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Garelli S, Dalla Costa M, Sabbadin C, Barollo S, Rubin B, Scarpa R, Masiero S, Fierabracci A, Bizzarri C, Crinò A, Cappa M, Valenzise M, Meloni A, De Bellis AM, Giordano C, Presotto F, Perniola R, Capalbo D, Salerno MC, Stigliano A, Radetti G, Camozzi V, Greggio NA, Bogazzi F, Chiodini I, Pagotto U, Black SK, Chen S, Rees Smith B, Furmaniak J, Weber G, Pigliaru F, De Sanctis L, Scaroni C, Betterle C. Autoimmune polyendocrine syndrome type 1: an Italian survey on 158 patients. J Endocrinol Invest 2021; 44:2493-2510. [PMID: 34003463 PMCID: PMC8502131 DOI: 10.1007/s40618-021-01585-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 04/29/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Autoimmune Polyglandular Syndrome type 1 (APS-1) is a rare recessive inherited disease, caused by AutoImmune Regulator (AIRE) gene mutations and characterized by three major manifestations: chronic mucocutaneous candidiasis (CMC), chronic hypoparathyroidism (CH) and Addison's disease (AD). METHODS Autoimmune conditions and associated autoantibodies (Abs) were analyzed in 158 Italian patients (103 females and 55 males; F/M 1.9/1) at the onset and during a follow-up of 23.7 ± 15.1 years. AIRE mutations were determined. RESULTS The prevalence of APS-1 was 2.6 cases/million (range 0.5-17 in different regions). At the onset 93% of patients presented with one or more components of the classical triad and 7% with other components. At the end of follow-up, 86.1% had CH, 77.2% AD, 74.7% CMC, 49.5% premature menopause, 29.7% autoimmune intestinal dysfunction, 27.8% autoimmune thyroid diseases, 25.9% autoimmune gastritis/pernicious anemia, 25.3% ectodermal dystrophy, 24% alopecia, 21.5% autoimmune hepatitis, 17% vitiligo, 13.3% cholelithiasis, 5.7% connective diseases, 4.4% asplenia, 2.5% celiac disease and 13.9% cancer. Overall, 991 diseases (6.3 diseases/patient) were found. Interferon-ω Abs (IFNωAbs) were positive in 91.1% of patients. Overall mortality was 14.6%. The AIRE mutation R139X was found in 21.3% of tested alleles, R257X in 11.8%, W78R in 11.4%, C322fsX372 in 8.8%, T16M in 6.2%, R203X in 4%, and A21V in 2.9%. Less frequent mutations were present in 12.9%, very rare in 9.6% while no mutations in 11% of the cases. CONCLUSIONS In Italy, APS-1 is a rare disorder presenting with the three major manifestations and associated with different AIRE gene mutations. IFNωAbs are markers of APS-1 and other organ-specific autoantibodies are markers of clinical, subclinical or potential autoimmune conditions.
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Affiliation(s)
- S Garelli
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
- Unit of Internal Medicine, Ospedale dell'Angelo, Mestre-Venice, Italy
| | - M Dalla Costa
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
- Unit of Internal Medicine, Ospedale di Feltre, Belluno, Italy
| | - C Sabbadin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - S Barollo
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - B Rubin
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - R Scarpa
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - S Masiero
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - A Fierabracci
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - C Bizzarri
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - A Crinò
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Cappa
- Endocrine Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - M Valenzise
- Unit of Pediatrics, Department of Adulthood and Childhood Human Pathology, University of Messina, Messina, Italy
| | - A Meloni
- Ospedale Microcitemico and Dipartimento di Scienze Biomediche e Biotecnologiche, University of Cagliari, Cagliari, Italy
| | - A M De Bellis
- Unit of Endocrinology and Metabolic Diseases, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - C Giordano
- Endocrine Unit, Department of Biomedical Internal and Specialist Medicine (DIBIMIS), Palermo University, Palermo, Italy
| | - F Presotto
- Unit of Internal Medicine, Ospedale dell'Angelo, Mestre-Venice, Italy
| | - R Perniola
- Department of Pediatrics, Regional Hospital Vito Fazzi, Lecce, Italy
| | - D Capalbo
- Department of Mother and Child, University Federico II, Naples, Italy
| | - M C Salerno
- Pediatric Section, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - A Stigliano
- Endocrinology, Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - G Radetti
- Marienklinik, General Hospital, Bolzano, Italy
| | - V Camozzi
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - N A Greggio
- EU-Endo-ERN Advisory Board Member, National Coordinator Endo-ERN Pediatric (SIEDP), Padua, Italy
| | - F Bogazzi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - I Chiodini
- Unit of Bone Metabolism Diseases and Diabetes, Istituto Auxologico Italiano, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - U Pagotto
- Unit of Endocrinology and Prevention and Care of Diabetes, Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - S K Black
- FIRS Laboratories RSR Ltd, Cardiff, UK
| | - S Chen
- FIRS Laboratories RSR Ltd, Cardiff, UK
| | | | | | - G Weber
- Unit of Pediatrics, Vita-Salute San Raffaele University, IRCSS San Raffaele Scientific Institute, Milan, Italy
| | - F Pigliaru
- Endocrine Unit, Azienda Ospedaliera-Universitaria of Cagliari, Cagliari, Italy
| | - L De Sanctis
- Pediatric Endocrinology, Department of Public Health and Pediatric Sciences, Regina Margherita Children's Hospital, University of Turin, Turin, Italy
| | - C Scaroni
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy
| | - C Betterle
- Endocrine Unit, Department of Medicine (DIMED), University of Padua, Via Ospedale Civile 105, 35128, Padua, Italy.
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Perniola R, Fierabracci A, Falorni A. Autoimmune Addison's Disease as Part of the Autoimmune Polyglandular Syndrome Type 1: Historical Overview and Current Evidence. Front Immunol 2021; 12:606860. [PMID: 33717087 PMCID: PMC7953157 DOI: 10.3389/fimmu.2021.606860] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/25/2021] [Indexed: 12/11/2022] Open
Abstract
The autoimmune polyglandular syndrome type 1 (APS1) is caused by pathogenic variants of the autoimmune regulator (AIRE) gene, located in the chromosomal region 21q22.3. The related protein, AIRE, enhances thymic self-representation and immune self-tolerance by localization to chromatin and anchorage to multimolecular complexes involved in the initiation and post-initiation events of tissue-specific antigen-encoding gene transcription. Once synthesized, the self-antigens are presented to, and cause deletion of, the self-reactive thymocyte clones. The clinical diagnosis of APS1 is based on the classic triad idiopathic hypoparathyroidism (HPT)—chronic mucocutaneous candidiasis—autoimmune Addison's disease (AAD), though new criteria based on early non-endocrine manifestations have been proposed. HPT is in most cases the first endocrine component of the syndrome; however, APS1-associated AAD has received the most accurate biochemical, clinical, and immunological characterization. Here is a comprehensive review of the studies on APS1-associated AAD from initial case reports to the most recent scientific findings.
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Affiliation(s)
- Roberto Perniola
- Department of Pediatrics-Neonatal Intensive Care, V. Fazzi Hospital, ASL LE, Lecce, Italy
| | - Alessandra Fierabracci
- Infectivology and Clinical Trials Research Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Falorni
- Section of Internal Medicine and Endocrinological and Metabolic Sciences, Department of Medicine, University of Perugia, Perugia, Italy
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Catacchio CR, Alagna F, Perniola R, Bergamini C, Rotunno S, Calabrese FM, Crupi P, Antonacci D, Ventura M, Cardone MF. Transcriptomic and genomic structural variation analyses on grape cultivars reveal new insights into the genotype-dependent responses to water stress. Sci Rep 2019; 9:2809. [PMID: 30809001 PMCID: PMC6391451 DOI: 10.1038/s41598-019-39010-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 12/12/2018] [Indexed: 12/29/2022] Open
Abstract
Grapevine (Vitis vinifera L.) is importantly cultivated worldwide for table grape and wine production. Its cultivation requires irrigation supply, especially in arid and semiarid areas. Water deficiency can affect berry and wine quality mostly depending on the extent of plant perceived stress, which is a cultivar-specific trait. We tested the physiological and molecular responses to water deficiency of two table grape cultivars, Italia and Autumn royal, and we highlighted their different adaptation. Microarray analyses revealed that Autumn royal reacts involving only 29 genes, related to plant stress response and ABA/hormone signal transduction, to modulate the response to water deficit. Instead, cultivar Italia orchestrates a very broad response (we found 1037 differentially expressed genes) that modifies the cell wall organization, carbohydrate metabolism, response to reactive oxygen species, hormones and osmotic stress. For the first time, we integrated transcriptomic data with cultivar-specific genomics and found that ABA-perception and -signalling are key factors mediating the varietal-specific behaviour of the early response to drought. We were thus able to isolate candidate genes for the genotype-dependent response to drought. These insights will allow the identification of reliable plant stress indicators and the definition of sustainable cultivar-specific protocols for water management.
