1
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Caracciolo D, Polerà N, Belmonte B, Conforti F, Signorelli S, Gulino A, Staropoli N, Tuccillo FM, Bonelli P, Juli G, Grillone K, Ascrizzi S, Cirillo M, Migale L, Ballerini A, Pelizon C, Di Martino MT, Tagliaferri P, Riillo C, Tassone P. UMG1/CD3ε-bispecific T-cell engager redirects T-cell cytotoxicity against diffuse large B-cell lymphoma. Br J Haematol 2024; 204:555-560. [PMID: 37963444 DOI: 10.1111/bjh.19183] [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] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 10/08/2023] [Accepted: 10/20/2023] [Indexed: 11/16/2023]
Abstract
UMG1 is a unique epitope of CD43, not expressed by normal cells and tissues of haematopoietic and non-haematopoietic origin, except thymocytes and a minority (<5%) of peripheral blood T lymphocytes. By immunohistochemistry analysis of tissue microarray and pathology slides, we found high UMG1 expression in 20%-24% of diffuse large B-cell lymphomas (DLBCLs), including highly aggressive BCL2high and CD20low cases. UMG1 membrane expression was also found in DLBCL bone marrow-infiltrating cells and established cell lines. Targeting UMG1 with a novel asymmetric UMG1/CD3ε-bispecific T-cell engager (BTCE) induced redirected cytotoxicity against DLBCL cells and was synergistic with lenalidomide. We conclude that UMG1/CD3ε-BTCE is a promising therapeutic for DLBCLs.
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Affiliation(s)
- Daniele Caracciolo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Nicoletta Polerà
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, University of Palermo, Palermo, Sicily, Italy
| | | | - Stefania Signorelli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Alessandro Gulino
- Cogentech srl Società Benefit, FIRC Institute of Molecular Oncology (IFOM), Milan, Italy
| | - Nicoletta Staropoli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Franca Maria Tuccillo
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Napoli, Italy
| | - Patrizia Bonelli
- Molecular Biology and Viral Oncology Unit, Istituto Nazionale Tumori - IRCCS - Fondazione Pascale, Napoli, Italy
| | - Giada Juli
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Katia Grillone
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Serena Ascrizzi
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Maria Cirillo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Leonardo Migale
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | | | | | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
- Medical and Translational Oncology, AOU Renato Dulbecco, Catanzaro, Italy
- S.H.R.O., Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
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2
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Merola GP, Boy OB, Fascina I, Pecoraro V, Falone A, Patti A, Santarelli G, Cicero DC, Ballerini A, Ricca V. Aberrant Salience Inventory: A meta-analysis to investigate its psychometric properties and identify screening cutoff scores. Scand J Psychol 2023; 64:734-745. [PMID: 37243361 DOI: 10.1111/sjop.12931] [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: 02/18/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The Aberrant Salience Inventory (ASI) is a useful tool to measure salience abnormalities among the general population. There is strong clinical and scientific evidence that salience alteration is linked to psychosis. To the present day, no meta-analysis evaluating ASI's psychometric properties and screening potential has been published. MATERIALS AND METHODS PubMed, Google Scholar, Scopus, and Embase were searched using terms including "psychosis," "schizophrenia," and "Aberrant Salience Inventory." Observational and experimental studies employing ASI on populations of non-psychotic controls and patients with psychosis were included. ASI scores and other demographic measures (age, gender, ethnicity) were extracted as outcomes. Individual patients' data (IPD) were collected. Exploratory factor analysis (EFA) was performed on the IPD. RESULTS Eight articles were finally included in the meta-analysis. ASI scores differ significantly between psychotic and non-psychotic populations; a novel three-factor model is proposed regarding subscales structure. Theoretical positive predictive values (PPVs) and negative predictive values (NPVs) were calculated and presented together with different cutoff points depending on preselected specific populations of interest. DISCUSSION PPV and NPV values reached levels adequate for ASI to be considered a viable screening tool for psychosis. The factor analysis highlights the presence of a novel subscale that was named "Unveiling experiences." Implications regarding the meaning of the new factor structure are discussed, as well as ASI's potential as a screening tool.
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Affiliation(s)
| | - Ottone Baccaredda Boy
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Isotta Fascina
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenzo Pecoraro
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Falone
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Patti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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3
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Dardi F, Ballerini A, Guarino D, Donato F, Bertozzi R, Martini G, Magnani I, Manes A, Palazzini M, Galie' N. A clinical and echocardiographic score to differentiate pulmonary hypertension due to heart failure with preserved ejection fraction from idiopathic pulmonary hypertension: the PH-HFPEF score. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.768] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
One of the most challenging differential diagnoses in pulmonary hypertension clinical practice, is the discrimination between idiopathic pulmonary arterial hypertension (IPAH) and pulmonary hypertension due to heart failure with preserved ejection fraction (PH-HFpEF).
Aim
We elaborate a score (considering patient clinical history, demographics, and echocardiographic characteristics) that can predict, noninvasively, PH-HFpEF vs IPAH diagnosis.
Methods
Data were prospectively collected on 466 consecutive patients with a final diagnosis of IPAH or PH-HFpEF referred to a single tertiary pulmonary vascular disease centre. Data included clinical history, demographics, and parameters of an electrocardiogram and a transthoracic echocardiogram. A multivariate regression model was developed to predict a PH-HFpEF diagnosis, and an integer risk score was generated using adjusted regression coefficients of the multivariate logistic regression analysis.
Results
At the multivariate logistic regression a high ratio between left and right ventricular dimensions, a history of atrial fibrillation (AF), a high body mass index (BMI), a reduced mitral deceleration time and a high E-wave at trans-mitral doppler, an advanced age and a high right ventricular fractional area change (FAC) were predictors of PH-HFpEF. The derived PH-HFPEF score is shown in Table 1 and, with a cut-point ≥11, it yielded a specificity/sensitivity, respectively, for the diagnosis of PH-HFpEF, of 100%/49% with an AUC of 0.987.
Conclusions
The PH-HFPEF score can predict PH-HFpEF vs IPAH. The PH-HFPEF score may be used to potentially avoid an invasive diagnostic testing in almost half of PH-HFpEF patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F Dardi
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - A Ballerini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - D Guarino
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - F Donato
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - R Bertozzi
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - G Martini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - I Magnani
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - A Manes
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - M Palazzini
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
| | - N Galie'
- Alma Mater Studiorum, University of Bologna, CardioThoracicVascular Department of IRCCS Sant'Orsola Hospital , Bologna , Italy
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Fagiolini A, Aguglia E, Ballerini A, Callista G, Carpiniello B, Clerici M, Corrivetti G, Cuomo A, De Fazio P, De Filippis S, De Giorgi S, Goracci A, La Barbera D, Mencacci C, Montagnani G, Pigato G, Vannucchi J, Vita A. Treatment persistence with aripiprazole once monthly: a 4-year follow-up. Ann Gen Psychiatry 2022; 21:39. [PMID: 36175924 PMCID: PMC9520898 DOI: 10.1186/s12991-022-00416-z] [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: 12/03/2021] [Accepted: 06/07/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Treatment persistence refers to the act of continuing a treatment as prescribed and reflects the patient's or doctor's judgment about efficacy, tolerability, and acceptability. In patients with schizophrenia, antipsychotic persistence is often poor, because of issues such as lack or loss of efficacy, side effects, and poor adherence, which is often related to the degree to which patients find the medication and overall intervention to be helpful, tolerable, fair, reasonable, appropriate, and consistent with expectations of treatment. Despite the poor antipsychotic persistence that has been reported to date in patients with schizophrenia, we previously observed a relatively high (86%) 6 months persistence with aripiprazole once-monthly (AOM) in a group of patients with schizophrenia, treated in the real world Italian clinical practice. The present study explores the longer term persistence with AOM, over a mean follow-up period of 48 months. METHODS This was a multicenter, retrospective, non-interventional follow-up study, aimed at evaluating the longer term persistence with AOM in a group of patients with schizophrenia who had already shown persistence over a period of at least 6 months. The study included 161 individuals who had participated in our previous study, where 86% of participating individuals had shown persistence with AOM for at least 6 months. Non-persistence was defined as discontinuing the medication for any reason. Baseline demographic and clinical characteristics of patients who continued AOM were then compared to those of patients who discontinued the medication. RESULTS Study subjects were predominantly male (64.4%) and their mean age was 39.7 (SD: 12.24). Treatment persistence with AOM was 69.6% and 112 out of 161 patients were still receiving AOM treatment at the last follow-up visit. The mean duration of AOM treatment until the last recorded observation was 55.87 months (median 56.17, SD6.23) for the 112 persistent patients and 32.23 (median 28.68.SD 15.09) months for the 49 non-persistent individuals. The mean observation period for all patients (persistent and non-persistent) was 48.78 months (median 52.54, SD 14.64). For non-persistent subjects, the observation period ended with the discontinuation of AOM. Subjects treated with AOM at 400 mg presented a 69.6% lower risk of all-cause treatment discontinuation when compared with patients treated with 300 mg (HR: 0.314; 95% confidence interval [CI] 0.162-0.608; P = 0.001). The main reasons for discontinuation were lack of efficacy (30.6%), patient/caregiver choice (18.4%), physician's choice (16.3%), non-adherence (12.2%) and inconvenience (6.1%). Only 3 patients (6.1%) discontinued AOM for tolerability issues. CONCLUSIONS In subjects with schizophrenia, who had already shown a 6 months persistence with AOM, a high number of patients (69.6%) continued to be persistent over a 4-year follow-up period. This may reflect a favourable profile of efficacy, tolerability, and acceptability. Larger and prospective studies are warranted to confirm our observations.
