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Colosimo S, Martínez-Sánchez MA, Balaguer-Román A, Fernández-Ruiz VE, Núñez-Sánchez MA, Ferrer-Gómez M, Frutos MD, Tomlinson JW, Bertoli S, Marchesini G, Ramos-Molina B. A novel model for predicting diabetes remission after bariatric surgery based on the measurement of C-peptide and creatinine in serum: A pilot study. Nutr Metab Cardiovasc Dis 2024; 34:1142-1145. [PMID: 38220504 DOI: 10.1016/j.numecd.2023.12.008] [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: 07/17/2023] [Revised: 11/24/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Bariatric surgery is effective for treating type 2 diabetes (T2D) in patients with obesity, although a significant proportion of these patients do not achieve diabetes remission after the surgery even after significant weight loss and metabolic improvement. C-peptide is a valuable marker of beta cell function and insulin secretion, but renal function must be considered when interpreting measurements in patients with T2D. The study aims to investigate the association of serum levels of C-peptide adjusted for creatinine with diabetes remission and glycemic target achievement after bariatric surgery in patients with obesity and T2D. METHODS AND RESULTS Prospective data from a cohort of 84 patients with obesity and T2D submitted to Roux-en-Y gastric bypass (RYGB) were collected at baseline and at least a 6-month follow up. A multivariate binomial regression model showed that Ln(C-peptide/creatinine) and age were significantly associated with 6-month T2D remission. The area under the curve for the receiver operating characteristic analysis (AUROC) to predict remission was 0.87, and more accurate than the AUROC based on C-peptide levels alone (0.75). The same model was also able to predict achieving an HbA1c target of 7 % (53 mmol/mol) (AUROC 0.96). CONCLUSION In conclusion, Ln(C-peptide/creatinine) ratio could be a useful tool in predicting T2D remission and target achievement after RYGB surgery, providing a more accurate reflection of beta cell function in bariatric patients.
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Affiliation(s)
- Santo Colosimo
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; School of Nutrition Science, University of Milan, Milan, Italy; Obesity Research Lab, Istituto Auxologico Italiano, Milan, Italy.
| | - María A Martínez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Andrés Balaguer-Román
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Virginia E Fernández-Ruiz
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain; Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - María A Núñez-Sánchez
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
| | - Mercedes Ferrer-Gómez
- Department of Endocrinology and Nutrition, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - María Dolores Frutos
- Department of General and Digestive System Surgery, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism and NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Simona Bertoli
- Obesity Research Lab, Istituto Auxologico Italiano, Milan, Italy; Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Bruno Ramos-Molina
- Obesity, Diabetes and Metabolism Laboratory, Biomedical Research Institute of Murcia (IMIB), Murcia, Spain
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Petroni ML, Colosimo S, Marchesini G. Editorial: Does knowledge about liver disease enhance adherence to lifestyle recommendations? Authors' reply. Aliment Pharmacol Ther 2024; 59:285-286. [PMID: 38153285 DOI: 10.1111/apt.17810] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
LINKED CONTENTThis article is linked to Petroni et al papers. To view these articles, visit https://doi.org/10.1111/apt.17768 and https://doi.org/10.1111/apt.17789
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Affiliation(s)
- Maria Letizia Petroni
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Santo Colosimo
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
| | - Giulio Marchesini
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy
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Petroni ML, Colosimo S, Brodosi L, Armandi A, Bertini F, Montesi D, Bugianesi E, Marchesini G. Long-term follow-up of web-based and group-based behavioural intervention in NAFLD in a real world clinical setting. Aliment Pharmacol Ther 2024; 59:249-259. [PMID: 37843741 DOI: 10.1111/apt.17768] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 09/05/2023] [Revised: 09/25/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The long-term results of web-based behavioural intervention in non-alcoholic fatty liver disease (NAFLD) have not been described in patients followed in specialised centres. AIMS To analyse the long-term effectiveness of web education compared with the results achieved by a group-based behavioural intervention in the same years 2012-2014. METHODS We followed 679 patients with NAFLD (web-based, n = 290; group-based, n = 389) for 5 years. Weight loss ≥10% was the primary outcome; secondary outcomes were attrition, changes in liver enzymes and in biomarkers of steatosis (Fatty liver Index) and fibrosis (Fibrosis-4 index). RESULTS The cohorts differed in age, education, working status and presence of diabetes. Attrition was higher in the web-based cohort (hazard ratio: 1.53; 95% CI: 1.24-1.88), but not different after adjustment for confounders. Among patients in active follow-up, 50% lost ≥5% of initial body weight and 19% lost ≥10%, without difference between cohorts. Alanine aminotransferase levels fell to within the normal range in 51% and 45% of web- and group-based cohorts, respectively. Fatty Liver Index declined progressively and, by year 5, it ruled out steatosis in 4.8%, whereas 24.9% were in the indeterminate range. Fibrosis-4 index increased in both cohorts, driven by age, but the prevalence of cases ruling-in advanced fibrosis remained very low (around 1%). Improvements in the class of both surrogate biomarkers were associated with ≥5% weight loss. CONCLUSIONS Although burdened by attrition, web-based behavioural intervention is feasible and effective in NAFLD, expanding the cohort involved in behavioural programs and reducing the risk of progressive disease.