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Affiliation(s)
- C R Catacchio
- Dipartimento di Biologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - F Alagna
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
- ENEA, Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile, Centro Ricerche Trisaia, Rotondella (MT), Italy
| | - R Perniola
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
| | - C Bergamini
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
| | - S Rotunno
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
| | - F M Calabrese
- Dipartimento di Biologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy
| | - P Crupi
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
| | - D Antonacci
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy
| | - M Ventura
- Dipartimento di Biologia, Università degli Studi di Bari "Aldo Moro", Bari, Italy.
| | - M F Cardone
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria (CREA), Centro di ricerca Viticoltura ed Enologia, Turi (BA), Italy.
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Forleo L, L’Abbate A, Bergamini C, Velenosi M, Marsico A, Cardone M, Antonacci D, Velasco R, Perniola R. Phenotypic evaluation of segregant population derived by crossing table grape varieties. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191501021] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the CREA-Viticoltura ed Enologia, Lab of Turi, during the last ten years, we started a breeding program for table grapes to obtain new seedless varieties, by using conventional breeding by crossings, and embryo rescue techniques. Other than seedlessness, additional targets for this breeding program are: the possibility of extending the harvesting period, the attitude to cold storage, transport and shelf-life, resistance to diseases both on the plant and in post-harvest conditions, the good productivity, the quality of the grapes, the easy cultivation management of the vineyard (reduced water, nutritional requirements, etc ...). More than 10.000 new genotypes have been obtained through the use of over 20 table grape varieties and more than 18 different crossing combinations. The following characteristics have been observed on these individuals for more than three years: berry color, length and weight cluster, average berry weight, sugars, pH, acidity, class of seedlessness, floral morphology, resistance to diseases. The results of these activities revealed that some combinations have better performance among all. In the near future, this activity will allow to focus on parental genotypes able to provide individuals with the best desired traits.
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Cardone M, Perniola R, Catacchio C, Alagna F, Rotunno S, Crupi P, Antonacci D, Velasco R, Ventura M, Bergamini C. Grapevine adaptation to drought: New candidate genes for the genotype-dependent response. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191501016] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Grapevine requires irrigation supply for its cultivation, especially in the arid and semiarid geographic areas. As consequence of the severe climatic changes, water consumption is becoming more and more important as environmental and cost factor that needs to be reduced. Water deficiency can affect berry and wine quality depending on the extent of plant perceived stress, which is a cultivar specific trait. In a four-year project, we tested the physiological and molecular responses to water deficiency of two different table grape cultivars, Italia and Autumn Royal, and we highlighted that they differently adapted to drought stress conditions. Physiological analyses on field-growth plants showed cultivar-specific variations in photosynthetic carbon assimilation and, stomatal conductance under water deficiency. We further combined “omic” analyses to identify candidate genes involved in drought stress response and adaptative traits. Microarray analyses revealed a broad response of cultivar Italia to drought stress conditions characterized by the modulation of 1037 genes involved in biological processes as cell wall organization, carbohydrate metabolism, ROS response, response to hormone and osmotic stress. On the contrary, Autumn Royal response was limited to the modulation of only 29 genes mainly involved in plant stress response, nitrogen metabolism and hormone signal transduction. Our data highlighted that ABA-perception and –signalling are key factors mediating the varietal-specific behavior of the early response to drought.
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Perniola R, Forleo L, Marsico A. Evoluzione della tecnica d'innesto su barbatella radicata. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191501024] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In viticoltura, per la realizzazione di nuovi impianti sono utilizzate piante bimembri ottenute in vivaio o direttamente in campo. Negli ultimi anni, allo scopo di ottenere rapidamente nuovi impianti, si sta diffondendo la tecnica dell'innesto su barbatella radicata. Tale tecnica, realizzata in vivaio, prevede l'innesto a tavolino delle marze della varietà scelta su barbatelle radicate di portainnesto di specie di Vitis americane. Dopo un periodo di forzatura e ambientamento in vivaio, le piantine vengono messe a dimora in campo, nello stesso anno di realizzazione dell'innesto. Al fine di valutare tale tecnica, presso il CREA – Viticoltura ed enologia sede di Turi, è stata sperimentata la possibilità di utilizzare due differenti tipologie d'innesto su diversi portinnesti. Per assicurare una buona resistenza del punto d'innesto ed una buona protezione dalla contaminazione e dalla disidratazione è stato utilizzato un materiale di saldatura costituito da una pellicola elastica e semitrasparente. La sperimentazione è stata condotta per due anni, su 12 varietà di uve da tavola di recente costituzione. I risultati hanno mostrato buoni attecchimenti e saldatura dei bionti. Alcune differenze sono state riscontrate sui portinnesti utilizzati e sui tempi di germogliamento dopo l'innesto.
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Basile T, Perniola R, Cardone M, Marsico A, Antonacci D. Analytical and sensory data correlation to understand consumers' grape preference. BIO Web Conf 2019. [DOI: 10.1051/bioconf/20191501017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
NIR spectroscopy is a rapid, economic and not destructive technique employed in food analysis. Concerning fresh table grape, the analysis is usually limited to juices, homogenates or skin extracts which usually give better NIR prediction models. Scanning of intact berries is challenging since each berry has specific features (berry shape, presence of superficial pigmentation, etc.) and, moreover, there are punctual variations even within the same berry. It would be of great interest to obtain information about maturity parameters and consumer's appreciation directly from intact berries, since it would save both time and money. In this article, near infrared (NIR) spectroscopy and chemometric methods have been employed to search for a correlation between sensory analysis and analytical data. The research findings show how it is possible to use a rapid, economic and not destructive emerging technology such as NIR spectroscopy to understand consumer's preference directly from intact berries.
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Abstract
About two decades ago, cloning of the autoimmune regulator (AIRE) gene materialized one of the most important actors on the scene of self-tolerance. Thymic transcription of genes encoding tissue-specific antigens (ts-ags) is activated by AIRE protein and embodies the essence of thymic self-representation. Pathogenic AIRE variants cause the autoimmune polyglandular syndrome type 1, which is a rare and complex disease that is gaining attention in research on autoimmunity. The animal models of disease, although not identically reproducing the human picture, supply fundamental information on mechanisms and extent of AIRE action: thanks to its multidomain structure, AIRE localizes to chromatin enclosing the target genes, binds to histones, and offers an anchorage to multimolecular complexes involved in initiation and post-initiation events of gene transcription. In addition, AIRE enhances mRNA diversity by favoring alternative mRNA splicing. Once synthesized, ts-ags are presented to, and cause deletion of the self-reactive thymocyte clones. However, AIRE function is not restricted to the activation of gene transcription. AIRE would control presentation and transfer of self-antigens for thymic cellular interplay: such mechanism is aimed at increasing the likelihood of engagement of the thymocytes that carry the corresponding T-cell receptors. Another fundamental role of AIRE in promoting self-tolerance is related to the development of thymocyte anergy, as thymic self-representation shapes at the same time the repertoire of regulatory T cells. Finally, AIRE seems to replicate its action in the secondary lymphoid organs, albeit the cell lineage detaining such property has not been fully characterized. Delineation of AIRE functions adds interesting data to the knowledge of the mechanisms of self-tolerance and introduces exciting perspectives of therapeutic interventions against the related diseases.