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Affiliation(s)
- Andrea Fagiolini
- Division of Psychiatry, University of Siena, Viale Bracci 12, 53100, Siena, Italy.
| | | | | | | | | | | | | | - Alessandro Cuomo
- Division of Psychiatry, University of Siena, Viale Bracci 12, 53100, Siena, Italy
| | | | | | | | - Arianna Goracci
- Division of Psychiatry, University of Siena, Viale Bracci 12, 53100, Siena, Italy
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5
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Riillo C, Caracciolo D, Grillone K, Polerà N, Tuccillo FM, Bonelli P, Juli G, Ascrizzi S, Scionti F, Arbitrio M, Lopreiato M, Siciliano MA, Sestito S, Talarico G, Galea E, Galati MC, Pensabene L, Loprete G, Rossi M, Ballerini A, Gentile M, Britti D, Di Martino MT, Tagliaferri P, Tassone P. A Novel Bispecific T-Cell Engager (CD1a x CD3ε) BTCE Is Effective against Cortical-Derived T Cell Acute Lymphoblastic Leukemia (T-ALL) Cells. Cancers (Basel) 2022; 14:cancers14122886. [PMID: 35740552 PMCID: PMC9221015 DOI: 10.3390/cancers14122886] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive and still orphan hematologic malignancy. No effective immunotherapeutic strategies are presently available for this poor prognosis disease. We here report the development and the preclinical evaluation of a novel bispecific T-cell engager (BTCE) that simultaneously targets CD1a and CD3ε (CD1a x CD3ε), therefore recruiting T cells against T-ALL cells. We demonstrate that this CD1a x CD3ε BTCE induces activation, proliferation, and cytokine release by T cells in co-cultures with CD1a expressing T-ALL cells, resulting in a concentration-dependent killing of leukemic cells in vitro. Moreover, CD1a x CD3ε BTCE inhibits the in vivo growth of human T-ALL xenografts and improves survival of immunocompromised mice reconstituted with human PBMC from healthy donors. We believe that this BTCE is suitable for clinical development for the treatment of CD1a-expressing T-ALL patients. Abstract T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive malignancy burdened by poor prognosis. While huge progress of immunotherapy has recently improved the outcome of B-cell malignancies, the lack of tumor-restricted T-cell antigens still hampers its progress in T-ALL. Therefore, innovative immunotherapeutic agents are eagerly awaited. To this end, we generated a novel asymmetric (2 + 1) bispecific T-cell engager (BTCE) targeting CD1a and CD3ε (CD1a x CD3ε) starting from the development of a novel mAb named UMG2. UMG2 mAb reacts against CD1a, a glycoprotein highly expressed by cortical T-ALL cells. Importantly, no UMG2 binding was found on normal T-cells. CD1a x CD3ε induced high T-cell mediated cytotoxicity against CD1a+ T-ALL cells in vitro, as demonstrated by the concentration-dependent increase of T-cell proliferation, degranulation, induction of cell surface activation markers, and secretion of pro-inflammatory cytokines. Most importantly, in a PBMC-reconstituted NGS mouse model bearing human T-ALL, CD1a x CD3ε significantly inhibited the growth of human T-ALL xenografts, translating into a significant survival advantage of treated animals. In conclusion, CD1a x CD3ε is a novel BTCE highly active against CD1a-expressing cortical-derived T-ALL cells suitable for clinical development as an effective therapeutic option for this rare and aggressive disease.
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Affiliation(s)
- Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Daniele Caracciolo
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Katia Grillone
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Nicoletta Polerà
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Franca Maria Tuccillo
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (P.B.)
| | - Patrizia Bonelli
- Istituto Nazionale Tumori IRCCS-Fondazione G. Pascale, 80131 Napoli, Italy; (F.M.T.); (P.B.)
| | - Giada Juli
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Serena Ascrizzi
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Francesca Scionti
- Institute of Research and Biomedical Innovation (IRIB), Italian National Council (CNR), 98164 Messina, Italy;
| | - Mariamena Arbitrio
- Institute of Research and Biomedical Innovation (IRIB), Italian National Council (CNR), 88100 Catanzaro, Italy;
| | - Mariangela Lopreiato
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Maria Anna Siciliano
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (S.S.); (L.P.)
| | - Gabriella Talarico
- Immunotransfusion Service Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy;
| | - Eulalia Galea
- Pediatric Hemato-Oncology Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy; (E.G.); (M.C.G.)
| | - Maria Concetta Galati
- Pediatric Hemato-Oncology Unit, Pugliese-Ciaccio Hospital, 88100 Catanzaro, Italy; (E.G.); (M.C.G.)
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Magna Græcia University, 88100 Catanzaro, Italy; (S.S.); (L.P.)
| | - Giovanni Loprete
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.L.); (D.B.)
| | - Marco Rossi
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | | | | | - Domenico Britti
- Department of Health Sciences, Magna Graecia University, 88100 Catanzaro, Italy; (G.L.); (D.B.)
| | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University, 88100 Catanzaro, Italy; (C.R.); (D.C.); (K.G.); (N.P.); (G.J.); (S.A.); (M.L.); (M.A.S.); (M.R.); (M.T.D.M.); (P.T.)
- College of Science and Technology, Temple University, Philadelphia, PA 19122, USA
- Correspondence:
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Santarelli G, Sanfilippo G, Benvenuti F, Santoro L, Nistri A, Innocenti M, Ballerini A, Ricca V. The effect of Working Alliance on drug attitude in patients with Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9565615 DOI: 10.1192/j.eurpsy.2022.1423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Working Alliance is defined as the emotional bond and the agreement on therapeutic goals and tasks between patients and therapists. Despite the wide use of the construct of working alliance in research on psychotherapy, few studies have investigated the role of working alliance in influencing adherence to pharmacotherapy, and drug attitude. A deeper knowledge of the interplay between working alliance and drug attitude could help to challenge low adherence to psychopharmacological treatments in Major Depressive Disorder.
Objectives
This study aimed to investigate the relationship between working alliance and drug attitude in patients with Major Depressive Disorder.
Methods
27 patients admitted in the Psychiatric Unit of Careggi with diagnosis of Major Depressive Disorders were enrolled. Working Alliance Inventory - patient version (WAI-P), Drug Attitude Inventory (DAI) and Beliefs about Medicines (BMQ) were administered. Pearson’s correlation was used to assess relationships between variables.
Results
A significant positive correlation was detected between BMQ total scores, DAI total scores and WAI-P task, bond, and goal subscales.
Correlations between WAI-P subscales and BMQ and DAI total scores
DAI total scores
BMQ total scores
r
p
r
p
WAI-P task
0.551
0.003
0.613
0.001
WAI-P bond
0.430
0.001
0.560
0.004
WAI-P goal
0.621
0.001
0.603
0.002
Conclusions
Such preliminary data suggest a relationship between Working Alliance and drug attitude. This could contribute to provide tools to challenge low adherence to psychopharmacological treatments in patients with Major Depressive Disorder.
Disclosure
No significant relationships.
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D’Anna G, Rotella F, Ballerini A, Ricca V. Therapeutic drug monitoring of LAI antipsychotics as a predictor of clinical relapse: a one-year follow-up. Eur Psychiatry 2022. [PMCID: PMC9563214 DOI: 10.1192/j.eurpsy.2022.520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
Clinical relapses in schizophrenia remain a frequent event. Long-acting injectable (LAI) antipsychotics enhance adherence, but low blood levels can sometimes be observed despite an adequate posology. Nonetheless, the evaluation of this parameter is uncommon in clinical practice.
Objectives
To explore the potential advantages of therapeutic drug monitoring (TDM) of LAIs as a predictor of relapse in clinically stable outpatients with schizophrenia.
Methods
44 individuals who had reached the pharmacokinetic steady state of LAI treatment (paliperidone, olanzapine, aripiprazole) underwent an anamnestic and psychopathological assessment. LAI blood levels were measured using liquid chromatography-mass spectrometry and classified as “in range” or “under range” according to the Arbeitsgemeinschaft für Neuropsychopharmakologie und Pharmakopsychiatrie (AGNP) guideline values. Individuals who relapsed during the one-year follow-up were compared to non-relapsers (Fisher’s exact test, χ2 or Mann-Whitney U). An exploratory binary logistic regression tested the role of other possible relevant predictors of relapse.
Results
No differences were observed in baseline use of mood stabilisers (p=0.211), antidepressants (p=0.530), or prescribed LAI (p=0.563). Other comparisons are presented in the table: among these variables, in-range LAI levels were the only significant predictor of relapse (F=5.95, p=0.015; OR 0.04, 95%CI 0.02-0.56).
Relapse (n=6)
No relapse (n=38)
p
Age (years)
41.33±10.78
43.95±12.98
0.667
Male
4 (66.7%)
21 (55.3%)
0.600
Illness duration (years)
21.83±2.64
19.13±11.82
0.289
Previous acute episodes
3.50±1.05
3.29±1.47
0.652
PANSS-total
49.33±14.83
42.74±14.14
0.231
In-range LAI
2 (33.3%)
32 (84.2%)
0.006
Conclusions
TDM of LAIs may optimise the clinical management of schizophrenia by highlighting a suboptimal dosage and a consequent higher relapse risk. Large-scale, drug-specific assessments are needed to confirm these findings.
Disclosure
No significant relationships.