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Affiliation(s)
| | - Santo Colosimo
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Lucia Brodosi
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Angelo Armandi
- Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Flavio Bertini
- Department of Mathematical, Physical and Computer Sciences, University of Parma, Parma, Italy
| | - Danilo Montesi
- Department of Computer Science and Engineering, Alma Mater University of Bologna, Bologna, Italy
| | - Elisabetta Bugianesi
- Department of Medical Sciences, Division of Gastroenterology and Hepatology, A.O. Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
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Colosimo S, Mitra SK, Chaudhury T, Marchesini G. Insulin resistance and metabolic flexibility as drivers of liver and cardiac disease in T2DM. Diabetes Res Clin Pract 2023; 206:111016. [PMID: 37979728 DOI: 10.1016/j.diabres.2023.111016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 08/23/2023] [Revised: 10/15/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
Metabolic flexibility refers to the ability of tissues to adapt their use of energy sources according to substrate availability and energy demands. This review aims to disentangle the emerging mechanisms through which altered metabolic flexibility and insulin resistance promote NAFLD and heart disease progression. Insulin resistance and metabolic inflexibility are central drivers of hepatic and cardiac diseases in individuals with type 2 diabetes. Both play a critical role in the complex interaction between glucose and lipid metabolism. Disruption of metabolic flexibility results in hyperglycemia and abnormal lipid metabolism, leading to increased accumulation of fat in the liver, contributing to the development and progression of NAFLD. Similarly, insulin resistance affects cardiac glucose metabolism, leading to altered utilization of energy substrates and impaired cardiac function, and influence cardiac lipid metabolism, further exacerbating the progression of heart failure. Regular physical activity promotes metabolic flexibility by increasing energy expenditure and enabling efficient switching between different energy substrates. On the contrary, weight loss achieved through calorie restriction ameliorates insulin sensitivity without improving flexibility. Strategies that mimic the effects of physical exercise, such as pharmacological interventions or targeted lifestyle modifications, show promise in effectively treating both diabetes and NAFLD, finally reducing the risk of advanced liver disease.
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Affiliation(s)
- Santo Colosimo
- School of Nutrition Science, University of Milan, Milan, Italy
| | - Sandip Kumar Mitra
- Diabetes and Endocrinology Unit, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Tirthankar Chaudhury
- Diabetes and Endocrinology Unit, Apollo Gleneagles Hospital, Kolkata, West Bengal, India
| | - Giulio Marchesini
- IRCCS-Azienda Ospedaliero-Universitaria di Bologna, Policlinico di Sant'Orsola, Bologna, Italy.
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Colosimo S, Bertoli S, Saffioti F. Use of Branched-Chain Amino Acids as a Potential Treatment for Improving Nutrition-Related Outcomes in Advanced Chronic Liver Disease. Nutrients 2023; 15:4190. [PMID: 37836474 PMCID: PMC10574343 DOI: 10.3390/nu15194190] [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] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
Advanced chronic liver disease (ACLD) represents a complex and multifactorial clinical entity characterized by liver dysfunction and associated complications. In recent years, the significance of nutritional status in ACLD prognosis has gained considerable attention. This review article delves into the multifactorial pathogenesis of malnutrition in ACLD and its profound consequences for health outcomes. We explore the clinical implications of secondary sarcopenia in ACLD and highlight the critical relevance of frailty in both decompensated and compensated ACLD. A specific focus of this review revolves around branched-chain amino acids (BCAAs) and their pivotal role in managing liver disease. We dissect the intricate relationship between low Fischer's ratio and BCAA metabolism in ACLD, shedding light on the molecular mechanisms involved. Furthermore, we critically evaluate the existing evidence regarding the effects of BCAA supplementation on outcomes in ACLD patients, examining their potential to ameliorate the nutritional deficiencies and associated complications in this population.
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Affiliation(s)
- Santo Colosimo
- School of Nutrition Science, University of Milan, 20133 Milan, Italy
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy
| | - Simona Bertoli
- Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, 20133 Milan, Italy
- Laboratory of Clinical Studies on Obesity, Istituto Auxologico Italiano IRCCS, 20145 Milan, Italy
| | - Francesca Saffioti
- Oxford Liver Unit, Department of Gastroenterology and Hepatology, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK;
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Affiliation(s)
- Santo Colosimo
- School of Nutrition Science, University of Milan, Milano, Italy
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences, Alma Mater University of Bologna, Bologna, Italy
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Colosimo S, Tan GD, Petroni ML, Marchesini G, Tomlinson JW. Improved glycaemic control in patients with type 2 diabetes has a beneficial impact on NAFLD, independent of change in BMI or glucose lowering agent. Nutr Metab Cardiovasc Dis 2023; 33:640-648. [PMID: 36710114 DOI: 10.1016/j.numecd.2022.12.010] [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: 11/09/2022] [Revised: 12/06/2022] [Accepted: 12/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM The current focus of the treatment of Non-Alcoholic Fatty Liver Disease (NAFLD) is lifestyle intervention with the aim of significant weight loss alongside aggressive cardiovascular risk reduction. NAFLD is tightly associated with type 2 diabetes (T2D) and obesity. In patients with T2D, glucose lowering agents that promote weight loss have shown a beneficial impact on NAFLD. However, it remains unclear as to whether glucose lowering can improve NALFD in patients with T2D, independent of weight loss. METHODS AND RESULTS In a retrospective analysis of data from 637 people with T2D, we examined the longitudinal impact of optimizing glycaemic control with DPP-IV inhibitors, GLP-1RAs and SGLT2 inhibitors on Fatty liver index (FLI) and Fibrosis score 4 (Fib-4) adjusting for changes in BMI and choice of glucose lowering regimen over a 12-month period. Multiple linear regression analysis demonstrated a significant correlation between the change in glycated haemoglobin and change in FLI after adjustment for change in BMI, age, sex, and drug class (R = 0.467, p = 0.031). The greatest reduction in FLI was observed in patients with the largest reduction in glycated haemoglobin (p < 0.0001). The probability of improvements in FLI with optimization of glycaemic control was similar with all 3 glucose lowering agents, despite differences in weight reduction. Similar relationships were observed examining the changes in glycaemic control and Fib-4. CONCLUSIONS Improvements in glucose control that are independent of weight loss are associated with improvement in NAFLD and should form an integral part of the management patients with co-existent NAFLD and T2D.