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Affiliation(s)
- Roberto Perniola
- Department of Pediatrics, Neonatal Intensive Care, Vito Fazzi Regional Hospital, Lecce, Italy
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Bergamini C, Perniola R, Cardone MF, Gasparro M, Pepe R, Caputo AR, Antonacci D. The molecular characterization by SSRs reveals a new South Italian kinship and the origin of the cultivar Uva di Troia. Springerplus 2016; 5:1562. [PMID: 27652135 PMCID: PMC5023643 DOI: 10.1186/s40064-016-3228-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 09/06/2016] [Indexed: 11/10/2022]
Abstract
Vitis vinifera L. varieties were spread through cuttings following historic migrations of people, trades, or after biological crises due to pests outbreaks. Some today’s varieties could be more than a 1000 years old and, although over the centuries these varieties generated most of the remaining cultivars, their origin could be impossible to track back. The Italian grapevine biodiversity is one of most important, most likely due to its strategic position in the middle of the Mediterranean sea. Unravelling of its structure is challenging because of its complexity and the lack of historical documentation. In this paper molecular data are compared with historical documentations. Simple Sequence Repeats fingerprinting are molecular markers best suited to investigate genetic relationships and identify pedigrees. South-Italian germplasm was studied with 54 nuclear microsatellites. A family was identified, consisting of two parents and three siblings and further genetically characterized with six nuclear and five chloroplast microsatellites and described with ampelographic and phylometric analysis. Although these latter were not informative for the kinship identification. The common Bombino bianco was the female parent and the previously unknown Uva rosa antica was the male parent. Bombino nero, Impigno and the popular Uva di Troia, all typical of the south-east Italy, were the offspring. Further research showed that the Uva rosa antica was a synonym of Quagliano and Bouteillan noir, both minor varieties. Quagliano was considered to be autochthonous of some alpine valleys in the north-west of Italy and Bouteillan noir is a neglected variety of Vancluse in France. This finding uncovers the intricate nature of Italian grape cultivars, considered peculiar of an area, but possibly being the remains of ancient latin founding varieties. Consequently, intriguing new hypotheses are discussed and some conclusions are drawn, based on the peculiar geographical origin of the parents, on the distribution of the offspring, on the chance of a single, and perhaps intentional, crossing event.
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Affiliation(s)
- C Bergamini
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
| | - R Perniola
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
| | - M F Cardone
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
| | - M Gasparro
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
| | - R Pepe
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Centro di ricerca per l'orticoltura, Via Cavalleggeri, 25, 84098 Pontecagnano, SA Italy
| | - A R Caputo
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
| | - D Antonacci
- Consiglio per la ricerca in agricoltura e l'analisi dell'economia agraria- CREA - Unità di ricerca per l'uva da tavola e la vitivinicoltura in ambiente mediterraneo, Research Unit for Viticulture and Enology in Southern Italy, Via Casamassima, 148, 70010 Turi, BA Italy
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Vento G, Pastorino R, Boni L, Cota F, Carnielli V, Cools F, Dani C, Mosca F, Pillow J, Polglase G, Tagliabue P, van Kaam AH, Ventura ML, Tana M, Tirone C, Aurilia C, Lio A, Ricci C, Gambacorta A, Consigli C, D'Onofrio D, Gizzi C, Massenzi L, Cardilli V, Casati A, Bottino R, Pontiggia F, Ciarmoli E, Martinelli S, Ilardi L, Colnaghi M, Matassa PG, Vendettuoli V, Villani P, Fusco F, Gazzolo D, Ricotti A, Ferrero F, Stasi I, Magaldi R, Maffei G, Presta G, Perniola R, Messina F, Montesano G, Poggi C, Giordano L, Roma E, Grassia C, Ausanio G, Sandri F, Mescoli G, Giura F, Garani G, Solinas A, Lucente M, Nigro G, Del Vecchio A, Petrillo F, Orfeo L, Grappone L, Quartulli L, Scorrano A, Messner H, Staffler A, Gargano G, Balestri E, Nobile S, Cacace C, Meli V, Dallaglio S, Pasqua B, Mattia L, Gitto E, Vitaliti M, Re MP, Vedovato S, Grison A, Berardi A, Torcetta F, Guidotti I, di Fabio S, Maranella E, Mondello I, Visentin S, Tormena F. Efficacy of a new technique - INtubate-RECruit-SURfactant-Extubate - "IN-REC-SUR-E" - in preterm neonates with respiratory distress syndrome: study protocol for a randomized controlled trial. Trials 2016; 17:414. [PMID: 27538798 PMCID: PMC4991115 DOI: 10.1186/s13063-016-1498-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 02/07/2016] [Accepted: 07/31/2016] [Indexed: 11/15/2022] Open
Abstract
Background Although beneficial in clinical practice, the INtubate-SURfactant-Extubate (IN-SUR-E) method is not successful in all preterm neonates with respiratory distress syndrome, with a reported failure rate ranging from 19 to 69 %. One of the possible mechanisms responsible for the unsuccessful IN-SUR-E method, requiring subsequent re-intubation and mechanical ventilation, is the inability of the preterm lung to achieve and maintain an “optimal” functional residual capacity. The importance of lung recruitment before surfactant administration has been demonstrated in animal studies showing that recruitment leads to a more homogeneous surfactant distribution within the lungs. Therefore, the aim of this study is to compare the application of a recruitment maneuver using the high-frequency oscillatory ventilation (HFOV) modality just before the surfactant administration followed by rapid extubation (INtubate-RECruit-SURfactant-Extubate: IN-REC-SUR-E) with IN-SUR-E alone in spontaneously breathing preterm infants requiring nasal continuous positive airway pressure (nCPAP) as initial respiratory support and reaching pre-defined CPAP failure criteria. Methods/design In this study, 206 spontaneously breathing infants born at 24+0–27+6 weeks’ gestation and failing nCPAP during the first 24 h of life, will be randomized to receive an HFOV recruitment maneuver (IN-REC-SUR-E) or no recruitment maneuver (IN-SUR-E) just prior to surfactant administration followed by prompt extubation. The primary outcome is the need for mechanical ventilation within the first 3 days of life. Infants in both groups will be considered to have reached the primary outcome when they are not extubated within 30 min after surfactant administration or when they meet the nCPAP failure criteria after extubation. Discussion From all available data no definitive evidence exists about a positive effect of recruitment before surfactant instillation, but a rationale exists for testing the following hypothesis: a lung recruitment maneuver performed with a step-by-step Continuous Distending Pressure increase during High-Frequency Oscillatory Ventilation (and not with a sustained inflation) could have a positive effects in terms of improved surfactant distribution and consequent its major efficacy in preterm newborns with respiratory distress syndrome. This represents our challenge. Trial registration ClinicalTrials.gov identifier: NCT02482766. Registered on 1 June 2015.