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Santarelli G, Sanfilippo G, Benvenuti F, Santoro L, Nistri A, Ballerini A, Ricca V. Preoccupied attachment style and beliefs about medicines in patients with Major Depressive Disorder. Eur Psychiatry 2022. [PMCID: PMC9566580 DOI: 10.1192/j.eurpsy.2022.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Introduction Attachment style is defined by the American Psychological Association as “the characteristic way people relate to others in the context of intimate relationships”. Four attachment styles have been described: secure, fearful, preoccupied, and dismissing. While the effect of attachment style on psychotherapy was widely investigated, few studies have investigated its role in determining beliefs about medicines in patients with Major Depressive Disorder (MDD). Objectives This study aimed to investigate the relationship between preoccupied attachment style and beliefs about medicines in patients with MDD. Methods 27 patients admitted in the Psychiatric Unit of Careggi with diagnosis of MDD were enrolled. Working Alliance Inventory - patient version (WAI-P), Relationship Style Questionnaire (RSQ) and Beliefs about Medicines Questionnaire (BMQ) were administered. An ANCOVA model having BMQ total score as dependent variable and age, sex, RSQ preoccupied attachment subscale and WAI-P task subscale as predictors was considered. WAI-P task was intended to assess the role of agreement on therapeutic choices. Results The overall model was significant (F(4,22)=9,571, P<0.001) and explained 66.8% of BMQ total score variance (R2=0.668). Both RSQ preoccupied attachment subscale (B=3.331, t(22)=3.907, p=0.001) and WAI-P task subscale (B=0.238, t(22)=4.565, p<0.001) showed a positive correlation with BMQ total scores. RSQ preoccupied attachment subscale explained 44.6% of variance of BMQ total scores (partial η2=0.446), WAI-P task explained 52.3% of variance of BMQ total scores (partial η2= 0.523). Age (B=0.059, t(22)=1.588, p=0.129) and sex (F(1,22)=0.035, p=0.854) had no significant effect. ![]()
Conclusions These preliminary data suggest a possible influence of preoccupied attachment style on beliefs about medicines in patients with MDD. Disclosure No significant relationships.
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Ballerini A, Tortorelli M, Marino P, Appignanesi C, Baschirotto C, Mallardo L, Tofani T, Pietrini F, D'Anna G, Rossi A, Ricca V, Santella M. Aberrant salience relationship with first rank symptoms. Ann Gen Psychiatry 2022; 21:8. [PMID: 35172844 PMCID: PMC8851729 DOI: 10.1186/s12991-022-00383-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Accepted: 12/26/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Aberrant salience is the incorrect assignment of salience, significance, or value to different innocuous stimuli that might precede the onset of psychotic symptoms. The present study aimed to perform a preliminary evaluation of potentially different correlations between the Aberrant Salience Inventory (ASI) score and dimensional or categorical diagnostic approaches. METHODS 168 adult outpatients with a current psychiatric diagnosis were consecutively enrolled. Patients were evaluated using different psychometric scales. ASI was used to evaluate aberrant salience, and to evaluate the association between ASI scores and first rank symptoms (FRS), and/or with a psychiatric diagnosis. Principal dichotomic clusters of ASI were identified using the Chi-square automatic interaction detection (CHAID) method. RESULTS Current (16.76 ± 6.02 vs 13.37 ± 5.76; p = 0.001), lifetime (15.74 ± 6.08 vs 13.16 ± 5.74; p = 0.005) and past (15.75 ± 6.01 vs 13.33 ± 5.80; p = 0.009) FRS were the main clusters dichotomizing ASI. The average ASI score did not significantly differ among patients with different diagnoses. CONCLUSIONS ASI could be used as a tool to identify psychopathological dimensions, rather than the categorical diagnoses, in the schizophrenic spectrum.
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Affiliation(s)
- Andrea Ballerini
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Marta Tortorelli
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Paolo Marino
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Cristina Appignanesi
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Cinzia Baschirotto
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Luca Mallardo
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Tommaso Tofani
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Rossi
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Marina Santella
- Psychiatry Unit, Department of Health Science, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Patti A, Santarelli G, D'Anna G, Ballerini A, Ricca V. Aberrant Salience among Young Healthy Postgraduate University Students: The Role of Cannabis Use, Psychotic-Like Experiences, and Personality. Psychopathology 2022; 55:116-122. [PMID: 35016193 DOI: 10.1159/000520331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 10/19/2021] [Indexed: 11/19/2022]
Abstract
Aberrant salience (AS) is an anomalous world experience which plays a major role in psychotic proneness. In the general population, a deployment of this construct - encompassing personality traits, psychotic-like symptoms, and cannabis use - could prove useful to outline the relative importance of these factors. For this purpose, 106 postgraduate university students filled the AS Inventory (ASI), the Community Assessment of Psychic Experiences (CAPE), the Temperament and Character Inventory (TCI), and the Symptom Checklist 90-Revised (SCL-90-R). Lifetime cannabis users (n = 56) and individuals who did not use cannabis (n = 50) were compared. The role of cannabis use and psychometric indexes on ASI total scores was tested in different subgroups (overall sample, cannabis users, and nonusers). The present study confirmed that cannabis users presented higher ASI scores. The deployment of AS proved to involve positive symptom frequency (assessed through CAPE), character dimensions of self-directedness and self-transcendence (TCI subscales), and cannabis use. Among nonusers, the role of personality traits (assessed through the TCI) was preeminent, whereas positive psychotic-like experiences (measured by means of CAPE) had a major weight among cannabis users. The present study suggests that pre-reflexive anomalous world experiences such as AS are intertwined with reflexive self-consciousness, personality traits, current subclinical psychotic symptoms, and cannabis use. In the present study, subthreshold psychotic experiences proved to play a major role among cannabis users, whereas personality appeared to be more relevant among nonusers.
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Affiliation(s)
- Andrea Patti
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
| | - Valdo Ricca
- Department of Health Sciences, Psychiatry Unit, University of Florence, Florence, Italy
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Lolli F, Salimova M, Scarpino M, Lanzo G, Cossu C, Bastianelli M, Occupati B, Gori F, Del Vecchio A, Ercolini A, Pascolo S, Cimino V, Meneghin N, Fierini F, D’Anna G, Innocenti M, Ballerini A, Pallanti S, Grippo A, Mannaioni G. A randomised, double-blind, sham-controlled study of left prefrontal cortex 15 Hz repetitive transcranial magnetic stimulation in cocaine consumption and craving. PLoS One 2021; 16:e0259860. [PMID: 34784373 PMCID: PMC8594832 DOI: 10.1371/journal.pone.0259860] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 06/21/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
Background Cocaine use disorder (CUD) is a global health issue with no effective treatment. Repetitive Transcranial Magnetic Stimulation (rTMS) is a recently proposed therapy for CUD. Methods We conducted a single-center, randomised, sham-controlled, blinded, parallel-group research with patients randomly allocated to rTMS (15 Hz) or Sham group (1:1) using a computerised block randomisation process. We enrolled 62 of 81 CUD patients in two years. Patients were followed for eight weeks after receiving 15 15 Hz rTMS/sham sessions over the left dorsolateral prefrontal cortex (DLPFC) during the first three weeks of the study. We targeted the DLFPC following the 5 cm method. Cocaine lapses in twice a week urine tests were the primary outcome. The secondary outcomes were craving severity, cocaine use pattern, and psychometric assessments. Findings We randomly allocated patients to either an active rTMS group (32 subjects) or a sham treatment group (30 subjects). Thirteen (42%) and twelve (43.3%) of the subjects in rTMS and sham groups, respectively, completed the full trial regimen, displaying a high dropout rate. Ten/30 (33%) of rTMS-treated patients tested negative for cocaine in urine, in contrast to 4/27 of placebo controls (p = 0.18, odd ratio 2.88, CI 0.9–10). The Kaplan-Meier survival curve did not state a significant change between the treated and sham groups in the time of cocaine urine negativisation (p = 0.20). However, the severity of cocaine-related cues mediated craving (VAS peak) was substantially decreased in the rTMS treated group (p<0.03) after treatment at T1, corresponding to the end of rTMS treatment. Furthermore, in the rTMS and sham groups, self-reported days of cocaine use decreased significantly (p<0.03). Finally, psychometric impulsivity parameters improved in rTMS-treated patients, while depression scales improved in both groups. Conclusions In CUD, rTMS could be a useful tool for lowering cocaine craving and consumption. Trial registration The study number on clinicalTrials.gov is NCT03607591.
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Affiliation(s)
- Francesco Lolli
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
- * E-mail:
| | - Maya Salimova
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Maenia Scarpino
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Giovanni Lanzo
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Cesarina Cossu
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Maria Bastianelli
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Brunella Occupati
- Azienda Ospedaliera Universitaria di Careggi, Clinical Toxicology and Poison Control Centre, Firenze, Italy
| | - Filippo Gori
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Amedeo Del Vecchio
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Anita Ercolini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Silvia Pascolo
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Virginia Cimino
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Nicolò Meneghin
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Fabio Fierini
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Giulio D’Anna
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Matteo Innocenti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Andrea Ballerini
- Azienda Ospedaliera Universitaria di Careggi, Clinical Psychiatry, Firenze, Italy
| | - Stefano Pallanti
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
| | - Antonello Grippo
- Azienda Ospedaliera Universitaria di Careggi, Neurophysiology Unit, Firenze, Italy
| | - Guido Mannaioni
- Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, Department of Neuroscience, Psychology, Drug Research and Child Health NEUROFARBA, Department of Health Sciences DSS, Università degli Studi di Firenze, Florence, Italy
- Azienda Ospedaliera Universitaria di Careggi, Clinical Toxicology and Poison Control Centre, Firenze, Italy
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12
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Rotunno M, Dardi F, Palazzini M, Guarino D, Zuffa E, Magnani I, De Lorenzis A, Ballerini A, Manes A, Galie N. Echocardiographic predictors of low risk haemodynamic parameters in patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
A periodic and multiparametric assessment of the risk profile of patients with pulmonary arterial hypertension (PAH) is essential for a low-risk oriented treatment strategy. Haemodynamic parameters anyway cannot be collected at each scheduled outpatients clinic follow-up visit.
