palbociclib modulates the expression of genes regulating arteriovenous identity, endothelial cell migration, metabolism, and VEGF-A (vascular endothelial growth factor A) and BMP9 signaling that collectively contribute to the prevention of vascular malformations. CONCLUSIONS This study provides new insights into molecular mechanisms leading to HHT by defining how endothelial cell cycle is dysregulated in AVMs because of BMP9/10 and Alk1 signaling deficiencies, and how restoration of endothelial cell cycle control may be used to treat AVMs in patients with HHT.
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Affiliation(s)
- Gael Genet
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Nafiisha Genet
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Umadevi Paila
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Shelby R Cain
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Aleksandra Cwiek
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Nicholas W Chavkin
- Robert M. Berne Cardiovascular Research Center (N.W.C., V.S., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Vlad Serbulea
- Robert M. Berne Cardiovascular Research Center (N.W.C., V.S., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Agnès Figueras
- Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain (A.F.)
- Oncobell Program (A.F.), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Pau Cerdà
- (P.C., A.R.-M.), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- HHT Unit, Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain (P.C., A.R.-M.)
| | - Stephanie P McDonnell
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Danya Sankaranarayanan
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Mahalia Huba
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Elizabeth A Nelson
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
| | - Antoni Riera-Mestre
- (P.C., A.R.-M.), Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- HHT Unit, Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain (P.C., A.R.-M.)
- Department of Clinical Science, Faculty of Medicine and Health Sciences, Universitat de Barcelona, Spain (A.R.-M.)
| | - Karen K Hirschi
- Department of Cell Biology (G.G., N.G., U.P., S.R.C., A.C., S.P.M., D.S., M.H., E.A.N., K.K.H.), School of Medicine, University of Virginia, Charlottesville
- Robert M. Berne Cardiovascular Research Center (N.W.C., V.S., K.K.H.), School of Medicine, University of Virginia, Charlottesville
- Department of Medicine, Yale Cardiovascular Research Center, Yale University School of Medicine, New Haven, CT (K.K.H.)
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Cerdà P, Castillo SD, Aguilera C, Iriarte A, Rocamora JL, Larrinaga AM, Viñals F, Graupera M, Riera-Mestre A. New genetic drivers in hemorrhagic hereditary telangiectasia. Eur J Intern Med 2024; 119:99-108. [PMID: 37689549 DOI: 10.1016/j.ejim.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/21/2023] [Accepted: 08/24/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is a rare vascular disease inherited in an autosomal dominant manner. Disease-causing variants in endoglin (ENG) and activin A receptor type II-like 1 (ACVRL1) genes are detected in around 90% of the patients; also 2% of patients harbor pathogenic variants at SMAD4 and GDF2. Importantly, the genetic cause of 8% of patients with clinical HHT remains unknown. Here, we present new putative genetic drivers of HHT. METHODS To identify new HHT genetic drivers, we performed exome sequencing of 19 HHT patients and relatives with unknown HHT genetic etiology. We applied a multistep filtration strategy to catalog deleterious variants and prioritize gene candidates based on their known relevance in endothelial cell biology. Additionally, we performed in vitro validation of one of the identified variants. RESULTS We identified variants in the INHA, HIF1A, JAK2, DNM2, POSTN, ANGPTL4, FOXO1 and SMAD6 genes as putative drivers in HHT. We have identified the SMAD6 p.(Glu407Lys) variant in one of the families; this is a loss-of-function variant leading to the activation of the BMP/TGFβ signaling in endothelial cells. CONCLUSIONS Variants in these genes should be considered for genetic testing in patients with HHT phenotype and negative for ACVRL1/ENG mutations.
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Affiliation(s)
- Pau Cerdà
- HHT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Sandra D Castillo
- Endothelial Pathobiology and Microenvironment Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Cinthia Aguilera
- HHT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Genetics Laboratory, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Adriana Iriarte
- HHT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Rocamora
- HHT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Molecular Signaling Group, Molecular Mechanisms and Experimental Therapy in Oncology Program (Oncobell), Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Ane M Larrinaga
- Endothelial Pathobiology and Microenvironment Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain
| | - Francesc Viñals
- Molecular Signaling Group, Molecular Mechanisms and Experimental Therapy in Oncology Program (Oncobell), Institut d'Investigacio Biomedica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Physiological Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Spain; Program Against Cancer Therapeutic Resistance (ProCURE), Institut Catala d'Oncologia (ICO), L'Hospitalet de Llobregat, Spain
| | - Mariona Graupera
- Endothelial Pathobiology and Microenvironment Group, Josep Carreras Leukaemia Research Institute, Badalona, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain; ICREA, Institució Catalana de Recerca i Estudis Avançats, Barcelona, Spain
| | - Antoni Riera-Mestre
- HHT Unit, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain; Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Department of Clinical Sciences, Faculty of Medicine and Health Sciences, Universitat de Barcelona (UB), L'Hospitalet de Llobregat, Spain.
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Riera-Mestre A, Cerdà P, Lladó L. Hereditary hemorrhagic telangiectasia relapse in liver allograft. Med Clin (Barc) 2023; 161:357-358. [PMID: 37474392 DOI: 10.1016/j.medcli.2023.06.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Antoni Riera-Mestre
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
| | - Pau Cerdà
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Laura Lladó
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain; Liver Transplant Unit, Surgery Department, Hospital Universitari Bellvitge, Barcelona, Spain
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Villanueva B, Cerdà P, Torres-Iglesias R, Rocamora JL, Figueras A, Viñals F, Riera-Mestre A. Potential angiogenic biomarkers in hereditary hemorrhagic telangiectasia and other vascular diseases. Eur J Intern Med 2023; 115:10-17. [PMID: 37225595 DOI: 10.1016/j.ejim.2023.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 05/01/2023] [Accepted: 05/15/2023] [Indexed: 05/26/2023]
Abstract
Biomarkers are new tools framed in precision and personalized medicine. Hereditary hemorrhagic telangiectasia (HHT) is a rare genetic vascular disease with disturbances in the angiogenic pathways. Descriptive evidence supports that some angiogenesis-related molecules are differently detected in HHT patients compared to healthy subjects. These molecules are also related to diagnosis, prognosis, complications and therapy monitoring in other common vascular diseases. Despite the need for improving knowledge before applying them in daily clinical practice, there are good candidates to be considered as potential biomarkers in HHT and other vascular diseases. In the present review, the authors aim to summarize and discuss current evidence regarding the main putative angiogenic biomarkers by describing the biological role of each biomarker, the evidence related to HHT and their potential use in this and other common vascular diseases from a clinical point-of-view.