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Affiliation(s)
- Giovanni Vento
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - Roberta Pastorino
- Section of Hygiene, Institute of Public Health, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168, Rome, Italy
| | - Luca Boni
- Clinical Trials Coordinating Center of Istituto Toscano Tumori, Department of Oncology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Cota
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Virgilio Carnielli
- Division of Neonatology, Department of Clinical Sciences, Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | - Filip Cools
- Department of Neonatology, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090, Brussels, Belgium
| | - Carlo Dani
- Department of Surgical and Medical Critical Care, Section of Neonatology, Careggi University Hospital, Viale Morgagni 85, 50141, Florence, Italy
| | - Fabio Mosca
- Department of Clinical Sciences and Community Health, University of Milan-Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Jane Pillow
- School of Anatomy, Physiology and Human Biology, University of Western Australia, Crawley, WA, Australia
| | - Graeme Polglase
- The Ritchie Centre Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology, Monash University, Clayton, 3168, VIC, Australia
| | | | - Anton H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | | | - Milena Tana
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Chiara Tirone
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Claudia Aurilia
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Alessandra Lio
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Cinzia Ricci
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | - Alessandro Gambacorta
- Division of Neonatology, Department for the Protection of Women's Health and the Nascent Life, Child and Adolescent, Policlinico A. Gemelli - Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy
| | | | | | - Camilla Gizzi
- Ospedale S. Giovanni Calibita Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Luca Massenzi
- Ospedale S. Giovanni Calibita Fatebenefratelli Isola Tiberina, Rome, Italy
| | - Viviana Cardilli
- Università di Roma "La Sapienza"/Policlinico Umberto I, Rome, Italy
| | | | | | | | | | | | | | - Mariarosa Colnaghi
- Department of Clinical Sciences and Community Health, University of Milan-Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Piero Giuseppe Matassa
- Department of Clinical Sciences and Community Health, University of Milan-Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | - Valentina Vendettuoli
- Department of Clinical Sciences and Community Health, University of Milan-Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Via Della Commenda 12, 20122, Milan, Italy
| | | | | | - Diego Gazzolo
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Ricotti
- Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Federica Ferrero
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Ilaria Stasi
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Rosario Magaldi
- Azienda Ospedaliero-Universitaria Ospedali Riuniti, Foggia, Italy
| | | | | | | | | | | | | | | | - Enza Roma
- Casa di Cura Pineta Grande, Castelvolturno (CE), Italy
| | | | - Gaetano Ausanio
- Azienda Ospedaliera Sant' Anna e San Sebastiano, Caserta, Italy
| | | | | | | | - Giampaolo Garani
- Azienda Ospedaliero-Universitaria Arcispedale S. Anna, Ferrara, Italy
| | - Agostina Solinas
- Azienda Ospedaliero-Universitaria Arcispedale S. Anna, Ferrara, Italy
| | | | | | | | | | | | | | | | | | | | | | - Giancarlo Gargano
- Azienda Ospedaliera Arcispedale S.Maria Nuova di Reggio Emilia/IRCCS, Reggio Emilia, Italy
| | - Eleonora Balestri
- Azienda Ospedaliera Arcispedale S.Maria Nuova di Reggio Emilia/IRCCS, Reggio Emilia, Italy
| | - Stefano Nobile
- Polytechnic University of Marche and Azienda Ospedaliero Universitaria Ospedali Riuniti, Ancona, Italy
| | | | | | - Sara Dallaglio
- Azienda Ospedaliera-Universitaria di Parma, Parma, Italy
| | - Betta Pasqua
- Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele- PO G. Rodolico, Catania, Italy
| | - Loretta Mattia
- Azienda Ospedaliero-Universitaria Policlinico Vittorio Emanuele- PO G. Rodolico, Catania, Italy
| | - Eloisa Gitto
- Azienda Ospedaliero-Universitaria Policlinico "G. Martino", Messina, Italy
| | - Marcello Vitaliti
- Azienda Ospedaliera di rilievo nazionale e di alta specializzazione Arnas Civico, Palermo, Italy
| | - Maria Paola Re
- Azienda Ospedaliera di rilievo nazionale e di alta specializzazione Arnas Civico, Palermo, Italy
| | | | | | | | | | | | | | | | - Isabella Mondello
- Azienda ospedaliera "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
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Falorni A, Brozzetti A, Perniola R. From Genetic Predisposition to Molecular Mechanisms of Autoimmune Primary Adrenal Insufficiency. Cortisol Excess and Insufficiency 2016; 46:115-32. [DOI: 10.1159/000443871] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Brozzetti A, Alimohammadi M, Morelli S, Minarelli V, Hallgren Å, Giordano R, De Bellis A, Perniola R, Kämpe O, Falorni A. Autoantibody response against NALP5/MATER in primary ovarian insufficiency and in autoimmune Addison's disease. J Clin Endocrinol Metab 2015; 100:1941-8. [PMID: 25734249 DOI: 10.1210/jc.2014-3571] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
CONTEXT NACHT leucine-rich-repeat protein 5 (NALP5)/maternal antigen that embryo requires (MATER) is an autoantigen in hypoparathyroidism associated with autoimmune polyendocrine syndrome type 1 (APS1) but is also expressed in the ovary. Mater is an autoantigen in experimental autoimmune oophoritis. OBJECTIVES The objectives of the study were to determine the frequency of NALP5/MATER autoantibodies (NALP5/MATER-Ab) in women with premature ovarian insufficiency (POI) and in patients with autoimmune Addison's disease (AAD) and to evaluate whether inhibin chains are a target for autoantibodies in POI. METHODS Autoantibodies against NALP5/MATER and inhibin chains-α and -βA were determined by radiobinding assays in 172 patients with AAD without clinical signs of gonadal insufficiency, 41 women with both AAD and autoimmune POI [steroidogenic cell autoimmune POI (SCA-POI)], 119 women with idiopathic POI, 19 patients with APS1, and 211 healthy control subjects. RESULTS NALP5/MATER-Ab were detected in 11 of 19 (58%) sera from APS1 patients, 12 of 172 (7%) AAD sera, 5 of 41 (12%) SCA-POI sera, 0 of 119 idiopathic POI sera and 1 of 211 healthy control sera (P < .001). None of 160 POI sera, including 41 sera from women with SCA-POI and 119 women with idiopathic POI, and none of 211 healthy control sera were positive for inhibin chain-α/βA autoantibodies. CONCLUSIONS NALP5/MATER-Ab are associated with hypoparathyroidism in APS1 but are present also in patients with AAD and in women with SCA-POI without hypoparathyroidism. Inhibin chains do not appear to be likely candidate targets of autoantibodies in human POI.
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Affiliation(s)
- Annalisa Brozzetti
- Department of Internal Medicine (A.B., S.M., V.M., A.F.), University of Perugia, 06126 Perugia, Italy; Department of Medical Sciences (M.A., O.K.), Science for Life Laboratory, Uppsala University, 750 03 Uppsala, Sweden; Centre of Molecular Medicine (M.A., A.H., O.K.), Department of Medicine (Solna), Karolinska Institutet, 171 76 Stockholm, Sweden; Division of Endocrinology, Diabetology, and Metabolism (R.G.), Department of Medical Sciences, University of Turin, 10126 Turin, Italy; Department of Cardio-Thoracic and Respiratory Science (A.D.B.), Endocrinology Unit, Second University of Naples, 80132 Naples, Italy; and Department of Pediatrics-Neonatal Intensive Care (R.P.), V. Fazzi Regional Hospital, 73100 Lecce, Italy
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Dalla Costa M, Bonanni G, Masiero S, Faggian D, Chen S, Furmaniak J, Rees Smith B, Perniola R, Radetti G, Garelli S, Chiarelli S, Albergoni MP, Plebani M, Betterle C. Gonadal function in males with autoimmune Addison's disease and autoantibodies to steroidogenic enzymes. Clin Exp Immunol 2014; 176:373-9. [PMID: 24666377 DOI: 10.1111/cei.12303] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/27/2022] Open
Abstract
Steroidogenic enzyme autoantibodies (SEAbs) are frequently present and are markers of autoimmune premature ovarian failure (POF) in females with autoimmune Addison's disease (AAD). The prevalence and significance of SEAbs in males with AAD have not yet been defined. We studied the prevalence of SEAbs in a large cohort of males with AAD and assessed the relationship between SEAbs positivity and testicular function. A total of 154 males with AAD (mean age 34 years) were studied. SEAbs included autoantibodies to steroid-producing cells (StCA), detected by immunofluorescence, and steroid 17α-hydroxylase (17α-OHAbs) and side chain cleavage enzyme (SCCAbs) measured by immunoprecipitation assays. Gonadal function was evaluated by measuring follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), sex hormone-binding globulin (SHGB), anti-müllerian hormone (AMH) and inhibin-B (I-B). Twenty-six males, 10 SEAbs((+)) and 16 SEAbs((-)), were followed-up for a mean period of 7·6 years to assess the behaviour of SEAbs and testicular function. SEAbs were found in 24·7% of males with AAD, with the highest frequency in patients with autoimmune polyendocrine syndrome type 1 (APS-1). The levels of reproductive hormones in 30 SEAbs((+)) males were in the normal range according to age and were not significantly different compared to 55 SEAbs((-)) males (P > 0·05). During follow-up, both SEAbs((+)) and SEAbs((-)) patients maintained normal testicular function. SEAbs were found with high frequency in males with AAD; however, they were not associated with testicular failure. This study suggests that the diagnostic value of SEAbs in males with AAD differs compared to females, and this may be related to the immunoprivileged status of the testis.
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Perniola R, Musco G. The biophysical and biochemical properties of the autoimmune regulator (AIRE) protein. Biochim Biophys Acta 2014; 1842:326-37. [PMID: 24275490 DOI: 10.1016/j.bbadis.2013.11.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [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: 07/27/2013] [Revised: 11/11/2013] [Accepted: 11/18/2013] [Indexed: 01/20/2023]
Abstract
AIRE (for autoimmune regulator) is a multidomain protein that performs a fundamental function in the thymus and possibly in the secondary lymphoid organs: the regulation, especially in the sense of activation, of the process of gene transcription in cell lines deputed to the presentation of self-antigens to the maturing T lymphocytes. The apoptosis of the elements bearing T-cell receptors with critical affinity for the exhibited self-antigens prevents the escape of autoreactive clones and represents a simple and efficient mechanism of deletional self-tolerance. However, AIRE action relies on an articulated complex of biophysical and biochemical properties, in most cases attributable to single subspecialized domains. Here a thorough review of the matter is presented, with a privileged look at the pathogenic changes of AIRE that interfere with such properties and lead to the impairment in its chief function.