Purpose
To evaluate echocardiographic predictors of haemodynamic low-risk parameters in patients with PAH.
Methods
Patients with PAH referred to our centre were included up to 31 December 2019. All patients underwent baseline demographic, clinical, WHO functional class, 6-minute walk test, brain natriuretic peptide (BNP), right cardiac catheterization and echocardiographic evaluation. Through a multivariate logistic regression analysis we evaluate the echocardiographic predictors of low risk for: 1) BNP/right atrial pressure (RAP): NT-proBNP <300 ng/l/BNP <50 ng/l AND RAP <8 mmHg; 2) cardiac index (CI)/mixed venous oxygen saturation (SvO2): CI ≥2.5 l/min/m2 AND SvO2 >65%. Echocardiographic parameters cut-offs were chosen on the basis of the ROC curves or Literature data.
Results
1020 patients were included. The two analysis were performed independently.
1. Independent echocardiographic predictors of low-risk BNP/RAP were: indexed right atrial area, mitral E/A ratio, dimension and inspiratory collapse of inferior vena cava and indexed left ventricular diastolic volume. We elaborated a score utilizing these parameter cut-offs: an indexed right atrial area of 10.4–15 cm2/m2, a mitral E/A ratio of 0.8, dimension and inspiratory collapse of inferior vena cava indicative of 0–5 vs 5–10 vs 10–20 mmHg and an indexed left ventricular diastolic volume of 32 ml/m2. The score has AUC: 0.62, specificity: 92%, sensitivity: 33%, negative predictive value: 70%, positive predictive value: 69%.
2. Independent echocardiographic predictors of low-risk CI/SvO2 were: S wave at TDI, Tei index, tricuspid annular plane systolic excursion (TAPSE), indexed left ventricular diastolic volume and the severity of the tricuspid regurgitation. We elaborated a score utilizing these parameter cut-offs: an S wave at TDI of 9.5 cm/s, a Tei index of 0.4, a TAPSE of 1.7 cm, an indexed left ventricular diastolic volume of 32 ml/m2 and a mild vs more than mild tricuspid regurgitation. The score has AUC: 0.70, specificity: 89%, sensitivity: 50%, negative predictive value: 71%, positive predictive value: 77%.
Conclusion
Echocardiographic parameters can be used to rule out the presence of low-risk BNP/RAP values (indexed right atrial area, mitral E/A ratio, dimension and inspiratory collapse of inferior vena cava and indexed left ventricular diastolic volume) and low-risk CI/SvO2 (S wave at TDI, Tei index, TAPSE, indexed left ventricular diastolic volume and severity of tricuspid regurgitation).
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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13
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Magnani I, Dardi F, Palazzini M, Zuffa E, Guarino D, Daddi N, Dolci G, Antonacci F, Solli P, Paganelli GM, De Lorenzis A, Rotunno M, Ballerini A, Manes A, Galie N. Survival of patients with pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension listed for lung transplantation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1946] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Lung transplantation (LT) still remains a treatment option for patients with pulmonary arterial hypertension (PAH) and not operable chronic thromboembolic pulmonary hypertension patients (CTEPH).
Purpose
The study is intended to compare the survival of transplant recipients (TR) and the survival of not-transplanted (NT) patients since listing.
Methods
We included all patients with PAH and not-operable CTEPH listed for LT. The survival of NT, TR and of all listed patients was evaluated starting from the date of listing (patients were censored as alive at the time of LT). The survival of TR was also evaluated starting from the date of the LT.
Results
125 patients were included (112, 90% had PAH). Fifty-eight (46%) patients were transplanted, after a mean waiting time of 1.5±1.3 years. Forty-one patients (33%) died while on the list and 25 (20%) patients were alive on the list on December 2019. The survival of NT patients at 1, 3 and 5 years after listing was 74%, 42%, 33%, respectively. The survival of TR patients at 1, 3 and 5 years after listing was 90%, 70%, 63%, respectively. The survival of all patients since listing (intention to treat analysis) at 1, 3 and 5 years was 85%, 59%, 48% respectively. The survival of TR at 1, 3 and 5 years since transplantation was 63%, 61%, 59%, respectively.
Conclusions
Despite biases in the comparison of non-randomized groups, the data confirm a better long-term survival since listing of TR as compared with NT PAH or not-operable CTEPH patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Daddi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - G Dolci
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Thoracic surgery, Bologna, Italy
| | - F Antonacci
- Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Thoracic surgery, Bologna, Italy
| | - P Solli
- Maggiore Hospital, Bellaria Hospital, Presidio Ospedaliero Bellaria-Maggiore, Thoracic Surgery, Bologna, Italy, Bologna, Italy
| | - G M Paganelli
- Policlinico S. Orsola-Malpighi, Universitary Hospital Sant'orsola Malpighi, Cardio-thoracic-vascular Department, Pulmonology, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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14
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De Lorenzis A, Dardi F, Guarino D, Palazzini M, Magnani I, Zuffa E, Ballerini A, Rotunno M, Manes A, Galie N. Role of cardiac magnetic resonance in stratifying the prognosis of patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1947] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pulmonary arterial hypertension (PAH) is a rare disease characterized by a complex remodeling of heart structures. Cardiac magnetic resonance (CMR) is the gold standard for a non-invasive evaluation of right ventricle (RV) volumes and mass.
Purpose
To define the relationship between clinical, functional, biochemical, haemodynamic and CMR parameters and survival in patients with PAH.
Methods
Consecutive patients with PAH referred to our centre underwent clinical, functional, brain natriuretic peptide (BNP) plasma levels, haemodynamic and CMR evaluation. All patients were treated according to current guidelines. Univariate Cox analysis for survival was performed. Parameters with a p-value <0.1 at the univariate analysis were included in the multivariate analysis.
Results
One hundred forty-seven patients with PAH (mean age 49±17 years, 69% female) were included in the study. Etiology of PAH was: idiopathic/heritable (49%), associated with connective tissue disease (19%), congenital heart disease (12%), portal hypertension/HIV infection (12%) and pulmonary veno-occlusive disease (8%). Thirty-six patients died during follow-up. Parameters significantly associated with mortality at the univariate analysis were age [Hazard Ratio (95% Confidence Interval): 1.043 (1.020–1.067); p<0.001], six-minute walk test (6MWT) [HR: 0.995 (0.993–0.998); p<0.001], WHO-functional class [HR: 2.489 (1.025–6.041); p=0.044], idiopathic-heritable-congenital heart disease aetiology [HR: 0.182 (0.085–0.389); p<0.001], connective tissue disease aetiology [HR: 2.274 (1.099–4.704); p=0.027], pulmonary veno-occlusive disease aetiology [HR: 5.864 (2.328–14.773); p<0.001], right atrial pressure [HR: 1.098 (1.032–1.169); p=0.003], pulmonary artery oxygen saturation [HR: 0.947 (0.921–0.975); p<0.001], BNP levels [HR: 2.214 (1.213–4.039); p=0.010], RV wall thickness [HR: 0.633 (0.399–1.006); p=0.053], RV end diastolic volume [HR: 1.012 (1.003–1.021); p=0.007], RV end systolic volume [HR: 1.014 (1.003–1.024); p=0.011]. Parameters independently associated with mortality at the multivariate analysis were age [HR: 1.035 (1.006–1.064); p=0.018], idiopathic-heritable-congenital heart disease aetiology [HR: 0.355 (0.146–0.860); p=0.022], pulmonary veno-occlusive disease aetiology [HR: 3.129 (1.071–9.143); p=0.037], pulmonary artery oxygen saturation [HR: 0.953 (0.919–0.989); p=0.011], RV wall thickness [HR: 0.527 (0.300–0.927); p=0.026], RV end systolic volume [HR: 1.016 (1.003–1.029); p=0.014].