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Affiliation(s)
- B Villanueva
- HHT Unit. Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - P Cerdà
- HHT Unit. Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - R Torres-Iglesias
- HHT Unit. Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - J L Rocamora
- HHT Unit. Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Figueras
- Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain; Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - F Viñals
- Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, Barcelona, Spain; Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - A Riera-Mestre
- HHT Unit. Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
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Villanueva B, Iriarte A, Torres-Iglesias R, Muñoz Bolaño M, Cerdà P, Riera-Mestre A. Aflibercept for Gastrointestinal Bleeding in Hereditary Hemorrhagic Telangiectasia: A Case Report. Medicina (Kaunas) 2023; 59:1533. [PMID: 37763652 PMCID: PMC10534796 DOI: 10.3390/medicina59091533] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/10/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023]
Abstract
Herein, we present the first described hereditary hemorrhagic telangiectasia (HHT) patient treated with aflibercept for severe GI involvement after tachyphylaxis to bevacizumab, with promising results. HHT is a rare genetic disease characterized by systemic vascular malformations. Gastrointestinal telangiectasia is one of the major involvements that can produce chronic severe iron-deficiency anemia. Nowadays, support treatment with iron replacement therapy, red blood cell transfusions, and antiangiogenic drugs-mainly bevacizumab, a monoclonal antibody against vascular endothelial growth factor (VEGF)-are the main therapeutic options for this complication. The evidence of alternative drugs in patients with failure to this approach, such as tachyphylaxis to bevacizumab, is scarce. Aflibercept is a VEGF inhibitor with antiangiogenic properties approved for the treatment of different types of cancer and ocular neovascularization diseases.
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Affiliation(s)
- Bernat Villanueva
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (B.V.); (A.I.); (R.T.-I.); (P.C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Adriana Iriarte
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (B.V.); (A.I.); (R.T.-I.); (P.C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Raquel Torres-Iglesias
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (B.V.); (A.I.); (R.T.-I.); (P.C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Miriam Muñoz Bolaño
- Pharmacist Department, Hospital Universitari Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain;
| | - Pau Cerdà
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (B.V.); (A.I.); (R.T.-I.); (P.C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
| | - Antoni Riera-Mestre
- HHT Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, 08907 Barcelona, Spain; (B.V.); (A.I.); (R.T.-I.); (P.C.)
- Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, 08908 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
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Torres-Iglesias R, Mora-Luján JM, Iriarte A, Cerdà P, Alba E, Sánchez-Corral MÁ, Berrozpe A, Cruellas F, Gamundí E, Ribas J, Castellote J, Riera-Mestre A. Long-term use of somatostatin analogs for chronic gastrointestinal bleeding in hereditary hemorrhagic telangiectasia. Front Med (Lausanne) 2023; 10:1146080. [PMID: 37250655 PMCID: PMC10213420 DOI: 10.3389/fmed.2023.1146080] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/27/2023] [Indexed: 05/31/2023] Open
Abstract
Background Chronic bleeding due to gastrointestinal (GI) involvement in patients with hemorrhagic hereditary telangiectasia (HHT) can provoke severe anemia with high red blood cells (RBC) transfusion requirements. However, the evidence about how to deal with these patients is scarce. We aimed to assess the long-term efficacy and safety of somatostatin analogs (SA) for anemia management in HHT patients with GI involvement. Methods This is a prospective observational study including patients with HHT and GI involvement attended at a referral center. SA were considered for those patients with chronic anemia. Anemia-related variables were compared in patients receiving SA before and during treatment. Patients receiving SA were divided into responders (patients with minimal hemoglobin levels improvement >10 g/L and maintaining hemoglobin levels ≥80 g/L during treatment), and non-responders. Adverse effects during follow-up were collected. Results Among 119 HHT patients with GI involvement, 67 (56.3%) received SA. These patients showed lower minimal hemoglobin levels (73 [60-87] vs. 99 [70.2-122.5], p < 0.001), and more RBC transfusion requirements (61.2% vs. 38.5%, p = 0.014) than patients without SA therapy. Median treatment period was 20.9 ± 15.2 months. During treatment, there was a statistically significant improvement in minimum hemoglobin levels (94.7 ± 29.8 g/L vs. 74.7 ± 19.7, p < 0.001) and a reduction of patients with minimal hemoglobin levels <80 g/L (39 vs. 61%, p = 0.007) and RBC transfusions requirement (33.9% vs. 59.3%, p < 0.001). Sixteen (23.9%) patients showed mild adverse effects, mostly diarrhea or abdominal pain, leading to treatment discontinuation in 12 (17.9%) patients. Fifty-nine patients were eligible for efficacy assessment and 32 (54.2%) of them were considered responders. Age was associated with non-responder patients, OR 95% CI; 1.070 (1.014-1.130), p = 0.015. Conclusion SA can be considered a long-term effective and safe option for anemia management in HHT patients with GI bleeding. Older age is associated with poorer response.