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Affiliation(s)
- Roberto Perniola
- Department of Pediatrics - Neonatal Intensive Care, V. Fazzi Regional Hospital, Piazza F. Muratore, I-73100, Lecce, Italy.
| | - Giovanna Musco
- Biomolecular NMR Laboratory, Center of Translational Genomics and Bioinformatics, Dulbecco Telethon Institute at San Raffaele Scientific Institute, Via Olgettina 58, I-20132, Milan, Italy.
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Perniola R. Expression of the autoimmune regulator gene and its relevance to the mechanisms of central and peripheral tolerance. Clin Dev Immunol 2012; 2012:207403. [PMID: 23125865 PMCID: PMC3485510 DOI: 10.1155/2012/207403] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2012] [Revised: 08/26/2012] [Accepted: 09/11/2012] [Indexed: 01/12/2023]
Abstract
The autoimmune polyendocrine syndrome type 1 (APS-1) is a monogenic disease due to pathogenic variants occurring in the autoimmune regulator (AIRE) gene. Its related protein, AIRE, activates the transcription of genes encoding for tissue-specific antigens (TsAgs) in a subset of medullary thymic epithelial cells: the presentation of TsAgs to the maturating thymocytes induces the apoptosis of the autoreactive clones and constitutes the main form of central tolerance. Dysregulation of thymic AIRE expression in genetically transmitted and acquired diseases other than APS-1 may contribute to further forms of autoimmunity. As AIRE and its murine homolog are also expressed in the secondary lymphoid organs, the extent and relevance of AIRE participation in the mechanisms of peripheral tolerance need to be thoroughly defined.
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Affiliation(s)
- Roberto Perniola
- Neonatal Intensive Care, Department of Pediatrics, V. Fazzi Regional Hospital, Piazza F. Muratore, 73100 Lecce, Italy.
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Brozzetti A, Marzotti S, La Torre D, Bacosi ML, Morelli S, Bini V, Ambrosi B, Giordano R, Perniola R, De Bellis A, Betterle C, Falorni A. Autoantibody responses in autoimmune ovarian insufficiency and in Addison's disease are IgG1 dominated and suggest a predominant, but not exclusive, Th1 type of response. Eur J Endocrinol 2010; 163:309-17. [PMID: 20498138 DOI: 10.1530/eje-10-0257] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Steroid-producing cell autoantibodies (SCAs) directed against 21-hydroxylase autoantibodies (21OHAbs), 17alpha-hydroxylase autoantibodies (17OHAb), and cholesterol side-chain cleavage enzyme (side-chain cleavage autoantibodies, P450sccAb) characterize autoimmune primary ovarian insufficiency (SCA-POI). The aim of the study was to analyze IgG subclass specificity of autoantibodies related to adrenal and ovarian autoimmunity. DESIGN We studied 29 women with SCA-POI, 30 women with autoimmune Addison's disease (AAD) without POI, and 14 patients with autoimmune polyendocrine syndrome type 1 (APS1). 21OHAb isotypes were also analyzed in 14 subjects with preclinical AAD. Samples from 30 healthy women served as control group to determine the upper level of normality in the isotype assays. METHODS Immunoradiometric assays with IgG subclass-specific secondary antibodies. RESULTS In 21OHAb-positive sera, IgG1 isotype was detected in 90% SCA-POI and non-POI AAD sera and 67% APS1 patients. IgG1 isotype was found in 69% 17OHAb-positive SCA-POI and 100% 17OHAb-positive APS1 sera, and in 60% P450sccAb-positive SCA-POI and 80% P450sccAb-positive APS1 sera. For 21OHAb, IgG4 isotype was detected in 17% SCA-POI, 7% non-POI AAD, and 8% APS1 sera. None of the 17OHAb-positive sera was positive for IgG4. In P450sccAb-positive sera, 15% POI and 20% APS1 sera were positive for IgG4. Two 21OHAb-positive SCA-POI (7%), one 21OHAb-positive AAD (3%), three P450sccAb-positive SCA-POI (15%), and two P450sccAb-positive APS1 (20%) sera were positive for IgG4, in the absence of IgG1. All preclinical AAD sera resulted as positive for IgG1-21OHAb, but not for IgG4-21OHAb. CONCLUSIONS The autoantibody responses in POI and AAD are IgG1 dominated, which suggests a predominant Th1 response. Selective IgG4 isotype specificity identified a small subset of patients with Th2-oriented response.
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Kisand K, Bøe Wolff AS, Podkrajšek KT, Tserel L, Link M, Kisand KV, Ersvaer E, Perheentupa J, Erichsen MM, Bratanic N, Meloni A, Cetani F, Perniola R, Ergun-Longmire B, Maclaren N, Krohn KJE, Pura M, Schalke B, Ströbel P, Leite MI, Battelino T, Husebye ES, Peterson P, Willcox N, Meager A. Chronic mucocutaneous candidiasis in APECED or thymoma patients correlates with autoimmunity to Th17-associated cytokines. J Exp Med 2010; 207:299-308. [PMID: 20123959 PMCID: PMC2822605 DOI: 10.1084/jem.20091669] [Citation(s) in RCA: 477] [Impact Index Per Article: 34.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2009] [Accepted: 01/04/2010] [Indexed: 12/14/2022] Open
Abstract
Chronic mucocutaneous candidiasis (CMC) is frequently associated with T cell immunodeficiencies. Specifically, the proinflammatory IL-17A-producing Th17 subset is implicated in protection against fungi at epithelial surfaces. In autoimmune polyendocrinopathy candidiasis ectodermal dystrophy (APECED, or autoimmune polyendocrine syndrome 1), CMC is often the first sign, but the underlying immunodeficiency is a long-standing puzzle. In contrast, the subsequent endocrine features are clearly autoimmune, resulting from defects in thymic self-tolerance induction caused by mutations in the autoimmune regulator (AIRE). We report severely reduced IL-17F and IL-22 responses to both Candida albicans antigens and polyclonal stimulation in APECED patients with CMC. Surprisingly, these reductions are strongly associated with neutralizing autoantibodies to IL-17F and IL-22, whereas responses were normal and autoantibodies infrequent in APECED patients without CMC. Our multicenter survey revealed neutralizing autoantibodies against IL-17A (41%), IL-17F (75%), and/ or IL-22 (91%) in >150 APECED patients, especially those with CMC. We independently found autoantibodies against these Th17-produced cytokines in rare thymoma patients with CMC. The autoantibodies preceded the CMC in all informative cases. We conclude that IL-22 and IL-17F are key natural defenders against CMC and that the immunodeficiency underlying CMC in both patient groups has an autoimmune basis.