Conclusion
RV wall thickness and RV end-systolic volume are associated with prognosis in patients with PAH independently from clinical and haemodynamic characteristics. These parameters may be used in the overall risk stratification of PAH patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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Pietrini F, Tatini L, Santarelli G, Brugnolo D, Squillace M, Bozza B, Ballerini A, Ricca V, D'Anna G. Self- and caregiver-perceived disability, subjective well-being, quality of life and psychopathology improvement in long-acting antipsychotic treatments: a 2-year follow-up study. Int J Psychiatry Clin Pract 2021; 25:307-315. [PMID: 34057873 DOI: 10.1080/13651501.2021.1912358] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Switching to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) represents a valuable strategy for schizophrenia. In a recovery-oriented approach, patient-reported outcomes (PROs) such as perceived disability, subjective well-being, and quality of life cannot be neglected. METHODS Forty clinically stable outpatients with schizophrenia treated with oral second-generation antipsychotics were enrolled at the time of switching to the equivalent dose of LAI. 35 subjects completed this 2-year longitudinal, prospective, open-label, observational study. Patients were assessed at baseline, after 1 year, and after 2 years of LAI-AMT, using psychometric scales (Positive And Negative Syndrome Scale, PANSS; Young Mania Rating Scale, YMRS; Montgomery-Åsberg Depression Rating Scale, MADRS), PROs (Subjective Well-Being under Neuroleptics short form, SWN-K; Short Form-36 health survey, SF-36; 12-item World Health Organisation Disability Assessment Schedule, WHODAS 2.0), and caregiver-reported outcomes (12-item WHODAS 2.0). RESULTS No psychotic relapses were observed. Psychopathology measures (PANSS total and subscales - excluding negative symptoms), mood symptoms (YMRS, MADRS), perceived disability (patient- and caregiver-administered WHODAS 2.0), subjective well-being (SWN-K), and quality of life (SF-36) showed a concomitant amelioration after 1 year, without further significant variations. DISCUSSION Switching to LAI-AMT may decrease perceived impairment, and increase subjective well-being and quality of life in clinically stable outpatients with schizophrenia.HighlightsLAI treatment may improve outcomes by reducing psychopathology levels and relapses.In a recovery-oriented approach, patient-reported outcomes cannot be neglected.LAI antipsychotics may optimise the subjective experience of treatment.Switching to LAI therapy may result in a reduction in perceived disability.There is a significant correlation between proxy- and patient-reported disability.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Gabriele Santarelli
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Dario Brugnolo
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marco Squillace
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Bernardo Bozza
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
| | - Giulio D'Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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Tatini L, D’Anna G, Pietrini F, Calligaris E, Ballerini A, Ricca V. Predictors of long-acting injectable antipsychotic treatment discontinuation in outpatients with schizophrenia: relevance of the Drug Attitude Inventory-10. Int Clin Psychopharmacol 2021; 36:181-187. [PMID: 33902086 PMCID: PMC9648982 DOI: 10.1097/yic.0000000000000359] [Citation(s) in RCA: 3] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Given the importance of patients' subjective experience and attitudes in the management of severe mental illness, the present study evaluated their potential role as predictors of future continuation of long-acting injectable antipsychotic maintenance treatment (LAI-AMT) in clinically stable outpatients with schizophrenia switching from an oral therapy. Retrospective data from 59 subjects receiving LAI-AMT for at least 6 months were collected. Patients who continued LAI treatment (n = 32) were compared to those who discontinued it (n = 27), assessing baseline socio-demographic and clinical characteristics, psychopathological features (Positive And Negative Syndrome Scale, Montgomery-Åsberg Depression Rating Scale and Young Mania Rating Scale) and patient-reported experience of treatment through Drug Attitude Inventory 10-item (DAI-10) and Subjective Well-being under Neuroleptics short form. Binary logistic and Cox regression analyses explored the predictive role of the mentioned variables on treatment discontinuation. The Kaplan-Meier estimator compared dropout from LAI treatment in subsamples with different characteristics. Unemployment and lower baseline DAI-10 scores predicted LAI-AMT discontinuation. No major differences were detected in other socio-demographic, clinical or psychometric indexes. When switching from oral to LAI-AMT, the preliminary assessment of attitude towards drug might be clinically relevant, allowing the identification of patients at risk for treatment discontinuation.
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Affiliation(s)
- Lorenzo Tatini
- Psychiatry Unit, Department of Health Sciences, University of Florence
| | - Giulio D’Anna
- Psychiatry Unit, Department of Health Sciences, University of Florence
| | - Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | | | - Andrea Ballerini
- Psychiatry Unit, Department of Health Sciences, University of Florence
| | - Valdo Ricca
- Psychiatry Unit, Department of Health Sciences, University of Florence
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D’Anna G, Tatini L, Pietrini F, Ballerini A, Ricca V. Drug attitude inventory is relevant to LAI treatment persistence in schizophrenia: Preliminary results. Eur Psychiatry 2021. [PMCID: PMC9471612 DOI: 10.1192/j.eurpsy.2021.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionPatients’ attitudes and subjective experience are crucial in the management of severe mental illness, but their practical value is overlooked.ObjectivesTo identify predictors of future adherence to LAI antipsychotic maintenance treatment of schizophrenia among socio-demographic, clinical, and psychometric characteristics – including Drug Attitude Inventory-10 (DAI-10) and Subjective Well-being under Neuroleptics short form (SWN-K) scores.MethodsRetrospective baseline data from 53 clinically stable outpatients with schizophrenia switched from oral to LAI therapy were collected. Patients continuing treatment at the time of analysis (n=29) were compared to those who had discontinued it (n=24). Selected variables were further evaluated in survival analyses.ResultsBetween-group differences are presented in Table 1 (**: p<0.01; *: p<0.05).Continued treatmentDiscontinued treatmentχ2 or tTreatment persistence (months)63.79±21.0123.88±25.806.21**Age (years)39.17±10.1135.58±13.391.11Male15 (51.7%)13 (54.1%)0.03Single20 (69.0%)15 (62.5%)0.25Instruction (years)13.28±3.3111.83±3.561.53Employed20 (69.0%)7 (29.2%)8.32**Illness duration (years)17.69±10.5313.42±11.361.42Previous hospitalisations2.10±1.322.67±1.86-1.29MADRS13.59±9.0614.67±8.99-0.43YMRS5.52±5.576.00±9.94-0.22p-PANSS12.17±5.2014.38±6.13-1.41n-PANSS10.90±5.3915.63±7.93-2.48*g-PANSS29.38±10.3333.63±10.26-1.49PANSS52.66±17.5763.96±20.61-2.15*DAI-103.86±4.96-1.13±5.803.38**SWN-K74.93±23.0781.00±15.60-1.09Cox regression analysis included instruction, employment, hospitalisations, PANSS subscales and DAI-10 scores: a protective role against treatment discontinuation was outlined only for employment (HR 0.16; 95%CI 0.05-0.50) and higher DAI-10 scores (HR 0.85; 95%CI 0.78-0.94). DAI-10 scores delineated distinct adherence trajectories (Figure 1).ConclusionsBaseline DAI-10 scores may identify patients at risk of dropout after switching to LAI.DisclosureNo significant relationships.
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Caracciolo D, Riillo C, Ballerini A, Gaipa G, Lhermitte L, Rossi M, Botta C, Duroyon E, Grillone K, Gallo Cantafio ME, Buracchi C, Alampi G, Gulino A, Belmonte B, Conforti F, Golino G, Juli G, Altomare E, Polerà N, Scionti F, Arbitrio M, Iannone M, Martino M, Correale P, Talarico G, Ghelli Luserna di Rorà A, Ferrari A, Concolino D, Sestito S, Pensabene L, Giordano A, Hildinger M, Di Martino MT, Martinelli G, Tripodo C, Asnafi V, Biondi A, Tagliaferri P, Tassone P. Therapeutic afucosylated monoclonal antibody and bispecific T-cell engagers for T-cell acute lymphoblastic leukemia. J Immunother Cancer 2021; 9:e002026. [PMID: 33597219 PMCID: PMC7893666 DOI: 10.1136/jitc-2020-002026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Subscribe] [Scholar Register] [Accepted: 01/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive disease with a poor cure rate for relapsed/resistant patients. Due to the lack of T-cell restricted targetable antigens, effective immune-therapeutics are not presently available and the treatment of chemo-refractory T-ALL is still an unmet clinical need. To develop novel immune-therapy for T-ALL, we generated an afucosylated monoclonal antibody (mAb) (ahuUMG1) and two different bispecific T-cell engagers (BTCEs) against UMG1, a unique CD43-epitope highly and selectively expressed by T-ALL cells from pediatric and adult patients. METHODS UMG1 expression was assessed by immunohistochemistry (IHC) on a wide panel of normal tissue microarrays (TMAs), and by flow cytometry on healthy peripheral blood/bone marrow-derived cells, on 10 different T-ALL cell lines, and on 110 T-ALL primary patient-derived cells. CD43-UMG1 binding site was defined through a peptide microarray scanning. ahuUMG1 was generated by Genetic Glyco-Engineering technology from a novel humanized mAb directed against UMG1 (huUMG1). BTCEs were generated as IgG1-(scFv)2 constructs with bivalent (2+2) or monovalent (2+1) CD3ε arms. Antibody dependent cellular cytotoxicity (ADCC), antibody dependent cellular phagocytosis (ADCP) and redirected T-cell cytotoxicity assays were analysed by flow cytometry. In vivo antitumor activity of ahUMG1 and UMG1-BTCEs was investigated in NSG mice against subcutaneous and orthotopic xenografts of human T-ALL. RESULTS Among 110 T-ALL patient-derived samples, 53 (48.1%) stained positive (24% of TI/TII, 82% of TIII and 42.8% of TIV). Importantly, no expression of UMG1-epitope was found in normal tissues/cells, excluding cortical thymocytes and a minority (<5%) of peripheral blood T lymphocytes. ahUMG1 induced strong ADCC and ADCP on T-ALL cells in vitro, which translated in antitumor activity in vivo and significantly extended survival of treated mice. Both UMG1-BTCEs demonstrated highly effective killing activity against T-ALL cells in vitro. We demonstrated that this effect was specifically exerted by engaged activated T cells. Moreover, UMG1-BTCEs effectively antagonized tumor growth at concentrations >2 log lower as compared with ahuUMG1, with significant mice survival advantage in different T-ALL models in vivo. CONCLUSION Altogether our findings, including the safe UMG1-epitope expression profile, provide a framework for the clinical development of these innovative immune-therapeutics for this still orphan disease.