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Affiliation(s)
- Raquel Torres-Iglesias
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - José María Mora-Luján
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Adriana Iriarte
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Pau Cerdà
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - Esther Alba
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Radiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Miguel Ángel Sánchez-Corral
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Cardiology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Ana Berrozpe
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Francesc Cruellas
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Otorhinolaryngology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Enric Gamundí
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Cytology and Hematology Laboratory, Antamomic Pathology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jesús Ribas
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Pneumology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), Madrid, Spain
| | - Jose Castellote
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Department of Digestive Diseases, Hospital Universitari de Bellvitge, Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Antoni Riera-Mestre
- HHT Unit, Hospital Universitari de Bellvitge, Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
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Aguilera C, Padró-Miquel A, Esteve-Garcia A, Cerdà P, Torres-Iglesias R, Llecha N, Riera-Mestre A. Improving Hereditary Hemorrhagic Telangiectasia Molecular Diagnosis: A Referral Center Experience. Genes (Basel) 2023; 14:genes14030772. [PMID: 36981042 PMCID: PMC10048779 DOI: 10.3390/genes14030772] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/14/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Hereditary hemorrhagic telangiectasia (HHT) is a rare vascular disease inherited in an autosomal dominant manner. Disease-causing variants in endoglin (ENG) and activin A receptor type II-like 1 (ACVRL1) genes are detected in more than 90% of the patients undergoing molecular testing. The identification of variants of unknown significance is often seen as a challenge in clinical practice that makes family screening and genetic counseling difficult. Here, we show that the implementation of cDNA analysis to assess the effect of splice site variants on mRNA splicing is a powerful tool. METHODS Gene panel sequencing of genes associated with HHT and other arteriovenous malformation-related syndromes was performed. To evaluate the effect of the splice site variants, cDNA analysis of ENG and ACVRL1 genes was carried out. RESULTS three novel splice site variants were identified in ENG (c.68-2A > T and c.1311+4_1311+8del) and ACVLR1 (c.526-6C > G) genes correspondingly in three individuals with HHT that met ≥ 3 Curaçao criteria. All three variants led to an aberrant splicing inducing exon skipping (ENG:c.68-2A > T and ACVRL1:c.526-6C > G) or intron retention (ENG:c.1311+4_1311+8del) allowing the confirmation of the predicted effect on splicing and the reclassification from unknown significance to pathogenic/likely pathogenic of two of them. CONCLUSIONS RNA analysis should be performed to assess and/or confirm the impact of variants on splicing. The molecular diagnosis of HHT patients is crucial to allow family screening and accurate genetic counseling. A multidisciplinary approach including clinicians and geneticists is crucial when dealing with patients with rare diseases.
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Affiliation(s)
- Cinthia Aguilera
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Genetics Laboratory, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Ariadna Padró-Miquel
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Genetics Laboratory, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Anna Esteve-Garcia
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Clinical Genetics Unit, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Pau Cerdà
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Raquel Torres-Iglesias
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Núria Llecha
- Genetics Laboratory, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Clinical Genetics Unit, Laboratori Clínic Territorial Metropolitana Sud, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
| | - Antoni Riera-Mestre
- Hereditary Hemorrhagic Telangiectasia Unit, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), 08907 L'Hospitalet de Llobregat, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, 08907 L'Hospitalet de Llobregat, Spain
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Riera-Mestre A, Cerdà P, Iriarte A, Graupera M, Viñals F. Translational medicine in hereditary hemorrhagic telangiectasia. Eur J Intern Med 2022; 95:32-37. [PMID: 34538686 DOI: 10.1016/j.ejim.2021.09.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 09/04/2021] [Indexed: 12/18/2022]
Abstract
Scientific community have gained lots of new insights in the genetic and biochemical background of different conditions, rare diseases included, settling the basis for preclinical models that are helping to identify new biomarkers and therapeutic targets. Translational Medicine (TM) is an interdisciplinary area of biomedicine with an essential role in bench-to-bedside transition enhancement, generating a circular flow of knowledge transference between research environment and clinical setting, always centered in patient needs. Here, we present different tools used in TM and an overview of what is being done related to hereditary hemorrhagic telangiectasia (HHT), as a disease's model. This work is focused on how this combination of basic and clinical research impacts in HHT patient's daily clinical management and also looking into the future. Further randomized clinical trials with HHT patients should assess the findings of this bench-to-bedside transition. The benefits of this basic and clinical research combination, may not only be important for HHT patients but for patients with other vascular diseases sharing angiogenic disturbances.
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Affiliation(s)
- A Riera-Mestre
- HHT Unit. Internal Medicine Department. Hospital Universitari Bellvitge, C/ Feixa Llarga s/n., L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain; Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain.
| | - P Cerdà
- HHT Unit. Internal Medicine Department. Hospital Universitari Bellvitge, C/ Feixa Llarga s/n., L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Iriarte
- HHT Unit. Internal Medicine Department. Hospital Universitari Bellvitge, C/ Feixa Llarga s/n., L'Hospitalet de Llobregat, Barcelona 08907, Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - M Graupera
- Endothelial Pathobiology and Microenvironment, Josep Carreras Leukaemia Research Institute, Barcelona 08916, Spain; CIBERONC, Instituto de Salud Carlos III, Madrid, Spain
| | - F Viñals
- Physiological Sciences Department. Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain; Program Against Cancer Therapeutic Resistance, Hospital Duran i Reynals, Institut Catala d'Oncologia, Barcelona, Spain; Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
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Ribas J, Valcárcel J, Alba E, Ruíz Y, Cuartero D, Iriarte A, Mora-Luján JM, Huguet M, Cerdà P, Martínez-Yélamos S, Corbella X, Santos S, Riera-Mestre A. Catheter-Directed Therapies in Patients with Pulmonary Embolism: Predictive Factors of In-Hospital Mortality and Long-Term Follow-Up. J Clin Med 2021; 10:jcm10204716. [PMID: 34682839 PMCID: PMC8537142 DOI: 10.3390/jcm10204716] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
(1) Background: Catheter-directed therapies (CDT) may be considered for selected patients with pulmonary embolism (PE); (2) Methods: Retrospective observational study including all consecutive patients with acute PE undergoing CDT (mechanical or pharmacomechanical) from January 2010 through December 2020. The aim was to evaluate in-hospital and long-term mortality and its predictive factors; (3) Results: We included 63 patients, 43 (68.3%) with high-risk PE. All patients underwent mechanical CDT and, additionally, 27 (43%) underwent catheter-directed thrombolysis. Twelve (19%) patients received failed systemic thrombolysis (ST) prior to CDT, and an inferior vena cava (IVC) filter was inserted in 28 (44.5%) patients. In-hospital PE-related and all-cause mortality rates were 31.7%; 95% CI 20.6-44.7% and 42.9%; 95% CI 30.5-56%, respectively. In multivariate analysis, age > 70 years and previous ST were strongly associated with PE-related and all-cause mortality, while IVC filter insertion during the CDT was associated with lower mortality rates. After a median follow-up of 40 (12-60) months, 11 more patients died (mortality rate of 60.3%; 95% CI 47.2-72.4%). Long-term survival was significantly higher in patients who received an IVC filter; (4) Conclusions: Age > 70 years and failure of previous ST were associated with mortality in acute PE patients treated with CDT. In-hospital and long-term mortality were lower in patients who received IVC filter insertion.