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Affiliation(s)
- Santo Colosimo
- School of Nutrition Science, University of Milan, Milan, Italy; Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | - Garry D Tan
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK
| | | | - Giulio Marchesini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, NIHR Oxford Biomedical Research Centre, University of Oxford, Churchill Hospital, Oxford, OX3 7LE, UK.
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Pezzoli G, Cereda E, Amami P, Colosimo S, Barichella M, Sacilotto G, Zecchinelli A, Zini M, Ferri V, Bolliri C, Calandrella D, Bonelli MG, Cereda V, Reali E, Caronni S, Cassani E, Canesi M, del Sorbo F, Soliveri P, Zecca L, Klersy C, Cilia R, Isaias IU. Onset and mortality of Parkinson's disease in relation to type II diabetes. J Neurol 2023; 270:1564-1572. [PMID: 36436068 PMCID: PMC9971073 DOI: 10.1007/s00415-022-11496-y] [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: 08/26/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES There is growing evidence that Parkinson's disease and diabetes are partially related diseases; however, the association between the two, and the impact of specific treatments, are still unclear. We evaluated the effect of T2D and antidiabetic treatment on age at PD onset and on all-cause mortality. RESEARCH DESIGN AND METHODS The standardized rate of T2D was calculated for PD patients using the direct method and compared with subjects with essential tremor (ET) and the general Italian population. Age at onset and survival were also compared between patients without T2D (PD-noT2D), patients who developed T2D before PD onset (PD-preT2D) and patients who developed T2D after PD onset (PD-postT2D). RESULTS We designed a retrospective and prospective study. The T2D standardized ratio of PD (N = 8380) and ET (N = 1032) patients was 3.8% and 6.1%, respectively, while in the Italian general population, the overall prevalence was 5.3%. In PD-preT2D patients, on antidiabetic treatment, the onset of PD was associated with a + 6.2 year delay (p < 0.001) while no difference was observed in PD-postT2D. Occurrence of T2D before PD onset negatively affected prognosis (adjusted hazard ratio = 1.64 [95% CI 1.33-2.02]; p < 0.001), while no effect on survival was found in PD-postT2D subjects (hazard ratio = 0.86, [95% CI 0.53-1.39]; p = 0.54). CONCLUSIONS T2D, treated with any antidiabetic therapy before PD, is associated with a delay in its onset. Duration of diabetes increases mortality in PD-preT2D, but not in PD-postT2D. These findings prompt further studies on antidiabetic drugs as a potential disease-modifying therapy for PD.
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Affiliation(s)
- Gianni Pezzoli
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Emanuele Cereda
- Clinical Nutrition and Dietetics Unit, Fondazione IRCCS Policlinico San Matteo, Viale Golgi 19, 27100, Pavia, Italy.
| | - Paolo Amami
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Santo Colosimo
- grid.4708.b0000 0004 1757 2822University of Milan, Specialization School in Nutrition Science, Milan, Italy ,Clinical Nutrition Unit, ASST-Pini-CTO, Milan, Italy
| | | | - Giorgio Sacilotto
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy
| | - Anna Zecchinelli
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy
| | - Michela Zini
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy
| | - Valentina Ferri
- grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy ,Clinical Nutrition Unit, ASST-Pini-CTO, Milan, Italy
| | - Carlotta Bolliri
- grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy ,Clinical Nutrition Unit, ASST-Pini-CTO, Milan, Italy
| | - Daniela Calandrella
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Maria Grazia Bonelli
- grid.5326.20000 0001 1940 4177Programming and Grant Offices (UPGO), Italian National Research Council (CNR), Rome, Italy
| | - Viviana Cereda
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Elisa Reali
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy
| | - Serena Caronni
- grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy ,Clinical Nutrition Unit, ASST-Pini-CTO, Milan, Italy
| | - Erica Cassani
- grid.479062.e0000 0004 6080 596XFondazione Grigioni per il Morbo di Parkinson, Milan, Italy ,Clinical Nutrition Unit, ASST-Pini-CTO, Milan, Italy ,grid.18887.3e0000000417581884Dietetic and Clinical Nutrition Unit, ASST-Fatebenefratelli-Sacco, University Hospital, Milan, Italy
| | - Margherita Canesi
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy ,Department of Parkinson’s Disease, Movement Disorders and Brain Injury Rehabilitation, “Moriggia-Pelascini” General Hospital, Como, Italy
| | | | - Paola Soliveri
- Parkinson Institute Milan, ASST-Pini-CTO, Via Bignami 1, Milan, Italy
| | - Luigi Zecca
- grid.5326.20000 0001 1940 4177Institute of Biomedical Technologies, National Research Council of Italy, Segrate, Milan Italy
| | - Catherine Klersy
- grid.419425.f0000 0004 1760 3027Unit of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Cilia
- grid.417894.70000 0001 0707 5492Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Ioannis U. Isaias
- grid.8379.50000 0001 1958 8658Department of Neurology, University Hospital of Würzburg and Julius Maximilian University of Würzburg, Würzburg, Germany
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Colosimo S, Tomlinson JW. Bile acids as drivers and biomarkers of hepatocellular carcinoma. World J Hepatol 2022; 14:1730-1738. [PMID: 36185719 PMCID: PMC9521453 DOI: 10.4254/wjh.v14.i9.1730] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 02/06/2023] Open
Abstract
The prevalence of hepatocellular carcinoma (HCC) is rapidly increasing, driven not least in part by the escalating prevalence of non-alcoholic fatty liver disease. Bile acid (BA) profiles are altered in patients with HCC and there is a developing body of evidence from in vitro human cellular models as well as rodent data suggesting that BA are able to modulate fundamental processes that impact on cellular phenotype predisposing to the development of HCC including senescence, proliferation and epithelial-mesenchymal transition. Changes in BA profiles associated with HCC have the potential to be exploited clinically. Whilst excellent diagnostic and imaging tools are available, their use to screen populations with advanced liver disease at risk of HCC is limited by high cost and low availability. The mainstay for HCC screening among subjects with cirrhosis remains frequent interval ultrasound scanning. Importantly, currently available serum biomarkers add little to diagnostic accuracy. Here, we review the current literature on the use of BA measurements as predictors of HCC incidence in addition to their use as a potential screening method for the early detection of HCC. Whilst these approaches do show early promise, there are limitations including the relatively small cohort sizes, the lack of a standardized approach to BA measurement, and the use of inappropriate control comparator samples.