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Affiliation(s)
- Daniele Caracciolo
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Caterina Riillo
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | - Giuseppe Gaipa
- Centro Ricerca M. Tettamanti, Clinica Pediatrica Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Ludovic Lhermitte
- Université de Paris, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, Paris, France
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Marco Rossi
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Cirino Botta
- Hematology Unit, Annunziata Hospital, Cosenza, Italy
| | - Eugénie Duroyon
- Université de Paris, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, Paris, France
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Katia Grillone
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | - Chiara Buracchi
- Centro Ricerca M. Tettamanti, Clinica Pediatrica Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Greta Alampi
- Centro Ricerca M. Tettamanti, Clinica Pediatrica Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Alessandro Gulino
- Tumor Immunology Unit, Department of Health Sciences, Human Pathology Section, University of Palermo, Palermo, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Health Sciences, Human Pathology Section, University of Palermo, Palermo, Italy
| | | | - Gaetanina Golino
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giada Juli
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Emanuela Altomare
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Nicoletta Polerà
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Francesca Scionti
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | | | | | - Massimo Martino
- Stem Cell Transplant Program, Clinical Section, Department of Hemato-Oncology and Radiotherapy, Grande Ospedale Metropolitano Bianchi-Melacrino-Morelli, Reggio Calabria, Italy
| | - Pierpaolo Correale
- Medical Oncology Unit, "Bianchi-Melacrino-Morelli" Grand Metropolitan Hospital, Reggio Calabria, Italy
| | - Gabriella Talarico
- Immunotransfusion Service Unit, Pugliese-Ciaccio Hospital, Catanzaro, Italy
| | | | - Anna Ferrari
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Daniela Concolino
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Simona Sestito
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Licia Pensabene
- Department of Medical and Surgical Sciences, Pediatric Unit, University "Magna Graecia" of Catanzaro, Catanzaro, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | | | - Maria Teresa Di Martino
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Giovanni Martinelli
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Claudio Tripodo
- Tumor Immunology Unit, Department of Health Sciences, Human Pathology Section, University of Palermo, Palermo, Italy
| | - Vahid Asnafi
- Université de Paris, Institut Necker-Enfants Malades, Institut National de Recherche Médicale U1151, Paris, France
- Laboratory of Onco-Hematology, Assistance Publique-Hôpitaux de Paris, Hôpital Necker Enfants-Malades, Paris, France
| | - Andrea Biondi
- Centro Ricerca M. Tettamanti, Clinica Pediatrica Università Milano-Bicocca, Ospedale San Gerardo, Monza, Italy
| | - Pierosandro Tagliaferri
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Pierfrancesco Tassone
- Department of Experimental and Clinical Medicine, Magna Græcia University of Catanzaro, Catanzaro, Italy
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
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De Lorenzis A, Dardi F, Palazzini M, Zuffa E, Pasca F, Guarino D, Magnani I, Rotunno M, Ballerini A, Manes A, Galie N. Prognostic role of comorbidities in patients with pulmonary arterial hypertension. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2236] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Epidemiology of pulmonary arterial hypertension (PAH) is changing and the age at diagnosis and the prevalence of comorbidities are increasing but their prognostic relevance is substantially undefined.
Purpose
To evaluate the prognostic value of comorbidities in patients with PAH and in the different clinical subgroups.
Methods
All patients with PAH referred to a single centre underwent baseline right heart catheterization, brain natriuretic peptide (BNP) plasma levels, 6-min walking distance (6MWD), WHO functional class and anamnestic comorbidities evaluation. Cox regression model was used for analysis (p-value <0.1 was considered for inclusion in multivariate analysis).
Results
1311 patients were included [age 51 years; aetiology: 522 idiopathic/heritable/drug-induced (I/H/D)-PAH, 258 connective tissue disease (CTD)-associated PAH, 242 congenital heart disease (CHD)-associated PAH, 196 portal hypertension/HIV (PoHIV)-associated PAH and 93 pulmonary veno-occlusive disease (PVOD)]. 5% of patients have no comorbidities. At multivariate analysis comorbidities independently associated with prognosis are: systemic hypertension in I/H/D [HR 0.616, p=0.030], mean systemic blood pressure in CTD [HR 0.980, p=0.002] and PVOD [HR 0.962, p=0.006], dyslipidemia in CTD [HR 0.447, p=0.001] and PoHIV [HR 0.201, p=0.026], estimated glomerular filtration rate in PoHIV [HR 1.000, p<0.001] and body mass index (BMI) [HR 0.966, p=0.069] in CTD. In CHD comorbidities are not independent determinants of prognosis. Other variables independently predictive of a worse prognosis are: advanced age in all PAH subgroups except PVOD; male gender in I/H/D; reduced 6MWD in I/H/D, CTD and PVOD; high BNP in I/H/D, CHD and PVOD; low cardiac index in CTD, high right atrial pressure in I/H/D and low mixed venous oxygen saturation in CHD.
Conclusion
The age at PAH diagnosis and the prevalence of comorbidities are increasing but their prognostic role seems of poor relevance as we found a protective role of these variables: high systemic blood pressure (maybe indicative of a better haemodynamic stability) in I/H/D, CTD and PVOD; dyslipidemia and high BMI (maybe indicative of a better nutritional status and a less severe autoimmune disease) in CTD; dyslipidemia and a high glomerular filtration rate (both indicative of a less severe liver disease) in PoHIV.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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Dardi F, Zuffa E, Palazzini M, Pasca F, De Lorenzis A, Guarino D, Magnani I, Ballerini A, Rotunno M, Manes A, Galie N. Short term effect of Selexipag in comparison to parenteral prostacyclin analogues in pulmonary arterial hypertension patients started on double-combination therapy with ERA and PDE-5 inhibitors. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The event-driven, phase 3, randomized, double-blind, placebo-controlled GRIPHON trial demonstrated that Selexipag reduces the risk of a composite end point of death or morbidity events in patients with pulmonary arterial hypertension (PAH). Despite the advantage of a per os formulation, its efficacy in comparison to parenteral prostacyclin analogues in patients already on oral double-combination therapy with endothelin receptor antagonist (ERA) and phosphodiesterase-5 inhibitor (PDE5-I) is not known.
Purpose
The aim of this study was to compare the effects of Selexipag (S) vs subcutaneous Treprostinil (T) vs intravenous Epoprostenol (E) in PAH patients initially started with double-combination therapy with ERA and PDE5-I.
Methods
We enrolled patients on double combination therapy with ERA + PDE5-I starting S, T or E. Drugs were gradually uptitrated to the maximum tolerated/approved dose. All patients were systematically assessed with WHO-functional class (FC), six minute walk test (6MWT) and right heart catheterization before treatment and 3 months after reaching a stable dose of the drug. Baseline characteristics and changes in 6MWT and haemodynamic parameters were analyzed using Wilcoxon signed-rank test and compared between the 3 drugs with Kruskal-Wallis test.
Results
One hundred and seventy-one patients with PAH were enrolled. Results are shown in the Table. Patients with a complete re-evaluation were 61% of S, 85% of T, 79% with E.
Conclusions
S was prescribed to the oldest and least severe PAH patients. E was prescribed to the youngest and most severe PAH patients and led to the strongest improvement of exercise capacity and haemodynamic profile. T has intermediate characteristics.
Table 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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Rotunno M, Dardi F, De Lorenzis A, Palazzini M, Zuffa E, Pasca F, Guarino D, Magnani I, Ballerini A, Manes A, Galie N. Additional role of echocardiogram in pulmonary arterial hypertension risk stratification according to current ESC/ERS guidelines. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2238] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Current pulmonary hypertension (PH) guidelines stratify the risk of patients with pulmonary arterial hypertension (PAH) using a multiparametric approach. A simplified risk table has been recently proposed and validated without including echocardiographic parameters.
Purpose
We evaluate the additional role of echocardiogram in PAH risk stratification using the recently proposed simplified risk table in patients with idiopathic/heritable (I/H) PAH and PAH associated with connective tissue disease (CTD) and congenital heart disease (CHD).
Methods
All patients with I/H-PAH, CTD-PAH and CHD-PAH referred to a single centre were included from 2003 to 2017. All patients were treated according to PH guidelines. The simplified risk assessment considered the following criteria: WHO functional class, 6-min walking distance, right atrial (RA) pressure or brain natriuretic peptide (BNP) plasma levels and cardiac index (CI) or mixed venous oxygen saturation (SvO2). For the last 2 criteria the worst parameter was chosen. Risk strata were defined as: Low risk= at least 3 low risk and no high-risk criteria; High risk= at least 2 high risk criteria including CI or SvO2; Intermediate risk= definitions of low or high risk not fulfilled. Then we performed a Cox analysis to evaluate the independent echocardiographic predictors of survival that were subsequently added to the simplified risk table to test their additional role in ameliorating risk stratification.
Results
461 treatment-naïve patients were enrolled. Echocardiographic independent predictors of prognosis were the severity of tricuspid regurgitation [HR (95% CI) = 1.013 (1.006–1.021); p-value = 0.001], right atrial area [HR (95% CI) = 1.028 (1.012–1.045); p-value = 0.001] and the presence of pericardial effusion [HR (95% CI) = 1.533 (1.142–2.057); p-value= 0.004]. Only RA area significantly ameliorate the risk stratification power of the recently validated simplified PAH risk table (likelihood ratio chi2 increased from 63.8 to 68.1, likelihood ratio test = 0.039). Due to the significant correlation between RA area and both RA pressure (r=0.470; p<0.001) and BNP (r=0.372; p=0.004), we elaborate a second risk table in which RA area (utilizing the cut-offs proposed by the current PH guidelines) was considered together within the criteria including RA pressure and BNP (the worst parameter of the 3 was considered). Considering the second risk table including RA area the risk stratification power significantly improved (likelihood ratio chi2 increased from 63.8 to 72.7, AIC/BIC decreased from 1956/1964 to 1947/1955).