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Affiliation(s)
- Jesús Ribas
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93-260-7685
| | - Joana Valcárcel
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Radiology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Esther Alba
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Radiology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Yolanda Ruíz
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
| | - Daniel Cuartero
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Adriana Iriarte
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - José María Mora-Luján
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Marta Huguet
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Critical Care Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Pau Cerdà
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Neurology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Xavier Corbella
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, 08017 Barcelona, Spain
| | - Salud Santos
- Pneumology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain; (Y.R.); (S.S.)
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Biomedical Research Networking Center on Respiratory Diseases (CIBERES), 28029 Madrid, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Antoni Riera-Mestre
- Bellvitge Biomedical Research Institute (IDIBELL), 08907 Barcelona, Spain; (J.V.); (E.A.); (D.C.); (A.I.); (J.M.M.-L.); (M.H.); (P.C.); (S.M.-Y.); (X.C.); (A.R.-M.)
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, L’Hospitalet de Llobregat, 08907 Barcelona, Spain
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Iriarte A, Ochoa-Callejero L, García-Sanmartín J, Cerdà P, Garrido P, Narro-Íñiguez J, Mora-Luján JM, Jucglà A, Sánchez-Corral MA, Cruellas F, Gamundi E, Ribas J, Castellote J, Viñals F, Martínez A, Riera-Mestre A. Adrenomedullin as a potential biomarker involved in patients with hereditary hemorrhagic telangiectasia. Eur J Intern Med 2021; 88:89-95. [PMID: 33888392 DOI: 10.1016/j.ejim.2021.03.039] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/28/2021] [Accepted: 03/30/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Adrenomedullin (AM) is a vasoactive peptide mostly secreted by endothelial cells with an important role in preserving endothelial integrity. The relationship between AM and hereditary hemorrhagic telangiectasia (HHT) is unknown. We aimed to compare the serum levels and tissue expression of AM between HHT patients and controls. METHODS Serum AM levels were measured by radioimmunoassay and compared between control and HHT groups. AM levels were also compared among HHT subgroups according to clinical characteristics. The single nucleotide polymorphism (SNP) rs4910118 was assessed by restriction analysis and sequencing. AM immunohistochemistry was performed on biopsies of cutaneous telangiectasia from eight HHT patients and on the healthy skin from five patients in the control group. RESULTS Forty-five HHT patients and 50 healthy controls were included, mean age (SD) was 50.7 (14.9) years and 46.4 (9.9) years (p = 0.102), respectively. HHT patients were mostly female (60% vs 38%, p = 0.032). Median [Q1-Q3] serum AM levels were 68.3 [58.1-80.6] pg/mL in the HHT group and 47.7 [43.2-53.8] pg/mL in controls (p<0.001), with an optimal AM cut-off according to Youden's J statistic of 55.32 pg/mL (J:0.729). Serum AM levels were similar in the HHT subgroups. No patient with HHT had the SNP rs4910118. AM immunoreactivity was found with high intensity in the abnormal blood vessels of HHT biopsies. CONCLUSIONS We detected higher AM serum levels and tissue expression in patients with HHT than in healthy controls. The role of AM in HHT, and whether AM may constitute a novel biomarker and therapeutic target, needs further investigation.
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Affiliation(s)
- A Iriarte
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Internal Medicine Department. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain
| | - L Ochoa-Callejero
- Angiogenesis Group, Oncology Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño Spain
| | - J García-Sanmartín
- Angiogenesis Group, Oncology Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño Spain
| | - P Cerdà
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Internal Medicine Department. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain
| | - P Garrido
- Angiogenesis Group, Oncology Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño Spain
| | - J Narro-Íñiguez
- Angiogenesis Group, Oncology Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño Spain
| | - J M Mora-Luján
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Internal Medicine Department. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain
| | - A Jucglà
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Dermatology Department. Hospital Universitari de Bellvitge, Barcelona Spain
| | - M A Sánchez-Corral
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Cardiology Department. Hospital Universitari de Bellvitge, Barcelona Spain
| | - F Cruellas
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Otorhinolaryngology Department. Hospital Universitari de Bellvitge, Barcelona Spain
| | - E Gamundi
- Hematology Department. Hospital Universitari de Bellvitge, Barcelona Spain
| | - J Ribas
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Pneumology Department. Hospital Universitari de Bellvitge, Barcelona Spain
| | - J Castellote
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Liver Transplant Unit, Gastroenterology Department. Hospital Universitari de Bellvitge, Barcelona Spain; Physiological Sciences Department. Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain
| | - F Viñals
- Physiological Sciences Department. Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain; Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, Barcelona Spain; Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Martínez
- Angiogenesis Group, Oncology Area, Center for Biomedical Research of La Rioja (CIBIR), Logroño Spain
| | - A Riera-Mestre
- HHT Unit. Hospital Universitari de Bellvitge, Barcelona Spain; Internal Medicine Department. Hospital Universitari de Bellvitge, Barcelona Spain; Bellvitge Biomedical Research Institute (IDIBELL), Barcelona Spain; Faculty of Medicine and Health Sciences. Universitat de Barcelona, Barcelona, Spain.