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Affiliation(s)
- Kai Kisand
- Molecular Pathology Group and Immunology Group, Institute of General and Molecular Pathology, University of Tartu, 50411 Tartu, Estonia
| | - Anette S. Bøe Wolff
- Institute of Medicine, University of Bergen and Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Katarina Trebušak Podkrajšek
- Centre for Medical Genetics and Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Liina Tserel
- Molecular Pathology Group and Immunology Group, Institute of General and Molecular Pathology, University of Tartu, 50411 Tartu, Estonia
| | - Maire Link
- Molecular Pathology Group and Immunology Group, Institute of General and Molecular Pathology, University of Tartu, 50411 Tartu, Estonia
| | - Kalle V. Kisand
- Molecular Pathology Group and Immunology Group, Institute of General and Molecular Pathology, University of Tartu, 50411 Tartu, Estonia
| | - Elisabeth Ersvaer
- Institute of Medicine, University of Bergen and Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Jaakko Perheentupa
- The Hospital for Children and Adolescents, University of Helsinki, 00290 Helsinki, Finland
| | - Martina Moter Erichsen
- Institute of Medicine, University of Bergen and Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Nina Bratanic
- Centre for Medical Genetics and Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Antonella Meloni
- Pediatric Clinic II, Ospedale Microcitemico and Department of Biomedical and Biotechnological Science, University of Cagliari, 09121 Cagliari, Italy
| | - Filomena Cetani
- Department of Endocrinology and Metabolism, University of Pisa, 56124 Pisa, Italy
| | - Roberto Perniola
- Department of Paediatrics-Neonatal Intensive Care, V. Fazzi Regional Hospital, 73100 Lecce, Italy
| | - Berrin Ergun-Longmire
- Division of Pediatric Endocrinology, University of Medicine and Dentistry of New Jersey/Robert Wood Johnson Medical School, New Brunswick, NJ 08901
| | | | - Kai J. E. Krohn
- Department of Pathology, Tampere University Hospital, 33521 Tampere, Finland
| | - Mikuláš Pura
- Department of Endocrinology, National Institute of Endocrinology and Diabetology, 03491 Lubochna, Slovakia
| | - Berthold Schalke
- Department of Neurology, University of Regensburg, 93053 Regensburg, Germany
| | - Philipp Ströbel
- Mannheim Medical Center, University of Heidelberg, 68135 Mannheim, Germany
| | - Maria Isabel Leite
- Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, OX3 9DS Oxford, England, UK
| | - Tadej Battelino
- Centre for Medical Genetics and Department of Pediatric Endocrinology, Diabetes and Metabolism, University Children's Hospital, 1000 Ljubljana, Slovenia
| | - Eystein S. Husebye
- Institute of Medicine, University of Bergen and Department of Medicine, Haukeland University Hospital, 5021 Bergen, Norway
| | - Pärt Peterson
- Molecular Pathology Group and Immunology Group, Institute of General and Molecular Pathology, University of Tartu, 50411 Tartu, Estonia
| | - Nick Willcox
- Neurosciences Group, Weatherall Institute of Molecular Medicine, University of Oxford, OX3 9DS Oxford, England, UK
| | - Anthony Meager
- Biotherapeutics Group, National Institute for Biological Standards and Control, South Mimms, EN6 3QG Hertfordshire, England, UK
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Meloni A, Furcas M, Cetani F, Marcocci C, Falorni A, Perniola R, Pura M, Bøe Wolff AS, Husebye ES, Lilic D, Ryan KR, Gennery AR, Cant AJ, Abinun M, Spickett GP, Arkwright PD, Denning D, Costigan C, Dominguez M, McConnell V, Willcox N, Meager A. Autoantibodies against type I interferons as an additional diagnostic criterion for autoimmune polyendocrine syndrome type I. J Clin Endocrinol Metab 2008; 93:4389-97. [PMID: 18728167 DOI: 10.1210/jc.2008-0935] [Citation(s) in RCA: 122] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
CONTEXT In autoimmune polyendocrinopathy syndrome type I (APS-I), mutations in the autoimmune regulator gene (AIRE) impair thymic self-tolerance induction in developing T cells. The ensuing autoimmunity particularly targets ectodermal and endocrine tissues, but chronic candidiasis usually comes first. We recently reported apparently APS-I-specific high-titer neutralizing autoantibodies against type I interferons in 100% of Finnish and Norwegian patients, mainly with two prevalent AIRE truncations. OBJECTIVES Because variability in clinical features and age at onset in APS-I frequently results in unusual presentations, we prospectively checked the diagnostic potential of anti-interferon antibodies in additional APS-I panels with other truncations or rare missense mutations and in disease controls with chronic mucocutaneous candidiasis (CMC) but without either common AIRE mutation. DESIGN The study was designed to detect autoantibodies against interferon-alpha2 and interferon-omega in antiviral neutralization assays. SETTING AND PATIENTS Patients included 14 British/Irish, 15 Sardinian, and 10 Southern Italian AIRE-mutant patients with APS-I; also 19 other patients with CMC, including four families with cosegregating thyroid autoimmunity. OUTCOME The diagnostic value of anti-interferon autoantibodies was assessed. RESULTS We found antibodies against interferon-alpha2 and/or interferon-omega in all 39 APS-I patients vs. zero of 48 unaffected relatives and zero of 19 British/Irish CMC patients. Especially against interferon-omega, titers were nearly always high, regardless of the exact APS-I phenotype/duration or AIRE genotype, including 12 different AIRE length variants or 10 point substitutions overall (n=174 total). Strikingly, in one family with few typical APS-I features, these antibodies cosegregated over three generations with autoimmune hypothyroidism plus a dominant-negative G228W AIRE substitution. CONCLUSIONS Otherwise restricted to patients with thymoma and/or myasthenia gravis, these precocious persistent antibodies show 98% or higher sensitivity and APS-I specificity and are thus a simpler diagnostic option than detecting AIRE mutations.
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Affiliation(s)
- Antonella Meloni
- Pediatric Clinic II, Ospedale Microcitemico and Dipartimento di Sciencze Biomediche e Biotechno-logiche, University of Cagliari, Cagliari, Sardinia, Italy
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Perniola R, Filograna O, Greco G, Pellegrino V. High prevalence of thyroid autoimmunity in Apulian patients with autoimmune polyglandular syndrome type 1. Thyroid 2008; 18:1027-9. [PMID: 18713028 DOI: 10.1089/thy.2008.0027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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20
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Perniola R, Congedo M, Rizzo A, Damiani AS, Faneschi ML, Pizzolante M, Lobreglio G. Innate and adaptive immunity in patients with autoimmune polyendocrinopathy–candidiasis–ectodermal dystrophy. Mycoses 2008; 51:228-35. [DOI: 10.1111/j.1439-0507.2007.01475.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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21
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Candeloro P, Voltattorni CB, Perniola R, Bertoldi M, Betterle C, Mannelli M, Giordano R, De Bellis A, Tiberti C, Laureti S, Santeusanio F, Falorni A. Mapping of human autoantibody epitopes on aromatic L-amino acid decarboxylase. J Clin Endocrinol Metab 2007; 92:1096-105. [PMID: 17200166 DOI: 10.1210/jc.2006-2319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Aromatic l-amino acid decarboxylase (AADC) is target of autoantibodies in autoimmune polyendocrine syndrome I (APS I), especially in patients with autoimmune hepatitis. Little information is currently available on AADC autoantibody epitopes and on the interrelation between autoantibody-mediated inhibition of enzymatic activity and epitope specificity. DESIGN We tested the immunoreactivity of full-length porcine AADC and of eight fragments of the enzyme with human serum from 18 patients with APS I, 199 with non-APS I autoimmune Addison's disease, 124 with type 1 diabetes mellitus, 36 with Graves' disease, and 141 healthy control subjects, and we evaluated the autoantibody-mediated enzymatic inhibition. RESULTS AADC antibodies (Ab) were detected in 12 of 18 (67%) APS I patients and in six of 199 (3%) autoimmune Addison's disease patients. Four patients with autoimmune hepatitis were all positive for AADCAb. None of the 141 healthy control subjects, 82 patients with nonautoimmune adrenal insufficiency, 124 with type 1 diabetes mellitus, and 36 with Graves' disease were found positive. Two epitope regions, corresponding to amino acids 274-299 (E1) and 380-471 (E2) were identified. Localization of E1 was confirmed by displacement studies with synthetic peptides corresponding to peptides of porcine AADC. All 12 AADCAb-positive APS I sera reacted with E1, and seven of 12 (58%) reacted also with E2. E2-specific, but not E1-specific, autoantibodies were associated with a significant inhibition of in vitro AADC enzymatic activity. CONCLUSIONS We mapped the human AADCAb epitopes to the middle and COOH-terminal regions of the enzyme. Autoantibodies to the COOH-terminal region induce a significant inhibition of enzymatic activity.
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Affiliation(s)
- Paola Candeloro
- Department of Internal Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, Via E. Dal Pozzo, 06126 Perugia, Italy
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22
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Perniola R, Faneschi ML, Manso E, Pizzolante M, Rizzo A, Sticchi Damiani A, Longo R. Rhodotorula mucilaginosa outbreak in neonatal intensive care unit: microbiological features, clinical presentation, and analysis of related variables. Eur J Clin Microbiol Infect Dis 2006; 25:193-6. [PMID: 16525775 DOI: 10.1007/s10096-006-0114-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Reported here are the features of a Rhodotorula mucilaginosa outbreak that occurred in a neonatal intensive care unit. Over a period of 19 days, clinical and laboratory signs of sepsis appeared in four premature infants carrying indwelling vascular catheters. After bloodstream infection with R. mucilaginosa was ascertained, the patients underwent amphotericin B therapy and recovered completely. In a retrospective case-control study, the variables displaying a statistical difference between case and control-group neonates were birth weight, gestational age, duration of parenteral nutrition, duration of antibiotic therapy and prophylactic administration of fluconazole. To our knowledge, this is the first reported outbreak caused by yeasts of the Rhodotorula genus.