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Affiliation(s)
- Santo Colosimo
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, United Kingdom
- School of Nutrition Science, University of Milan, Milan 20133, Italy
| | - Jeremy W Tomlinson
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford OX3 7LE, United Kingdom
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Grancini V, Vianello FA, Colosimo S, Gaglio A, Resi V, Arosio M, Ardissino G, Montini G, Orsi E. Glucose Control in Post-hemolytic-Uremic Syndrome Diabetes: A New Approach Offered by Sensor-Augmented Pump Therapy. Front Pediatr 2022; 10:882319. [PMID: 35712621 PMCID: PMC9197158 DOI: 10.3389/fped.2022.882319] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 3-year-old girl admitted to her town emergency department for fever (39°C) associated with diarrhea, generalized edema, oliguria, and drowsiness. The blood test revealed metabolic acidosis, leucocytosis, increased inflammatory markers, anemia, thrombocytopenia, and acute kidney failure. Based on the diagnosis of hemolytic-uremic syndrome, the patient was referred to a third-level children hospital. Assisted ventilation, hemodialysis, and parenteral nutrition were instituted. The blood glucose levels increased above 200 mg/dl with peaks at 500 mg/dl. Islet auto-antibodies were negative and C-peptide was undetectable, thus ruling out the diagnosis of type 1 diabetes. Multiple-daily-injection insulin therapy was then instituted with the following regimen: Detemir 2 U once daily and Aspart 0.5 U if blood glucose >200 mg/dl. Despite the very low insulin dosage, the patient experienced frequent and severe hypoglycemic events during the following 24 h and was therefore switched to sensor-augmented pump therapy. Optimal glucose control was achieved without further hypoglycemic episodes. Moreover, thanks to the possibility to customize insulin therapy hour by hour during the day and the use of a pre-low glucose suspend system, glucose control was maintained even despite the continuous modifications in the nutritional scheme due to the multiple complications that arose during hospitalization. This rare case of post-hemolytic-uremic syndrome diabetes, treated with sensor-augmented therapy from its outbreak, suggests for the first time the potential of this therapeutic strategy in achieving glucose control without significant hypoglycemic episodes in children with secondary forms of diabetes associated with very low insulin requirement.
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Affiliation(s)
- Valeria Grancini
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Santo Colosimo
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.,Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, United Kingdom
| | - Alessia Gaglio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Veronica Resi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Maura Arosio
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Gianluigi Ardissino
- Pediatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Montini
- Pediatric Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuela Orsi
- Endocrinology Unit, Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico, Milan, Italy
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Colosimo S, Ravaioli F, Petroni ML, Brodosi L, Marchignoli F, Barbanti FA, Sasdelli AS, Marchesini G, Pironi L. Effects of antidiabetic agents on steatosis and fibrosis biomarkers in type 2 diabetes: A real-world data analysis. Liver Int 2021; 41:731-742. [PMID: 33497019 PMCID: PMC8248247 DOI: 10.1111/liv.14799] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS There is intense research for drugs able to reduce disease progression in nonalcoholic fatty liver disease. We aimed to test the impact of novel antidiabetic drugs (dipeptidyl-peptidase-4 inhibitors - DPP-4Is, glucagon-like peptide-1 receptor agonists - GLP-1RAs, sodium-glucose cotransporter-2 inhibitors - SGLT-2Is) on non-invasive biomarkers of steatosis (fatty liver index, FLI) and fibrosis (Fibrosis-4 score, FIB-4) in patients with type 2 diabetes (T2D). METHODS Clinical, anthropometric and biochemical parameters were retrospectively analysed in 637 consecutive T2D patients switched from metformin w/wo sulfonylureas and/or pioglitazone to DPP-4Is, GLP-1RAs and SGLT-2Is in a tertiary care setting. 165 patients maintained on original treatments served as controls. The effects on FLI and FIB-4 at 6- and 12-month follow-up were analysed by logistic regression after adjustment for baseline differences, computed by propensity scores, and additional adjustment for changes in glycosylated hemoglobin (HbA1c) and body mass index. RESULTS Body mass index, HbA1c and aminotrasferases significantly decreased following switching to GLP-1RAs and SGLT2-Is, compared with both controls and DPP-4Is, whereas only HbA1c was reduced on DPP-4Is. FLI and FIB-4 were reduced on GLP-1RA and SGLT-2I; logistic regression analysis confirmed a significant improvement of both biomarkers after adjustment for propensity score. The shift of FIB-4 values towards the category ruling out advanced fibrosis was maintained after additional adjustment for confounders. These effects were confirmed in a sensitivity analysis on effect size. CONCLUSIONS Glucagon-like peptide-1 receptor agonists and SGLT-2Is improve biomarkers of steatosis and fibrosis, in keeping with beneficial effects on liver disease progression, and should be considered the treatment of choice in T2D.