Conclusions
Echocardiographic RA area significantly improve the risk discrimination power of the recently proposed simplified risk table for patients with PAH.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Rotunno
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Dardi
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A De Lorenzis
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - M Palazzini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - E Zuffa
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - F Pasca
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - D Guarino
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - I Magnani
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Ballerini
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - A Manes
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
| | - N Galie
- University of Bologna, Department of Specialized, Diagnostic and Experimental Medicine – DIMES - Bologna/IT, Bologna, Italy
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Fierini F, Moretti D, Ballerini A. Psychosis spectrum disorders during and after the COVID-19 pandemic: Warning signs of "stress incubation". Psychiatry Res 2020; 291:113291. [PMID: 32763551 PMCID: PMC7352105 DOI: 10.1016/j.psychres.2020.113291] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/10/2020] [Indexed: 01/10/2023]
Affiliation(s)
- Fabio Fierini
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy.
| | - Davide Moretti
- Psychiatry Unit, Department of Health Sciences, University of Florence, Florence, Italy
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23
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Ballerini A, Chua CYX, Rhudy J, Susnjar A, Di Trani N, Jain PR, Laue G, Lubicka D, Shirazi‐Fard Y, Ferrari M, Stodieck LS, Cadena SM, Grattoni A. Muscle Atrophy: Counteracting Muscle Atrophy on Earth and in Space via Nanofluidics Delivery of Formoterol (Adv. Therap. 7/2020). Adv Therap 2020. [DOI: 10.1002/adtp.202070014] [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: 11/10/2022]
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24
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Ballerini A, Chua CYX, Rhudy J, Susnjar A, Di Trani N, Jain PR, Laue G, Lubicka D, Shirazi‐Fard Y, Ferrari M, Stodieck LS, Cadena SM, Grattoni A. Counteracting Muscle Atrophy on Earth and in Space via Nanofluidics Delivery of Formoterol. Adv Therap 2020. [DOI: 10.1002/adtp.202000014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Andrea Ballerini
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
- Department of Medical Biotechnology and Translational Medicine University of Milan Milan 20122 Italy
| | - Corrine Ying Xuan Chua
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
| | - Jessica Rhudy
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
| | - Antonia Susnjar
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
| | - Nicola Di Trani
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
- College of Materials Science and Opta‐Electronic Technology University of Chinese Academy of Science Shijingshan, 19 Yuquan Road Beijing 100049 China
| | - Priya R. Jain
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
| | - Grit Laue
- Novartis Institutes for Biomedical Research Novartis Campus Basel 4056 Switzerland
| | - Danuta Lubicka
- Novartis Institutes for Biomedical Research 181 Massachusetts Avenue Cambridge MA 02139 USA
| | - Yasaman Shirazi‐Fard
- Bone and Signaling Laboratory Space BioSciences Division NASA Ames Research Center Mail‐Stop 236‐7, Moffett Field, CA, 94035 USA
| | - Mauro Ferrari
- University of Washington Box 357630H375 Health Science Building Seattle WA 98195‐7630 USA
| | - Louis S. Stodieck
- BioServe Space Technologies Department of Aerospace Engineering Sciences University of Colorado Boulder CO 80309 USA
| | - Samuel M. Cadena
- Novartis Institutes for Biomedical Research 181 Massachusetts Avenue Cambridge MA 02139 USA
| | - Alessandro Grattoni
- Department of Nanomedicine Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
- Department of Surgery Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
- Department of Radiation Oncology Houston Methodist Research Institute 6670 Bertner Ave Houston TX 77030 USA
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25
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Perrin E, Anand E, Dyachkova Y, Wagner T, Frediani S, Ballerini A. A prospective, observational study of the safety and effectiveness of intramuscular psychotropic treatment in acutely agitated patients with schizophrenia and bipolar mania. Eur Psychiatry 2020; 27:234-9. [DOI: 10.1016/j.eurpsy.2010.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Revised: 03/04/2010] [Accepted: 04/04/2010] [Indexed: 11/15/2022] Open
Abstract
AbstractThis naturalistic, observational pan-European study assessed the safety and early effectiveness of intramuscular (IM) psychotropic treatments in patients with acute agitation suffering from schizophrenia or bipolar mania. One thousand nine hundred and forty of 1945 patients completed the 24-hour observation period after initial IM treatment. Patients from 12 European countries were included (mean age 39 years; 58% male, 66% schizophrenia). IM treatment was at the physician's discretion. The primary objective was to describe the acute tolerability of IM psychotropic therapies in clinical practice, with particular emphasis on EPS. At baseline, 68% of the patients received IM monotherapy, with IM olanzapine most commonly prescribed (36%). During the first 24hours, 190 (9.8%) patients experienced EPS. The occurrence of EPS was statistically significantly lower in patients treated with IM olanzapine compared to those treated with other IM psychotropic medications (mainly typical antipsychotics and benzodiazepines): acute dystonia: 1.1%, 95% CI 0.5–2.3 and 2.9%, CI 2.0–4.0; akathisia: 2.3%, CI 1.3–3.7 and 5.5%, CI 4.3–6.9; Parkinsonism: 2.9%, CI 1.8–4.4 and 7.8%, CI 6.4–9.4, respectively. Anticholinergic treatment was given to 12% IM olanzapine versus 31% non-olanzapine treated patients. Acute agitation after 24hours was reduced by 1.68 (95% CI 1.46–1.91) points on the Clinical Global Impression of Severity (CGI-S) in IM olanzapine patients and 1.51 (95% CI 1.30–1.73) points in non-olanzapine patients. Additional psychotropic medication was required for 90% of the patients during the first 24hours of treatment. Results provide naturalistic evidence for low EPS rates and improvement of agitation with IM psychotropic medications during acute states of patients suffering from acute mania or schizophrenia.
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26
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Cuomo A, Ballerini A, Bruni AC, Decina P, Di Sciascio G, Fiorentini A, Scaglione F, Vampini C, Fagiolini A. Clinical guidance for the use of trazodone in major depressive disorder and concomitant conditions: pharmacology and clinical practice. Riv Psichiatr 2019; 54:137-149. [PMID: 31379379 DOI: 10.1708/3202.31796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
AIM To provide a review of the clinically relevant evidence pertaining to the use of trazodone in major depressive disorder. METHODS Medline and Cochrane Library searches were searched using the keywords 'trazodone' AND 'depression', to identify the most relevant literature pertinent to the pharmacological properties of trazodone and its use in clinical practice. Articles that were selected included basic pharmacology papers, clinical trials, clinical practice guidelines, and reviews. Related references were cross checked. European and United States prescribing information was reviewed as well. An effort was made to give weight to the information that was most relevant for daily clinical practice. RESULTS Trazodone is an antidepressant with a mechanism of action that remains innovative and with a favorable profile for the treatment of depression. The appropriate antidepressant doses are usually 150-300 mg/day and are often higher than the doses that are used when trazodone is prescribed to augment the antidepressant effect of another medication, for instance when trazodone is prescribed to address insomnia in a patient treated with an SSRI. Trazodone is usually well tolerated and has a low risk of anticholinergic side effects, weight gain and sexual side effects. DISCUSSION Trazodone is an established medication that is efficacious for the treatment of a broad array of depressive symptoms, including symptoms that are less likely to respond to other antidepressants (e.g. SSRI), such as insomnia. As an antidepressant, trazodone has proven as efficacious as the tricyclic and second-generation antidepressants and is tolerated relatively well. Trazodone may be helpful for patients with major depression and comorbid insomnia, anxiety or psychomotor agitation. CONCLUSIONS Trazodone is efficacious antidepressants with a relatively low risks of side effects such as weight gain, sexual or anticholinergic effects (such as constipation, urinary retention, dry mouth). In addition to being able to control a wide range of depressive symptoms, trazodone may improve sleep and be particularly helpful for patients whose symptoms of depression include insomnia.
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Affiliation(s)
- Alessandro Cuomo
- Dipartimento di Medicina Molecolare e dello Sviluppo, Università di Siena - Divisione di Psichiatria, Sistema Sanitario Nazionale della Lombardia, Mantova
| | - Andrea Ballerini
- Sod di Psichiatria, Azienda Ospedaliero-Universitaria Careggi, Firenze
| | - Amalia Cecilia Bruni
- Centro Regionale di Neurogenetica, Lamezia Terme, Azienda Sanitaria Provinciale di Catanzaro
| | | | | | | | | | - Claudio Vampini
- Servizio di Psichiatria e Psicogeriatria, Clinica San Francesco, Verona
| | - Andrea Fagiolini
- Dipartimento di Medicina Molecolare e dello Sviluppo, Università di Siena
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27
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Pons-Faudoa FP, Ballerini A, Sakamoto J, Grattoni A. Advanced implantable drug delivery technologies: transforming the clinical landscape of therapeutics for chronic diseases. Biomed Microdevices 2019; 21:47. [PMID: 31104136 PMCID: PMC7161312 DOI: 10.1007/s10544-019-0389-6] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic diseases account for the majority of all deaths worldwide, and their prevalence is expected to escalate in the next 10 years. Because chronic disorders require long-term therapy, the healthcare system must address the needs of an increasing number of patients. The use of new drug administration routes, specifically implantable drug delivery devices, has the potential to reduce treatment-monitoring clinical visits and follow-ups with healthcare providers. Also, implantable drug delivery devices can be designed to maintain drug concentrations in the therapeutic window to achieve controlled, continuous release of therapeutics over extended periods, eliminating the risk of patient non-compliance to oral treatment. A higher local drug concentration can be achieved if the device is implanted in the affected tissue, reducing systemic adverse side effects and decreasing the challenges and discomfort of parenteral treatment. Although implantable drug delivery devices have existed for some time, interest in their therapeutic potential is growing, with a global market expected to reach over $12 billion USD by 2018. This review discusses implantable drug delivery technologies in an advanced stage of development or in clinical use and focuses on the state-of-the-art of reservoir-based implants including pumps, electromechanical systems, and polymers, sites of implantation and side effects, and deployment in developing countries.
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Affiliation(s)
- Fernanda P Pons-Faudoa
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- School of Medicine and Health Sciences, Tecnologico de Monterrey, Avenida Eugenio Garza Sada 2501, 64849, Monterrey, NL, Mexico
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
- Department of Oncology and Onco-Hematology, University of Milan, Via Festa del Perdono 7, 20122, Milan, Italy
| | - Jason Sakamoto
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, 6670 Bertner Avenue, Houston, TX, 77030, USA.
- Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
- Department of Radiation Oncology, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX, 77030, USA.