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MESH Headings
- Amphotericin B/therapeutic use
- Antifungal Agents/therapeutic use
- Bacteremia/drug therapy
- Bacteremia/epidemiology
- Bacteremia/microbiology
- Case-Control Studies
- Catheterization, Central Venous/adverse effects
- Catheters, Indwelling/adverse effects
- Disease Outbreaks
- Female
- Humans
- Infant, Low Birth Weight
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/drug therapy
- Infant, Premature, Diseases/epidemiology
- Infant, Premature, Diseases/microbiology
- Intensive Care Units, Neonatal
- Male
- Mycoses/drug therapy
- Mycoses/epidemiology
- Mycoses/microbiology
- Rhodotorula/isolation & purification
- Rhodotorula/pathogenicity
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Affiliation(s)
- R Perniola
- Neonatal Intensive Care Unit, V. Fazzi Regional Hospital, Piazza F. Muratore, 73100 Lecce, Italy.
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23
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Abstract
We report two novel mutations, c.230T>C (p.F77S) and c.64_69del (p.V22_D23del) within the HSR domain of the AIRE protein in two patients of Italian descent affected by APECED. Both mutations were found in the compound heterozygous state respectively with c.994+5G>T and c.232T>A (p.W78R). With the two-hybrid assay in the yeast system we found that constructs containing the two mutations fail to interact with the wild-type protein. These findings indicate that both mutations negatively affected the homodimerization properties of the AIRE protein, thereby leading to a defective function.
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Affiliation(s)
- A Meloni
- Istituto di Neurogenetica e Neurofarmacologia, National Research Council, Cagliari, Italy
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24
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Perniola R, Lobreglio G, Rosatelli MC, Pitotti E, Accogli E, De Rinaldis C. Immunophenotypic characterisation of peripheral blood lymphocytes in autoimmune polyglandular syndrome type 1: clinical study and review of the literature. J Pediatr Endocrinol Metab 2005; 18:155-64. [PMID: 15751604 DOI: 10.1515/jpem.2005.18.2.155] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Autoimmune endocrinopathies are characterised by an increased number of peripheral blood lymphocytes (PBL) expressing activation/ memory markers on their surface. The aim of this study was to determine whether a similar finding could be detected in a group of 11 paediatric and young adult patients suffering from autoimmune polyglandular syndrome type 1 (APS1), also called autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), as very few data have previously been reported in this field. The control group was made up of 11 sex- and age-matched healthy subjects. Fifteen lymphocyte subsets were compared, in terms of percentage and absolute number, and statistical analysis was performed by the Mann-Whitney test. Measurement of T (CD3+), B (CD19+), natural killer (NK, CD3-CD16/56+), CD4+ and CD8+ T lymphocytes showed that patients with APS1 had a higher percentage and absolute count of T lymphocytes: this was entirely due to the statistically larger CD3+CD4+ fraction. Patients with APS1 also had slightly fewer B and NK lymphocytes, but the difference was negligible. Comparison of CD4+ subpopulations bearing activation and naive/memory antigens (marked by CD69, CD25, anti-HLA-DR, CD45RA and CD45RO) showed that patients with APS1 had generally larger percentages and absolute counts of these subsets: however, only the percentage and absolute size of the CD4+CD25+ subset (p = 0.0354 and p = 0.0151, respectively), and the absolute number of the CD4+ anti-HLA-DR+ and CD4+ CD45RO+ subsets (p = 0.0193 and p = 0.0209, respectively) were significantly higher. Interestingly, patients with APS1 also had significantly fewer CD8+CD11b+ and CD3-CD8+ cells. In conclusion, PBL distribution in APS1 resembles that of other autoimmune diseases. Further studies are needed to confirm and possibly extend these data.
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Affiliation(s)
- Roberto Perniola
- Paediatric Medicine Unit, Vito Fazzi Regional Hospital, Lecce, Italy.
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25
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Faneschi M, Rizzo A, Sticchi Damiani A, Pizzolante M, Perniola R. RHODOTORULA MUCILLAGINOSA: PICCOLO FOCOLAIO EPIDEMICO IN UN REPARTO DI TERAPIA INTENSIVA. Microbiol Med 2003. [DOI: 10.4081/mm.2003.4334] [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: 11/23/2022] Open
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26
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Meloni A, Perniola R, Faà V, Corvaglia E, Cao A, Rosatelli MC. Delineation of the molecular defects in the AIRE gene in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy patients from Southern Italy. J Clin Endocrinol Metab 2002; 87:841-6. [PMID: 11836330 DOI: 10.1210/jcem.87.2.8209] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In this study, we have carried out molecular analysis of the AIRE (autoimmune regulator) gene in 11 patients (from 8 families) affected by autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy, originating from a restricted area of Southern Italy (the Salento peninsula in Puglia). Of the 16 mutant AIRE alleles from the 8 probands studied, 12 carried a missense mutation (W78R in 9, P539L in 2, and P252L in 1), 2 carried the Q358X nonsense mutation, and 2 carried the 1058delT frameshift mutation. All these mutations except the 1058delT are novel. Each of the detected mutations either predicts a premature termination of the protein or results in a nonconservative amino acid change, most likely adversely affecting the function of the protein. The W78R missense mutation is relatively common in these patients, having been detected (in homozygosity or compound heterozygosity) in 6 of the 8 probands tested, indicating the presence of a founder effect. The results of this study contribute to the delineation of the molecular pathology of the AIRE gene and enhance our ability to perform a molecular diagnosis in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy patients from Southern Italy.
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Affiliation(s)
- Alessandra Meloni
- Istituto di Ricerca sulle Talassemie e Anemie Mediterranee, Consiglio Nazionale Ricerche, 09121 Cagliari
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27
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Perniola R, Falorni A, Clemente MG, Forini F, Accogli E, Lobreglio G. Organ-specific and non-organ-specific autoantibodies in children and young adults with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). Eur J Endocrinol 2000; 143:497-503. [PMID: 11022196 DOI: 10.1530/eje.0.1430497] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The aim of the study was to assess the complex of autoantibodies which can be detected in patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED), a rare autosomal recessive disease in which the extent of autoimmunity is still unknown. DESIGN Antibodies (A) to parathyroid glands, adrenal cortex (AC-A), ovary and testis (steroid cell antibodies, SC-A), pancreatic islet cells (IC-A), gastric parietal cells, and non-organ-specific antigens were investigated in 11 APECED patients living in the Salento region of southern Italy. Further measurements included antibodies to cytochrome P450 (CYP) enzymes: cholesterol side-chain cleavage enzyme (CYP11A), 21-hydroxylase (CYP21) and 17alpha-hydroxylase (CYP17); and to glutamic acid decarboxylase 65-kDa isoform (GAD65), tyrosine phosphatase-like protein IA2, thyroglobulin (TG), thyroperoxidase (TPO), thyrotropin receptor, liver CYP enzymes and intrinsic factor. METHODS Antibodies to organs and subcellular fractions were detected by immunofluorescence. Radiobinding, immunoradiometric, and immunoblotting assays were used for the other measurements. RESULTS AC-A and SC-A were positive in all sera; among antibodies to adrenal CYP enzymes, only CYP21-A were present in all the patients with Addison's disease of short-medium duration (<15 years). Of three patients with Addison's disease of long duration (>15 years), two tested positive for antibodies to all three CYP enzymes, and the other for only CYP11A-A. In all sera CYP11A-A and/or CYP17-A were found. Two patients tested positive for both IC-A and GAD65-A, one for both IC-A and IA2-A, and one for GAD65-A; the fasting C-peptide assay showed no statistical difference between these four subjects and the others. All four hypothyroid patients were positive for TPO-A, while two of them were positive and two were negative for TG-A; two euthyroid subjects had positivity for TG-A. Liver-kidney microsomal antibodies reacting against the CYP2A6 were detected in two patients with autoimmune hepatitis. All but one sera contained anti-nuclear antibodies at a titre ranging between 1:20 and 1:80; however, only two patients had a connective tissue disease (Sjögren's syndrome). CONCLUSIONS Several autoantibodies may be detected in any APECED patient. Our data confirm that CYP21-A and TPO-A are major autoantibodies involved in APECED-associated Addison's disease and hypothyroidism respectively, while CYP11A-A and CYP17-A correlate with positivity for SC-A. Markers of islet cell autoimmunity are frequent, but prevalence and modalities of progression to overt beta-cell failure have to be clarified. Low-titre non-organ-specific autoantibodies are a feature of autoimmunity in APECED, but their role has yet to be fully explained.