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Affiliation(s)
- Santo Colosimo
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly,Fondazione IRCSS Ca' GrandaOspedale Maggiore Policlinico di MilanoMilanItaly
| | - Federico Ravaioli
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Maria L. Petroni
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Lucia Brodosi
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Francesca Marchignoli
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Francesca A. Barbanti
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Anna S. Sasdelli
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Giulio Marchesini
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
| | - Loris Pironi
- Department of Medical and Surgical SciencesIRCCS Azienda Ospedaliero‐Universitaria di BolognaBolognaItaly
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Colosimo S, Balzani E, Cioni R, Campesato M, Cicero A. Supplementation with Anti-inflammatory Nutraceutical Products in the Management of Chronic Pelvic Pain: A Narrative Review. CURR TOP NUTRACEUT R 2021. [DOI: 10.37290/ctnr2641-452x.20:265-275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Chronic pelvic pain is a chronic syndrome that affects patients’ life quality and expectancy as far as bladder, bowel and sexual functioning are compromised. So far treatment options are limited since pharmaceutical research has not provided any specific drug therapy to manage chronic pelvic pain. Nutraceutical products represent useful tools to supply this lack of medications. The aim of this narrative review is to provide some insight from a neuroscience perspective on the nutraceuticals’ use as adjuvant therapy in chronic pelvic pain. A review of the literature, between 2001 and 2019 on PMC and PubMed was performed in order to identify studies proving safety and efficacy of nutraceuticals in chronic pelvic pain. Inclusion criteria were nutraceutical compounds, namely curcumin, quercetin, bromelain, and diseases known for causing chronic pelvic pain. Nineteen studies were selected. Quercetin demonstrates to inhibit mast-cells, pro-inflammatory cytokines and regulate cell proliferation; curcumin suppresses inflammatory cytokines expression, inhibits invasion, angiogenesis of endometrial lesions. Bromelain resulted in a reduction of painkiller rescue doses required in endometriosis. Pre-clinical studies show promising effects of nutraceutical supplementation with selected enzymes and antioxidant compounds in patients suffering from chronic pelvic pain. Positive weak evidence suggests efficacy of these products in use as antiinflammatory and analgesic medications for chronic pelvic pain treatment.
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Affiliation(s)
- S. Colosimo
- Unit of Endocrinology, IRCCS Ca’ Granda Policlinico, State University of Milan, Milan
| | - E. Balzani
- Department of Surgical Sciences, University of Turin, Turin
| | - R.M. Cioni
- Department of Medicine and Surgery, University of Milan Bicocca, Milan
| | - M. Campesato
- Anesthesia and Pain Medicine, Sant’Orsola University Hospital, Bologna and
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Colosimo S, Campesato M, Balzani E. Supplementation of anti-inflammatory nutraceutical products in the management of chronic pelvic pain: a narrative review of the literature. Clin Nutr ESPEN 2020. [DOI: 10.1016/j.clnesp.2020.09.396] [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: 11/29/2022]
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14
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Garrett PE, Rodríguez TR, Varela AD, Green KL, Bangay J, Finlay A, Austin RAE, Ball GC, Bandyopadhyay DS, Bildstein V, Colosimo S, Cross DS, Demand GA, Finlay P, Garnsworthy AB, Grinyer GF, Hackman G, Jigmeddorj B, Jolie J, Kulp WD, Leach KG, Morton AC, Orce JN, Pearson CJ, Phillips AA, Radich AJ, Rand ET, Schumaker MA, Svensson CE, Sumithrarachchi C, Triambak S, Warr N, Wong J, Wood JL, Yates SW. Multiple Shape Coexistence in ^{110,112}Cd. Phys Rev Lett 2019; 123:142502. [PMID: 31702191 DOI: 10.1103/physrevlett.123.142502] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 06/29/2019] [Indexed: 06/10/2023]
Abstract
From detailed spectroscopy of ^{110}Cd and ^{112}Cd following the β^{+}/electron-capture decay of ^{110,112}In and the β^{-} decay of ^{112}Ag, very weak decay branches from nonyrast states are observed. The transition rates determined from the measured branching ratios and level lifetimes obtained with the Doppler-shift attenuation method following inelastic neutron scattering reveal collective enhancements that are suggestive of a series of rotational bands. In ^{110}Cd, a γ band built on the shape-coexisting intruder configuration is suggested. For ^{112}Cd, the 2^{+} and 3^{+} intruder γ-band members are suggested, the 0_{3}^{+} band is extended to spin 4^{+}, and the 0_{4}^{+} band is identified. The results are interpreted using beyond-mean-field calculations employing the symmetry conserving configuration mixing method with the Gogny D1S energy density functional and with the suggestion that the Cd isotopes exhibit multiple shape coexistence.