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11
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Blondon M, Jimenez D, Robert‐Ebadi H, Del Toro J, Lopez‐Jimenez L, Falga C, Skride A, Font L, Vazquez FJ, Bounameaux H, Monreal M, Prandoni P, Brenner, B, Farge‐Bancel D, Barba R, Di Micco P, Bertoletti L, Schellong S, Tzoran I, Reis A, Bosevski M, Malý R, Verhamme P, Caprini JA, My Bui H, Adarraga MD, Agud M, Aibar J, Aibar MA, Alfonso J, Amado C, Arcelus JI, Baeza C, Ballaz A, Barba R, Barbagelata C, Barrón M, Barrón‐Andrés B, Blanco‐Molina A, Botella E, Camon AM, Castro J, Caudevilla MA, Cerdà P, Chasco L, Criado J, de Ancos C, de Miguel J, Demelo‐Rodríguez P, Díaz‐Peromingo JA, Díez‐Sierra J, Díaz‐Simón R, Domínguez IM, Encabo M, Escribano JC, Falgá C, Farfán AI, Fernández‐Capitán C, Fernández‐Reyes JL, Fidalgo MA, Flores K, Font C, Francisco I, Gabara C, Galeano‐Valle F, García MA, García‐Bragado F, García‐Mullor MM, Gavín‐Blanco O, Gavín‐Sebastián O, Gil‐Díaz A, Gómez‐Cuervo C, González‐Martínez J, Grau E, Guirado L, Gutiérrez J, Hernández‐Blasco L, Jara‐Palomares L, Jaras MJ, Jiménez D, Joya MD, Jou I, Lacruz B, Lecumberri R, Lima J, Lobo JL, López‐Brull H, López‐Jiménez L, López‐Miguel P, López‐Núñez JJ, López‐Reyes R, López‐Sáez JB, Lorente MA, Lorenzo A, Loring M, Madridano O, Maestre A, Marchena PJ, Martín del Pozo M, Martín‐Martos F, Martínez‐Baquerizo C, Mella C, Mellado M, Mercado MI, Moisés J, Morales MV, Muñoz‐Blanco A, Muñoz‐Guglielmetti D, Muñoz‐Rivas N, Nart E, Nieto JA, Núñez MJ, Olivares MC, Ortega‐Michel C, Ortega‐Recio MD, Osorio J, Otalora S, Otero R, Parra P, Parra V, Pedrajas JM, Pellejero G, Pérez‐Jacoiste A, Peris ML, Pesántez D, Porras JA, Portillo J, Reig L, Riera‐Mestre A, Rivas A, Rodríguez‐Cobo A, Rodríguez‐Matute C, Rogado J, Rosa V, Rubio CM, Ruiz‐Artacho P, Ruiz‐Giménez N, Ruiz‐Ruiz J, Ruiz‐Sada P, Sahuquillo JC, Salgueiro G, Sampériz A, Sánchez‐Muñoz‐Torrero JF, Sancho T, Sigüenza P, Sirisi M, Soler S, Suárez S, Suriñach JM, Tiberio G, Torres MI, Tolosa C, Trujillo‐Santos J, Uresandi F, Usandizaga E, Valle R, Vela JR, Vidal G, Vilar C, Villares P, Zamora C, Gutiérrez P, Vázquez FJ, Vanassche T, Vandenbriele C, Verhamme P, Hirmerova J, Malý R, Salgado E, Benzidia I, Bertoletti L, Bura‐Riviere A, Crichi B, Debourdeau P, Espitia O, Farge‐Bancel D, Helfer H, Mahé I, Moustafa F, Poenou G, Schellong S, Braester A, Brenner B, Tzoran I, Amitrano M, Bilora F, Bortoluzzi C, Brandolin B, Ciammaichella M, Colaizzo D, Dentali F, Di Micco P, Giammarino E, Grandone E, Mangiacapra S, Mastroiacovo D, Maida R, Mumoli N, Pace F, Pesavento R, Pomero F, Prandoni P, Quintavalla R, Rocci A, Siniscalchi C, Tufano A, Visonà A, Vo Hong N, Zalunardo B, Kalejs RV, Maķe K, Ferreira M, Fonseca S, Martins F, Meireles J, Bosevski M, Zdraveska M, Mazzolai L, Caprini JA, Tafur AJ, Weinberg I, Wilkins H, Bui HM. Comparative clinical prognosis of massive and non-massive pulmonary embolism: A registry-based cohort study. J Thromb Haemost 2021; 19:408-416. [PMID: 33119949 DOI: 10.1111/jth.15146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/29/2020] [Accepted: 10/21/2020] [Indexed: 01/16/2023]
Abstract
AIMS Little is known about the prognosis of patients with massive pulmonary embolism (PE) and its risk of recurrent venous thromboembolism (VTE) compared with non-massive PE, which may inform clinical decisions. Our aim was to compare the risk of recurrent VTE, bleeding, and mortality after massive and non-massive PE during anticoagulation and after its discontinuation. METHODS AND RESULTS We included all participants in the RIETE registry who suffered a symptomatic, objectively confirmed segmental or more central PE. Massive PE was defined by a systolic hypotension at clinical presentation (<90 mm Hg). We compared the risks of recurrent VTE, major bleeding, and mortality using time-to-event multivariable competing risk modeling. There were 3.5% of massive PE among 38 996 patients with PE. During the anticoagulation period, massive PE was associated with a greater risk of major bleeding (subhazard ratio [sHR] 1.72, 95% confidence interval [CI] 1.28-2.32), but not of recurrent VTE (sHR 1.15, 95% CI 0.75-1.74) than non-massive PE. An increased risk of mortality was only observed in the first month after PE. After discontinuation of anticoagulation, among 11 579 patients, massive PE and non-massive PE had similar risks of mortality, bleeding, and recurrent VTE (sHR 0.85, 95% CI 0.51-1.40), but with different case fatality of recurrent PE (11.1% versus 2.4%, P = .03) and possibly different risk of recurrent fatal PE (sHR 3.65, 95% CI 0.82-16.24). CONCLUSION In this large prospective registry, the baseline hemodynamic status of the incident PE did not influence the risk of recurrent VTE, during and after the anticoagulation periods, but was possibly associated with recurrent PE of greater severity.