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Affiliation(s)
- R Perniola
- Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy.
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28
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Abstract
Reproductive failure is common in beta-thalassemia major patients because of endocrine damage resulting from iron overload. Here 3 full-term pregnancies following spontaneous ovulation in 2 splenectomized beta-thalassemia major women are reported. The main echocardiographic parameters, such as left ventricular end-diastolic and end-systolic diameters, fractional shortening and ejection fraction, were within the normal range before pregnancy, but worsened during gestation, and 1 patient developed pre-congestive heart failure. Deferoxamine therapy was continued throughout 2 pregnancies, while in the other it was stopped after 8 weeks: no abnormalities were noted in the children. Thanks to the currently applied therapies, an increased number of pregnancies may now be expected in beta-thalassemia major women: it is important to find out more about the pregnancy-related problems and their management in these patients.
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Affiliation(s)
- R Perniola
- Department of Pediatrics, Vito Fazzi Regional Hospital, Lecce, Italy
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29
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Perniola R, De Rinaldis C, Leo G. Third-generation assays for hepatitis C antibodies: a four-year study of pattern changes in patients with chronic and past infection. Panminerva Med 1999; 41:291-4. [PMID: 10705708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
BACKGROUND Many advances have been made in the sensitivity of assays for hepatitis C virus antibodies (HCV-Ab). Nevertheless, polymerase chain reaction (PCR) is still the best method to establish if infection has become chronic. In this study we utilised third-generation assays for HCV-Ab in a four-year follow-up to determine the trend in antibody levels in currently and past infected patients. METHODS Seventy-two multitransfused subjects were enrolled. All the patients were reactive at the first test with third-generation screening and confirmatory assays (ELISA-3 and RIBA-3) for HCV-Ab. They were subsequently retested in a follow-up ranging from 41 to 47 months. Viraemia was investigated with a standardised PCR kit; negative samples were reevaluated with nested PCR. Differences in antibody trend were calculated with the Wilcoxon signed-rank test. RESULTS No statistical variation in antibody titre was found in the 41 HCV-RNA positive patients, although some of these showed a decrease in anti-c100p level. In contrast, anti-c22p, anti-c33c and anti-c100p levels decreased significantly in the 19 past infected patients. Twelve patients were HCV-RNA negative or intermittently positive with commercial PCR test, and consistently or intermittently positive in nested PCR: in these patients, antibody trend varied. CONCLUSIONS Although resolving hepatitis is associated with a decrease in antibody titre, the trend should be observed for a long period to distinguish between chronic and past infection. However, the evaluation in a single patient can be unreliable. Since a doubtful response for HCV-RNA is in some cases obtained, further improvements in the diagnosis of chronic HCV infection are needed.
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Affiliation(s)
- R Perniola
- Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy
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30
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Perniola R, De Rinaldis C, Accogli E, Lobreglio G. Prevalence and clinical features of cryoglobulinaemia in multitransfused beta-thalassaemia patients. Ann Rheum Dis 1999; 58:698-702. [PMID: 10531074 PMCID: PMC1752797 DOI: 10.1136/ard.58.11.698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of cryoglobulinaemia and its clinical features among beta-thalassaemia patients. METHODS Eighty eight multitransfused beta-thalassaemia patients were studied. They were physically examined and asked about the presence of cryoglobulinaemia related symptoms. Hepatitis C virus (HCV) serology, HCV-RNA, HCV subtypes, viraemia, serum ferritin, liver and kidney function tests, rheumatoid factor (RF), circulating immune complexes (CIC), complement levels and autoantibodies were all evaluated. The patients were divided into four groups: HCV-RNA positive patients with and without cryoglobulinaemia (groups A and B), HCV-Ab positive/HCV-RNA negative patients (group C), HCV-Ab negative patients (group D). RESULTS Cryoglobulinaemia was present in 35 of 53 (66.0%) patients with chronic HCV infection. They had higher viraemia than non-cryoglobulinaemic viral carriers, but no statistical difference relating to sex or HCV subtypes was found. In comparison with the other groups, group A patients were older, had undergone transfusion therapy for a longer period, had received a higher number of transfusions, and had increased levels of RF and CIC, as well as consumption of C4; in addition, they had a higher prevalence of cirrhosis. Cutaneous lesions (purpura, Raynaud's phenomenon, nodules and leg rash), peripheral neuropathy and sicca syndrome symptoms were present only in group A. Musculoskeletal symptoms (bone pain, arthralgia and myalgia), weakness, splenomegaly, lymphadenopathy, skin ulcers and proteinuria were also commoner in group A, but the difference did not reach statistical significance, possibly because of partial overlap between cryoglobulinaemia and beta-thalassaemia syndromes. CONCLUSION Because of its high prevalence in multitransfused beta-thalassaemia patients, cryoglobulinaemia needs to be systematically studied and considered in the differential diagnosis of various beta-thalassaemia manifestations.
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Affiliation(s)
- R Perniola
- Paediatric Unit, Vito Fazzi Regional Hospital, Lecce, Italy
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31
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Perniola R, Tamborrino G, Marsigliante S, De Rinaldis C. Assessment of enamel hypoplasia in autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED). J Oral Pathol Med 1998; 27:278-82. [PMID: 9707281 DOI: 10.1111/j.1600-0714.1998.tb01956.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The features of enamel hypoplasia in a small group of patients with autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) are described. Using a recently developed method, the authors evaluated quantitatively the amount of defect in each tooth by measuring the width of the hypoplastic lesions and dividing the value by the crown height. They then assessed the degree of damage in each tooth type (from central incisors to second premolars) and patient. Canines were the most severely affected among maxillary and mandibular teeth, but all tooth types were involved. Analysing both the differences between patients and their age at the beginning of the defect, the authors observe that hypoparathyroidism is not responsible for the onset of enamel hypoplasia in APECED, although it may contribute to the damage.
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Affiliation(s)
- R Perniola
- Pediatric Unit, ASL Vito Fazzi Hospital, Lecce, Italy
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32
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Perniola R, De Rinaldis C, Muratore M. Human chorionic gonadotrophin therapy in hypogonadal thalassaemic patients with osteopenia: increase in bone mineral density. J Pediatr Endocrinol Metab 1998; 11 Suppl 3:995-6. [PMID: 10091183] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- R Perniola
- Paediatric Unit, V. Fazzi Hospital, Lecce, Italy
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Perniola R, Petracca M, De Rinaldis C, Perrone A, Pizzolante M. A severe case of Yersinia enterocolitica infection in a thalassemic patient. Ital J Gastroenterol Hepatol 1997; 29:82-3. [PMID: 9265586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Fedeli G, Certo M, Cannizzaro O, Forti G, Perniola R, Manna R, Gambassi G. Extramedullary hematopoiesis involving the esophagus in myelofibrosis. Am J Gastroenterol 1990; 85:1512-4. [PMID: 2239880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this report, we describe a case of myelofibrosis with myeloid metaplasia; a 53-yr-old man was splenectomized for a massively enlarged spleen in which multiple foci of myeloid metaplasia were histologically demonstrated. The patient was referred to us for endoscopic examination, following the repeated occurrence of melena. Upper gastrointestinal endoscopy revealed two active ulcerative lesions in the bulb, and only a moderate erythema in the lower third of the esophagus, which showed no varices. There was no endoscopic evidence of active or recent bleeding. Subsequent histologic examination of biopsies taken from the esophageal lesion surprisingly revealed the presence of hematopoietic tissue.
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Affiliation(s)
- G Fedeli
- Istituto di Clinica Medica, Unitá di Gastroenterologia, Universitá Cattolica del Sacro Cuore, Rome, Italy
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