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Affiliation(s)
- P E Garrett
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville ZA-7535, South Africa
| | - T R Rodríguez
- Departamento de Física Teórica and CIAFF, Universidad Autónoma de Madrid, E-28049 Madrid, Spain
| | - A Diaz Varela
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - K L Green
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - J Bangay
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - A Finlay
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - R A E Austin
- Department of Physics and Astronomy, St. Mary's University, Halifax, Nova Scotia B3H3C3, Canada
| | - G C Ball
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T2A3, Canada
| | - D S Bandyopadhyay
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - V Bildstein
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - S Colosimo
- Department of Physics and Astronomy, St. Mary's University, Halifax, Nova Scotia B3H3C3, Canada
| | - D S Cross
- Department of Chemistry, Simon Fraser University, Burnaby, British Columbia V5A1S6, Canada
| | - G A Demand
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - P Finlay
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - A B Garnsworthy
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T2A3, Canada
| | - G F Grinyer
- Department of Physics, University of Regina, Regina, Saskatchewan S4S0A2, Canada
| | - G Hackman
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T2A3, Canada
| | - B Jigmeddorj
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - J Jolie
- Institut für Kernphysik, Universität zu Köln, Zülpicherstrasse 77, D-50937 Köln, Germany
| | - W D Kulp
- Defense Threat Reduction Agency, 8725 John J Kingman Road, Fort Belvoir, Virginia 22060-6217, USA
| | - K G Leach
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - A C Morton
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T2A3, Canada
| | - J N Orce
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville ZA-7535, South Africa
| | - C J Pearson
- TRIUMF, 4004 Wesbrook Mall, Vancouver, British Columbia V6T2A3, Canada
| | - A A Phillips
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - A J Radich
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - E T Rand
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - M A Schumaker
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - C E Svensson
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - C Sumithrarachchi
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - S Triambak
- Department of Physics and Astronomy, University of the Western Cape, P/B X17, Bellville ZA-7535, South Africa
| | - N Warr
- Institut für Kernphysik, Universität zu Köln, Zülpicherstrasse 77, D-50937 Köln, Germany
| | - J Wong
- Department of Physics, University of Guelph, Guelph, Ontario N1G2W1, Canada
| | - J L Wood
- Department of Physics, Georgia Institute of Technology, Atlanta, Georgia 30332, USA
| | - S W Yates
- Departments of Chemistry and Physics and Astronomy, University of Kentucky, Lexington, Kentucky 40506-0055, USA
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Petroni ML, Montesi L, Colosimo S, Caletti MT, Mazzotti A, Marchesini G. Combination of GLP-1 receptor agonists and behavioural treatment in type 2 diabetes elicits synergistic effects on body weight: A retrospective cohort study. Endocrinol Diabetes Metab 2019; 2:e00082. [PMID: 31592154 PMCID: PMC6775466 DOI: 10.1002/edm2.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/08/2019] [Accepted: 06/02/2019] [Indexed: 01/18/2023] Open
Abstract
AIMS Intensification of type 2 diabetes (T2DM) treatment with GLP-1 receptor agonists (GLP-1RAs) promotes weight loss. We aimed to determine the synergistic effect of behavioural programmes on body weight on top of GLP-1RA treatment. MATERIALS AND METHODS We retrospectively analysed the time course of 328 individuals with T2DM starting GLP-1RA treatment because of insufficient metabolic control. In 29, a structured programme of elementary nutritional counselling was also implemented (elementary nutritional education [ENE]-5 group sessions), whereas 53 entered a programme of cognitive-behavioural treatment (CBT-12 group sessions). Both programmes were completed within 6 months of switching to GLP-1RAs. Data of body weight and metabolic control were followed up to 2 years as part of regular follow-up. Weight loss targets (≥10% and ≥5%) and metabolic target (HbA1c < 7%) were analysed by Cox regression model in comparison with standard care (SC, N = 244). RESULTS Body weight remarkably decreased following both behavioural programmes, with significant differences compared with SC at 2 years (CBT, 8.5 ± 5.9% vs 6.3 ± 6.9 in ENE and only 3.1 ± 5.7 in SC; P < 0.001 and P = 0.045 vs CBT and ENE, respectively). The 10% weight loss was achieved and maintained in approximately 30% of cases during follow-up, and an additional 35% of cases lost between 5% and 10%. Data were consistent between behavioural programmes, after adjustment for confounders, including initial body weight (logreg Mantel-Cox: ENE vs SC, P < 0.01; CBT vs SC, P < 0.001). No differences in metabolic control were detected between groups. CONCLUSIONS Initiation of GLP-1RA treatment provides an opportunity for addressing patients' needs of weight control. By producing initial weight loss, patients' motivation and self-efficacy are expected to increase and adherence to long-term lifestyle changes might be more easily attained.
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Affiliation(s)
- Maria Letizia Petroni
- Department of Medical and Surgical Sciences‐DIMEC“Alma Mater” UniversityBolognaItaly
| | - Luca Montesi
- Department of Medical and Surgical Sciences‐DIMEC“Alma Mater” UniversityBolognaItaly
- Department of Eating and Weight DisordersVilla Garda HospitalGardaItaly
| | - Santo Colosimo
- Department of Medical and Surgical Sciences‐DIMEC“Alma Mater” UniversityBolognaItaly
| | | | - Arianna Mazzotti
- Department of Medical and Surgical Sciences‐DIMEC“Alma Mater” UniversityBolognaItaly
- AUSL Diabetes Unit RomagnaRavennaItaly
| | - Giulio Marchesini
- Department of Medical and Surgical Sciences‐DIMEC“Alma Mater” UniversityBolognaItaly
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Nicolini A, Giardino R, Carpi A, Ferrari P, Anselmi L, Colosimo S, Conte M, Fini M, Giavaresi G, Berti P, Miccoli P. Metastatic breast cancer: an updating. Biomed Pharmacother 2006; 60:548-56. [PMID: 16950593 DOI: 10.1016/j.biopha.2006.07.086] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2006] [Accepted: 07/28/2006] [Indexed: 01/09/2023] Open