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Affiliation(s)
- Marc Blondon
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - David Jimenez
- Respiratory Department Hospital Ramón y Cajal and Medicine Department Universidad de Alcalá (IRYCIS) Madrid Spain
| | - Helia Robert‐Ebadi
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Jorge Del Toro
- Department of Internal Medicine Hospital General Universitario Gregorio Marañón Madrid Spain
| | | | - Conxita Falga
- Department of Internal Medicine Hospital de Mataro Barcelona Spain
| | - Andris Skride
- Department of Cardiology Ospedale Pauls Stradins Clinical University Hospital Riga Latvia
| | - Llorenç Font
- Department of Haematology Hospital de Tortosa Verge de la Cinta Tarragona Spain
| | | | - Henri Bounameaux
- Division of Angiology and Hemostasis Geneva University Hospitals and Faculty of Medicine Geneva Switzerland
| | - Manuel Monreal
- Department of Internal Medicine Hospital Germans Trias i Pujol Badalona Spain
- Universidad Catolica de Murcia Murcia Spain
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Cerdà P, Becattini C, Iriarte A, Hernández JC, Corbella X, Riera-Mestre A. Direct oral anticoagulants versus vitamin K antagonists in antiphospholipid syndrome: A meta-analysis. Eur J Intern Med 2020; 79:43-50. [PMID: 32482595 DOI: 10.1016/j.ejim.2020.05.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/03/2020] [Accepted: 05/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anticoagulant treatment is recommended in patients with thrombosis and antiphospholipid syndrome (APS). Conflicting results have been reported on the role of direct oral anticoagulants (DOACs) in these patients. We performed a meta-analysis of randomized controlled trials (RCTs) focused on this issue. METHODS We searched MEDLINE and EMBASE for RCTs comparing DOACs and vitamin K antagonists (VKAs) for secondary thromboprophylaxis in patients with thrombotic APS. The primary objective was to assess the efficacy of DOACs compared to VKAs to prevent recurrence of thromboembolic events. Risk difference (RD) was reported as weighted RD according to Mantel-Haenszel random-effect method. RESULTS Three RCTs (426 patients) were included, all comparing rivaroxaban with VKAs. The proportion of recurrences (either arterial or venous) was higher among rivaroxaban patients when compared with those receiving VKAs (9.5% vs 2.8%; RD 6%, 95% CI, -0.05 - 0.18, p=0.29), although non-statistically significant. In patients with an arterial index event, thromboembolic recurrences were more frequent in those treated with rivaroxaban compared to those treated with VKAs (25% vs 6.2%; RD 19%, 95% CI, 0.04 - 0.33; p =0.01; I2 49%). In triple aPL positive patients, rivaroxaban showed higher rates of thromboembolic recurrences compared with VKAs (12% vs 3%; RD 9%, 95% CI, 0.02 - 0.15; p= 0.01; I2 13%). Non-statistically significant differences were observed in major bleeding events or mortality. CONCLUSIONS The use of rivaroxaban in APS patients is associated with an increased rate of thromboembolic recurrences compared to VKAs, at least in those with arterial index event or triple aPL positivity.
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Affiliation(s)
- Pau Cerdà
- Internal Medicine Department, Hospital Universitari Bellvitge - IDIBELL, Barcelona, Spain
| | - Cecilia Becattini
- Internal and Cardiovascular Medicine - Stroke Unit, University of Perugia, Perugia, Italy
| | - Adriana Iriarte
- Internal Medicine Department, Hospital Universitari Bellvitge - IDIBELL, Barcelona, Spain
| | - Josefina Cortés Hernández
- Internal Medicine Department. Rheumatology Research Group. Vall d´Hebrón University Hospital Research Institute, Barcelona, Spain
| | - Xavier Corbella
- Internal Medicine Department, Hospital Universitari Bellvitge - IDIBELL, Barcelona, Spain; Faculty of Medicine and Health Sciences. Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Riera-Mestre
- Internal Medicine Department, Hospital Universitari Bellvitge - IDIBELL, Barcelona, Spain; Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
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13
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Mora-Luján JM, Iriarte A, Alba E, Sánchez-Corral MA, Cerdà P, Cruellas F, Ordi Q, Corbella X, Ribas J, Castellote J, Riera-Mestre A. Gender differences in hereditary hemorrhagic telangiectasia severity. Orphanet J Rare Dis 2020; 15:63. [PMID: 32122373 PMCID: PMC7053104 DOI: 10.1186/s13023-020-1337-5] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 02/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background Gender differences in organ involvement and clinical severity have been poorly described in hereditary hemorrhagic telangiectasia (HHT). The aim of this study was to describe differences in the severity of HHT manifestations according to gender. Methods Severity was measured according to Epistaxis Severity Score (ESS), Simple Clinical Scoring Index for hepatic involvement, a general HHT-score, needing for invasive treatment (pulmonary or brain arteriovenous malformations -AVMs- embolization, liver transplantation or Young’s surgery) or the presence of adverse outcomes (severe anemia, emergency department -ED- or hospital admissions and mortality). Results One hundred forty-two (58.7%) women and 100 (41.3%) men were included with a mean age of 48.9 ± 16.6 and 49 ± 16.5 years, respectively. Women presented hepatic manifestations (7.1% vs 0%) and hepatic involvement (59.8% vs 47%), hepatic AVMs (28.2% vs 13%) and bile duct dilatation (4.9% vs 0%) at abdominal CT, and pulmonary AVMs at thoracic CT (35.2% vs 23%) more often than men. The Simple Clinical Scoring Index was higher in women (3.38 ± 1.2 vs 2.03 ± 1.2), and more men were considered at low risk of harboring clinically significant liver disease than women (61% vs 25.3%). These differences were mantained when considering HHT1 and HHT2 patients separetely. Duodenal telangiectasia were more frequent in men than women (21% vs 9.8%). Invasive treatments were more frequently needed in women (28.2% vs 16%) but men needed attention at the ED more often than women (48% vs 28.2%), with no differences in ESS, HHT-score, anemia hospital admissions or mortality. Conclusions HHT women showed more severe hepatic involvement than men, also among HHT1 and HHT2 patients. Women had higher prevalence of pulmonary AVMs and needed invasive procedures more frequently, while men needed attention at the ED more often. These data might help physicians to individualize HHT patients follow-up.
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Affiliation(s)
- J M Mora-Luján
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - A Iriarte
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - E Alba
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - M A Sánchez-Corral
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Cardiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - P Cerdà
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain
| | - F Cruellas
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Otorhinolaryngology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - Q Ordi
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Radiology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - X Corbella
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - J Ribas
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Pneumology Department, Hospital Universitari Bellvitge, Barcelona, Spain
| | - J Castellote
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain.,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Liver Transplant Unit, Department of Digestive Diseases, Hospital Universitari Bellvitge, Barcelona, Spain.,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - A Riera-Mestre
- HHT Unit, Hospital Universitari de Bellvitge, C/Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Internal Medicine Department, Hospital Universitari Bellvitge, Barcelona, Spain. .,Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. .,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
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14
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Iriarte A, Figueras A, Cerdà P, Mora JM, Jucglà A, Penín R, Viñals F, Riera-Mestre A. PI3K (Phosphatidylinositol 3-Kinase) Activation and Endothelial Cell Proliferation in Patients with Hemorrhagic Hereditary Telangiectasia Type 1. Cells 2019; 8:cells8090971. [PMID: 31450639 PMCID: PMC6770684 DOI: 10.3390/cells8090971] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 12/12/2022] Open
Abstract
Hemorrhagic hereditary telangiectasia (HHT) type 2 patients have increased activation of the phosphatidylinositol 3-kinase (PI3K) signaling pathway in telangiectasia. The main objective is to evaluate the activation of the PI3K pathway in cutaneous telangiectasia of HHT1 patients. A cutaneous biopsy of a digital hand telangiectasia was performed in seven HHT1 and eight HHT2 patients and compared with six controls. The study was approved by the Clinical Research Ethics Committee of our center. A histopathological pattern with more dilated and superficial vessels that pushed up the epidermis was identified in HHT patients regardless of the type of mutation and was associated with older age, as opposed to the common telangiectasia pattern. The mean proliferation index (Ki-67) was statistically higher in endothelial cells (EC) from HHT1 than in controls. The percentage of positive EC for pNDRG1, pAKT, and pS6 in HHT1 patients versus controls resulted in higher values, statistically significant for pNDRG1 and pS6. In conclusion, we detected an increase in EC proliferation linked to overactivation of the PI3K pathway in cutaneous telangiectasia biopsies from HHT1 patients. Our results suggest that PI3K inhibitors could be used as novel therapeutic agents for HHT.
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Affiliation(s)
- Adriana Iriarte
- HHT Unit, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Agnes Figueras
- Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Pau Cerdà
- HHT Unit, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - José María Mora
- HHT Unit, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
| | - Anna Jucglà
- HHT Unit, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Dermatology Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Rosa Penín
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- Pathological Anatomy Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain
| | - Francesc Viñals
- Program Against Cancer Therapeutic Resistance, Institut Catala d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Oncobell Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Physiological Sciences Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
| | - Antoni Riera-Mestre
- HHT Unit, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain.
- Internal Medicine Department, Hospital Universitari de Bellvitge, 08907 Barcelona, Spain.
- Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
- Clinical Sciences Department, Faculty of Medicine and Health Sciences, Universitat de Barcelona, L'Hospitalet de Llobregat, 08907 Barcelona, Spain.
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15
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Riera-Mestre A, Mora-Luján JM, Trujillo-Santos J, Del Toro J, Nieto JA, Pedrajas JM, López-Reyes R, Soler S, Ballaz A, Cerdà P, Monreal M. Natural history of patients with venous thromboembolism and hereditary hemorrhagic telangiectasia. Findings from the RIETE registry. Orphanet J Rare Dis 2019; 14:196. [PMID: 31399146 PMCID: PMC6688272 DOI: 10.1186/s13023-019-1172-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022] Open
Abstract
Background Limited data exist about the clinical presentation, ideal therapy and outcomes of patients with hereditary hemorrhagic telangiectasia (HHT) who develop venous thromboembolism (VTE). Methods We used the data in the RIETE Registry to assess the clinical characteristics, therapeutic approaches and clinical outcomes during the course of anticoagulant therapy in patients with HHT according to initial presentation as pulmonary embolism (PE) or deep venous thrombosis (DVT). Results Of 51,375 patients with acute VTE enrolled in RIETE from February 2009 to January 2019, 23 (0.04%) had HHT: 14 (61%) initially presented with PE and 9 (39%) with DVT alone. Almost half (47.8%) of the patients with VTE had a risk factor for VTE. Most PE and DVT patients received low-molecular-weight heparin for initial (71 and 100%, respectively) and long-term therapy (54 and 67%, respectively). During anticoagulation for VTE, the rate of bleeding events (major 2, non-major 6) far outweighed the rate of VTE recurrences (recurrent DVT 1): 50.1 bleeds per 100 patient-years (95%CI: 21.6-98.7) vs. 6.26 recurrences (95%CI: 0.31–30.9; p = 0.020). One major and three non-major bleeding were epistaxis. No patient died of bleeding. One patient died shortly after being diagnosed with acute PE. Conclusions During anticoagulation for VTE in HHT patients, there were more bleeding events than VTE recurrences. Most bleeding episodes were non-major epistaxis.