Abstract
UNLABELLED This article reports on recent advances on metastatic breast cancer. Detection, prognostic factors, predictors of response to therapy and therapy, with particular regard to targeted therapies, were examined. DETECTION Unlike current guidelines that yet do not routinely recommend intensive clinical-instrumental post-operative follow-up of breast cancer patients, relatively large data collected in the last decades have shown that an intensive post-operative follow-up with 'dynamic evaluation' of a suitable tumour marker panel precedes a few months as average the clinical and/or instrumental sign of a pending relapse in most relapsed patients and largely limits the use of the common instrumental examinations. PROGNOSIS AND THERAPY PREDICTORS Disease-free interval (DFI)<or=24 months, adjuvant chemotherapy, liver and distant soft tissue involvement or DFI>24 months and disease confined to bony skeleton are prognostic factors more often correlated with relatively poor or prolonged survival, respectively. Estrogen receptor (ER) expression in primary tumour and at the relapse correlates strongly with response to salvage hormone therapy and data from large trials showed that 38-59% of ER and/or PR+ post-menopausal patients had clinical benefit from first line tamoxifen or aromatase inhibitors. An inverse correlation of ER with epidermal growth factor receptor (EGFR) has been found. The co-expression of HER-2/neu and/or elevated serum HER-2/neu protein level were associated with a low rate and shorter duration of response of ER+ patients to first line hormone therapy. Accordingly, ER-EGFR- compared with ER-EGFR+ tumours are usually more responsive to endocrine therapy. High class III beta-tubulin expression or fall in insulin-like growth factor binding protein-3 (IGFBP-3) from baseline levels have been found to significantly predict resistance to chemotherapeutic agents. THERAPY Liposomes as carrier of doxorubicin (Caelix, Evacet, Myocet) is one approach to decrease the anthracycline-related cardiac toxicity. Weekly paclitaxel or docetaxel and oral formulation of vinorelbine and 5-fluorouracil (5-FU) (capecitabine) provide new effective and well tolerated options that reach greater dose intensity and cumulative dose than with the conventional schedules. As to the so called 'tailored' or targeted therapies, the more potent and highly selective third generation of aromatase inhibitors (letrozole, anastrozole, exemestane) targeting ER+ tumours by estrogen deprivation, challenge tamoxifen as current standard first line therapy in postmenopausals. One pilot study showed that stimulation of cellular immunity by the addition of beta-interferon-interleukin-2 sequence in patients on clinical benefit on first line tamoxifen significantly prolonged median overall survival (OS) and duration of response compared to that observed in similar patients only treated with tamoxifen. Trastuzumab, a humanised monoclonal antibody to extracellular domain of HER-2, plus conventional chemotherapy has become a standard of care for women with overexpressing HER-2 tumours. Bevacizumab is a recombinant humanised monoclonal antibody to vascular endothelial growth factor (VEGF) that in refractory metastatic breast cancer doubled the response rate of capecitabine although it did not affect survival. Finally, the so called 'oligometastatic' and a few stage IV diseases are conditions amenable to be rendered with no evidence of disease (NED) after local surgery and/or radiation. In both, as well as in complete responders to chemotherapy, minimal residual disease (m.r.d.) likely continues to be present. Recent data suggest that 'biological' therapy (immunomodulators and/or retinoids with or without hormone therapy), might be suitable to be successfully tested in these patients as maintenance treatment given soon after local intervention or chemotherapy.
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Affiliation(s)
- A Nicolini
- Department of Internal Medicine, University of Pisa, via Roma 67, 56126 Pisa, Italy.
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Fatigante L, Ducci F, Cartei F, Colosimo S, Marini C, Prediletto R, Danesi R, Laddaga M, Del Tacca M, Caciagli P. Carbogen and nicotinamide combined with unconventional radiotherapy in glioblastoma multiforme: a new modality treatment. Int J Radiat Oncol Biol Phys 1997; 37:499-504. [PMID: 9112444 DOI: 10.1016/s0360-3016(96)00605-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE A new radiotherapy schedule to treat glioblastoma multiforme after surgery, combining nicotinamide and carbogen. METHODS AND MATERIALS We analyzed 36 patients with glioblastoma multiforme treated after surgery with radiotherapy, Nicotinamide and Carbogen as follows: 7 patients were treated with accelerated fractionation: two fractions/day, 1.5 cGy/fraction, 6 h interval, 5 days/week, total dose 60 Gy in 4 weeks; 8 patients were treated with the same irradiation scheduling plus Nicotinamide at the dose of 4 g and 2 g in capsules, respectively, 1 h before the first and the second irradiation fraction; 21 patients were treated with accelerated radiotherapy, Nicotinamide, and Carbogen (inhaled 10 min before radiotherapy and during the whole course of irradiation). On the basis of surgical removal our patients were subdivided in three groups: totally resected, with residual tumor <50%, or >50%. Radiotherapy with accelerated fractionation was completed in the scheduled time without side effects on the whole group of patients and Carbogen inhalation did not cause significant change of cardiopulmonar parameters. The toxicity observed was predominant in the gastrointestinal tract and was related to Nicotinamide. RESULTS The median survival time (M.S.T.) was 10 months, as reported by others authors with conventional treatment, but in patients without surgical residual tumor and submitted to the complete treatment schedule, the survival at 35 months was around 25%. CONCLUSIONS We conclude that this method is feasible with acceptable toxicity; analyzing the survival curves appears to be a trend towards an improvement in survival in the subgroup of patients with gross total removal treated with the combination of Carbogen, Nicotinamide, and accelerated fractionation.