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Affiliation(s)
- Antoni Riera-Mestre
- HHT Unit and VTE Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain.
| | - José María Mora-Luján
- HHT Unit and VTE Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Javier Trujillo-Santos
- Department of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Universidad Católica de Murcia, Murcia, Spain
| | - Jorge Del Toro
- Department of Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Antonio Nieto
- Department of Internal Medicine, Hospital General Virgen De La Luz, Cuenca, Spain
| | | | - Raquel López-Reyes
- Department of Pneumonology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Silvia Soler
- Department of Internal Medicine, Fundació Hospital d'Olot i Comarcal de la Garrotxa, Gerona, Spain
| | - Aitor Ballaz
- Department of Pneumonology, Hospital De Galdakao, Galdakao, Vizcaya, Spain
| | - Pau Cerdà
- HHT Unit and VTE Unit, Internal Medicine Department, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), C/ Feixa Llarga s/n. L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Manel Monreal
- Department of Internal Medicine, Hospital Germans Trias i Pujol Badalona, Barcelona, Universidad Autónoma de Barcelona, Barcelona, Spain
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16
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Viúdez A, Carmona-Bayonas A, Gallego J, Lacalle A, Hernández R, Cano JM, Macías I, Custodio A, Martínez de Castro E, Sánchez A, Iglesia L, Reguera P, Visa L, Azkarate A, Sánchez-Cánovas M, Mangas M, Limón ML, Martínez-Torrón A, Asensio E, Ramchandani A, Martín-Carnicero A, Hurtado A, Cerdà P, Garrido M, Sánchez-Bayonas R, Serrano R, Jiménez-Fonseca P. Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry. Clin Transl Oncol 2019; 22:734-750. [PMID: 31385226 DOI: 10.1007/s12094-019-02183-y] [Citation(s) in RCA: 7] [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] [Received: 05/23/2019] [Accepted: 07/08/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
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Affiliation(s)
- A Viúdez
- Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain.
| | - A Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
| | - J Gallego
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Lacalle
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - R Hernández
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
| | - J M Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - I Macías
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - A Custodio
- Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | - E Martínez de Castro
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - A Sánchez
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - L Iglesia
- Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
| | - P Reguera
- Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain
| | - L Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - A Azkarate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - M Sánchez-Cánovas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
| | - M Mangas
- Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
| | - M L Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Martínez-Torrón
- Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - E Asensio
- Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
| | - A Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - A Martín-Carnicero
- Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain
| | - A Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - P Cerdà
- Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain
| | - M Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - R Sánchez-Bayonas
- Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - R Serrano
- Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain
| | - P Jiménez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
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Becattini C, Giustozzi M, Cerdà P, Cimini LA, Riera-Mestre A, Agnelli G. Risk of recurrent venous thromboembolism after acute pulmonary embolism: Role of residual pulmonary obstruction and persistent right ventricular dysfunction. A meta-analysis. J Thromb Haemost 2019; 17:1217-1228. [PMID: 31063646 DOI: 10.1111/jth.14477] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 05/01/2019] [Indexed: 08/31/2023]
Abstract
Essentials Debated is the role of residual pulmonary obstruction (RPO) in predicting venous thromboembolism. Whether right ventricular dysfunction (RVD) predicts recurrent venous thromboembolism is unknown. 15 studies on RPO and 4 on RVD and venous thromboembolism were included in this meta-analysis. RPO is a predictor of recurrent venous thromboembolism when assessed by perfusion lung scan. RVD after acute pulmonary embolism is not associated with recurrent venous thromboembolism. BACKGROUND There is conflicting evidence regarding the role of residual pulmonary obstruction (RPO) or persistent right ventricular dysfunction (RVD) after pulmonary embolism (PE) as a predictor of recurrent venous thromboembolism (VTE). The aim of this study was to assess whether RPO or persistent RVD after PE is associated with recurrent VTE. METHODS MEDLINE and EMBASE were searched through December 2018. Studies reporting on (a) RPO either on computed tomography (CT) angiography or perfusion lung scan, or RVD on echocardiography or CT angiography, after therapeutic anticoagulation for the acute PE, and (b) recurrent VTE, were included in this meta-analysis. RESULTS RPO was associated with an increased risk of recurrent VTE (16 studies; 3472 patients; odds ratio [OR] 2.22; 95% confidence interval [CI] 1.61-3.05; I2 = 26%); the association was statistically significant for lung scan-detected RPO (11 studies; 2916 patients; OR 2.21; 95% CI 1.63-3.01) but not for CT angiography-detected RPO (five studies; 556 patients; OR 2.56; 95% CI 0.82-7.94). No significant association was found between persistent RVD and recurrent VTE (four studies; 852 patients; OR 1.62; 95% CI 0.63-4.17). CONCLUSIONS RPO is a predictor of recurrent VTE after a first acute PE, mainly when assessed by perfusion lung scan.
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Affiliation(s)
- Cecilia Becattini
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Michela Giustozzi
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Pau Cerdà
- Internal Medicine, Hospital Universitari Bellvitge-IDIBELL, Barcelona, Spain
| | - Ludovica A Cimini
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
| | - Antoni Riera-Mestre
- Faculty of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Giancarlo Agnelli
- Internal and Cardiovascular Medicine-Stroke Unit, University of Perugia, Perugia, Italy
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18
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Jiménez-Fonseca P, Hernandez R, Custodio A, Ramchandani Vaswani A, Sánchez Cánovas M, Sánchez Bayona R, López López C, Echavarria Diaz-Guardamino I, Visa L, Buxo Orra E, Arias D, Viudez A, Martin Carnicero A, Cerdà P, Ferrer M, Lorenzo Barreto J, Limón M, MACIAS I, Felices P. Prognostic effect of surgery of metastases in patients with advanced gastric cancer: Real-world data from the AGAMENON registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Cerdà P, Franco J, Chivite D, Formiga F. Mortality in type 2 diabetes patients admitted because of acute heart failure. Rev Clin Esp 2016; 216:341-3. [PMID: 27086478 DOI: 10.1016/j.rce.2016.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Revised: 03/08/2016] [Accepted: 03/11/2016] [Indexed: 01/14/2023]
Affiliation(s)
- P Cerdà
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España.
| | - J Franco
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - D Chivite
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - F Formiga
- Servicio de Medicina Interna, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
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