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Affiliation(s)
- L Fatigante
- Cattedra di Radioterapia, Universita di Pisa, Italy
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Sohn OS, Surace A, Fiala ES, Richie JP, Colosimo S, Zang E, Weisburger JH. Effects of green and black tea on hepatic xenobiotic metabolizing systems in the male F344 rat. Xenobiotica 1994; 24:119-27. [PMID: 8017087 DOI: 10.3109/00498259409043226] [Citation(s) in RCA: 97] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
1. The induction of phase I and II enzymes in the liver of the male F344 rat drinking 2% (w/v) solutions of green or black tea for 6 weeks was investigated. Also studied were glutathione (GSH) and cyst(e)ine in blood, liver and kidney, as well as serum cholesterol, HDL cholesterol, triglycerides, and total and free testosterone. 2. The total carbon monoxide-discernible liver P450, b5 and NADPH-cytochrome c(P450) reductase activities were similar in all groups. 3. There were significant increases in liver of rat drinking green or black tea of P4501A1, 1A2 and 2B1 activities, but no change in P4502E1 and 3A4 activities. Of the phase II enzymes, UDP-glucuronyltransferase was increased, but glutathione S-transferase was not. 4. Serum GSH was higher in the group administered black tea, but GSH and cyst(e)ine in other groups was at control levels. Serum cholesterol was lower in rat given black compared with green tea. Triglycerides had a declining trend after green and black tea exposure compared with water controls. Free and total testosterone were not affected. 5. Thus, beverages widely used by man altered host biochemistry as regards specific phase I and II enzymes in liver of rat and specific serum parameters.
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Affiliation(s)
- O S Sohn
- American Health Foundation, Valhalla, NY 10595
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Pignatelli V, Colosimo S, Campassi C, Perri G, Savino A, Grassi L, Bagnolesi A. [The echographic picture of the breast following quadrantectomy and radiation therapy]. Radiol Med 1991; 82:788-94. [PMID: 1788433] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Our experience moved from the clinical relevance of an eventual positive role of US in the follow-up of breast cancers treated with conservative therapy. This trial was suggested by the more and more frequent use of conservative therapy an by the diagnostic difficulties offered by the breasts treated with surgery and radiation therapy. Aim of the study is to analyze the diagnostic value of US in the identification of local relapse in a group of 60 patients with breast carcinoma (stages I and II) treated with conservative therapy. The patients were studied for at least 2 years following treatment, with clinical, US, and mammographic controls at 6, 12, and 24 months. The following clinical problems were considered: 1) study of the US patterns of the morphological and structural changes induced by conservative treatment; 2) observation of US and mammographic agreement in case of local relapse; 3) role of US in the follow-up of this kind of patients. US patterns and results at 6 months follow: cutaneous scar (60/60 cases), skin thickening (55/60), architectural distortion (asymmetry and amputation of the glandular cone, intramammary scar) (52/60), volumetric changes in the treated breast (50/60), skin asymmetry and retraction (50/60), "parenchymal fibrosis" (48/60), mass (8/60) and calcifications (3/60). As for the very few relapses (4 cases), US failed to reveal a ductal carcinoma which presented as microcalcifications. In our experience, US is a complementary exam to clinical and radiologic investigations, especially in the period immediately following therapy and in case of particular clinical problems, such as increased breast volume, mastitis, and appearance of a nodule.
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Pignatelli V, Campassi C, Calderazzi A, Colosimo S, Savino A, Grassi L, Mazzeo S. [Mammographic control after quadrantectomy and radiation therapy]. Radiol Med 1991; 81:893-8. [PMID: 1857799] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The efficacy of combined surgery and radiation therapy in the treatment of breast cancer has increased the use of mammography in the follow-up to detect early recurrences. The authors report their experience in the follow-up of 43 breast cancers after treatment with local excision, axillary dissection, and irradiation. Mammography was performed at 6.12, and 24 months. The radiological findings were: 38/43 (88.3%) breasts with abnormal mammographic patterns, skin thickening in 36/43 (83.7%) cases, breast retraction in 16/43 (37.2%), architectural distortion in 17/43 (39.5%), increased parenchymal density in 33/43 (76.7%), calcifications in 6/43 (13.9%), and a mass in 10/43 (23.2%) cases. The authors describe histologic changes, corresponding to mammographic findings, and evolution of the treated breasts. Suspicious findings were microcalcifications in one case and a mass in 6 cases (4 of them at 6 months and 2 at 12). Excisional biopsy, performed in the above 7 patients, confirmed recurrence in 4 cases. In 3 cases with negative pathology, where the malignant nature of the lesion could not be demonstrated, we observed: a cluster of microcalcifications undistinguishable from neoplasm in 1 case and spiculated nodules with architectural distortion in the extant 2 cases. Further limitations of mammography were due to radiological density of the breast in one case, and to its minimal size in another--these elements delayed both correct interpretation of mammographic findings and final diagnosis. The low agreement between mammography and histology proved the difficulty of both analysis and evaluation of abnormal post-irradiation breast tissue. The authors, in agreement with literature reports, suggest the schedule for clinical and mammographic follow-up.
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Fatigante L, Colosimo S, Tana L, Lazzeri M, Laddaga M. [A decade's experience with electron radiotherapy]. Radiol Med 1990; 80:129-32. [PMID: 2251401] [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] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The experience related to 1170 patients treated with electron beam between 1979-1988 at Radiation Therapy Department in Pisa is reported. Beam dosimetry and dose distribution in tissue, patients contour and other parameters have been analysed as main important factors to optimise this technique. Electron beam therapy offers important contributions to the management of peculiar types of cancer because of the radiotherapy treatments optimisation and the reduced normal tissue reactions.
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Minervini R, Mosca F, Cecchi M, Colosimo S, Fiorentini L. [Computed axial tomography in the staging of bladder neoplasms]. MINERVA UROL NEFROL 1984; 36:193-5. [PMID: 6533822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Fiorentini L, Minervini R, Mosca F, Aragona F, Cecchi M, Colosimo S. [Total cystectomy with or without preoperative radiotherapy in the treatment of carcinoma of the bladder. Preliminary note]. MINERVA UROL NEFROL 1984; 36:107-10. [PMID: 6533808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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