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28
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Fagiolini A, Aguglia E, Ballerini A, Callista G, Carpiniello B, Clerici M, Corrivetti G, De Fazio P, De Filippis S, De Giorgi S, Favaretto G, Ferri E, Gargiulo G, Giustra MG, La Barbera D, Maina G, Mencacci C, Montagnani G, Panariello A, Pigato G, Tortorella A, Vernacotola L, Vita A. Real-world effectiveness of long acting aripiprazole: Treatment persistence and its correlates in the Italian clinical practice. Psychiatry Res 2019; 272:698-706. [PMID: 30832189 DOI: 10.1016/j.psychres.2019.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To identify the variables that are associated with persistence to Aripiprazole-Long Acting (A-LAI), in adult patients with schizophrenia. METHODS Observational, retrospective, non-interventional study involving 261 patients with schizophrenia. RESULTS Eighty-six percent of study subjects were persistent for at least 6 months. All subjects with baseline CGI-S of 1 or 2, 95% of subjects with CGI-S of 3, 86% with CGI-S of 4, 82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7 were persistent. A-LAI treatment continuation rate was higher in patients with: 1) baseline CGI score ≤ 4; 2) schizophrenia dimension (LDPS) mania score ≤ 5; 3) psychotic spectrum schizoid score ≤ 11. CONCLUSIONS A relatively high number of patients (n = 225, 86%) were persistent to A-LAI for at least 6 months. Not surprisingly, very severe patients were more unlikely to be persistent. However, it is noteworthy that a large number of subjects with high CGI score at the time when A-LAI was started (82% of subjects with CGI-S of 5, 73% of subjects with CGI of 6 and 90% of subjects with CGI of 7) were persistent. Larger, controlled, prospective and longer studies are warranted.
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Affiliation(s)
| | | | - A Ballerini
- U Sod di Psichiatria, AOU Careggi Firenze, Italy
| | - G Callista
- UOSD S.P.D.C. P.O. Giulianova Asl Teramo, Italy
| | | | | | | | - P De Fazio
- University Magna Graecia, Catanzaro, Italy
| | - S De Filippis
- Neuropsychiatric clinic villa von Siebenthal-Rome, Italy
| | - S De Giorgi
- Department of Mental Health, ASL Lecce, Italy
| | - G Favaretto
- Department of Mental Health, Ulss2 Marca Trevigiana, Italy
| | | | - G Gargiulo
- Area Vasta2, Ancona-A.S.U.R.Marche, Italy
| | | | | | | | - C Mencacci
- DSMD - Neuroscienze Asst Fatebenefratelli- Sacco, Milano, Italy
| | | | | | - G Pigato
- University of Padova Medical Center, Italy
| | | | | | - A Vita
- University of Brescia, Italy
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29
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Rizzari C, Lanvers-Kaminsky C, Valsecchi MG, Ballerini A, Matteo C, Gerss J, Wuerthwein G, Silvestri D, Colombini A, Conter V, Biondi A, Schrappe M, Moericke A, Zimmermann M, von Stackelberg A, Linderkamp C, Frühwald MC, Legien S, Attarbaschi A, Reismüller B, Kasper D, Smisek P, Stary J, Vinti L, Barisone E, Parasole R, Micalizzi C, Zucchetti M, Boos J. Asparagine levels in the cerebrospinal fluid of children with acute lymphoblastic leukemia treated with pegylated-asparaginase in the induction phase of the AIEOP-BFM ALL 2009 study. Haematologica 2019; 104:1812-1821. [PMID: 30705097 PMCID: PMC6717578 DOI: 10.3324/haematol.2018.206433] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 01/31/2019] [Indexed: 12/25/2022] Open
Abstract
Asparagine levels in cerebrospinal fluid and serum asparaginase activity were monitored in children with acute lymphoblastic leukemia treated with pegylated-asparaginase. The drug was given intravenously at a dose of 2,500 IU/m2 on days 12 and 26. Serum and cerebrospinal fluid samples obtained on days 33 and 45 were analyzed centrally. Since physiological levels of asparagine in the cerebrospinal fluid of children and adolescents are 4-10 μmol/L, in this study asparagine depletion was considered complete when the concentration of asparagine was ≤0.2 μmol/L, i.e. below the lower limit of quantification of the assay used. Over 24 months 736 patients (AIEOP n=245, BFM n=491) and 903 cerebrospinal fluid samples (n=686 on day 33 and n=217 on day 45) were available for analysis. Data were analyzed separately for the AIEOP and BFM cohorts and yielded superimposable results. Independently of serum asparaginase activity levels, cerebrospinal fluid asparagine levels were significantly reduced during the investigated study phase but only 28% of analyzed samples showed complete asparagine depletion while relevant levels, ≥1 μmol/L, were still detectable in around 23% of them. Complete cerebrospinal fluid asparagine depletion was found in around 5-6% and 33-37% of samples at serum asparaginase activity levels <100 and ≥ 1,500 IU/L, respectively. In this study cerebrospinal fluid asparagine levels were reduced during pegylated-asparaginase treatment, but complete depletion was only observed in a minority of patients. No clear threshold of serum pegylated-asparaginase activity level resulting in complete cerebrospinal fluid asparagine depletion was identified. The consistency of the results found in the two independent data sets strengthen the observations of this study. Details of the treatment are available in the European Clinical Trials Database at https://www.clin-icaltrialsregister.eu/ctr-search/trial/2007-004270-43/IT.
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Affiliation(s)
- Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Claudia Lanvers-Kaminsky
- Department of Pediatric Hematology and Oncology, University Childrens' Hospital of Münster, Münster, Germany
| | - Maria Grazia Valsecchi
- Medical Statistics Unit, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
| | - Andrea Ballerini
- Department of Oncology, Laboratory of Cancer Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Cristina Matteo
- Department of Oncology, Laboratory of Cancer Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, University of Münster, Münster, Germany
| | - Gudrun Wuerthwein
- Department of Pediatric Hematology and Oncology, University Childrens' Hospital of Münster, Münster, Germany
| | - Daniela Silvestri
- Medical Statistics Unit, Department of Clinical Medicine and Prevention, University of Milano-Bicocca, Milan, Italy
| | - Antonella Colombini
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, Monza, Italy
| | - Martin Schrappe
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Anja Moericke
- Department of Pediatrics, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Martin Zimmermann
- Department of Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | | | - Christin Linderkamp
- Pediatric Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | | | - Sabine Legien
- Pediatrics 5 (Oncology, Hematology, Immunology); Stuttgart Cancer Center; Klinikum Stuttgart - Olgahospital, Stuttgart, Germany
| | - Andishe Attarbaschi
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Vienna, Austria
| | - Bettina Reismüller
- Department of Pediatric Hematology and Oncology, St. Anna Children's Hospital, Vienna, Austria
| | - David Kasper
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petr Smisek
- Czech Paediatric Haematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Jan Stary
- Czech Paediatric Haematology/Oncology, Charles University and University Hospital Motol, Prague, Czech Republic
| | - Luciana Vinti
- Department of Pediatric Hemato-Oncology, Ospedale Bambino Gesù, Rome, Italy
| | - Elena Barisone
- Department of Pediatric Hemato-Oncology, Regina Margherita Children's Hospital, Turin, Italy
| | - Rosanna Parasole
- Department of Pediatric Hematology-Oncology, Ospedale Pausillipon, Naples, Italy
| | - Concetta Micalizzi
- Department of Pediatric Hematology-Oncology, IRCCS I.G. Gaslini, Genova, Italy
| | - Massimo Zucchetti
- Department of Oncology, Laboratory of Cancer Pharmacology, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Joachim Boos
- Department of Pediatric Hematology and Oncology, University Childrens' Hospital of Münster, Münster, Germany
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30
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Pietrini F, Albert U, Ballerini A, Calò P, Maina G, Pinna F, Vaggi M, Boggian I, Fontana M, Moro C, Carpiniello B. The modern perspective for long-acting injectables antipsychotics in the patient-centered care of schizophrenia. Neuropsychiatr Dis Treat 2019; 15:1045-1060. [PMID: 31118640 PMCID: PMC6503342 DOI: 10.2147/ndt.s199048] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 03/18/2019] [Indexed: 12/31/2022] Open
Abstract
Schizophrenia is a chronic syndrome involving different clinical dimensions, and causes significant disability with a negative impact on the quality of life of patients and their caregivers. Current guidelines for the treatment of schizophrenia focus on maximizing a patient's adaptive functioning and quality of life in a recovery-oriented approach that encourages active collaboration among patients, caregivers, and mental health professionals to design and manage a customized and comprehensive care plan. In the present study, a panel of experts (psychiatrists, psychologists, nurse, and social worker) gathered to review and explore the need for contemporary use of second-generation antipsychotic long-acting injectables (SGA LAIs) in "recovery-oriented" and "patient-centered" care of schizophrenia. Starting from the available data and from sharing personal attitudes and experiences, the panel selected three clinical dimensions considered useful in characterizing each patient: phase of disease, adherence to treatment, and level of functioning. For each clinical dimension, perspectives of patients and caregivers with regard to needs, expectations, and personal experiences were reviewed and the role of SGA LAIs in achieving shared goals examined. The experts concluded that from today's modern perspectives, SGA-LAIs may play an important role in breaking the spiral of desocialization and functional decline in schizophrenia, thus favoring the recovery process.
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Affiliation(s)
- Francesco Pietrini
- Department of Mental Health and Addictions, Central Tuscany NHS Trust, Florence, Italy
| | - Umberto Albert
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Andrea Ballerini
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Paola Calò
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Giuseppe Maina
- Rita Levi Montalcini Department of Neuroscience, University of Torino, Torino, Italy
| | - Federica Pinna
- Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
| | - Marco Vaggi
- Department of Mental Health and Drug Addiction ASL 3 Genoa, Azienda Sanitaria 3 Genovese, Genoa, Italy
| | - Ileana Boggian
- Department of Mental Health, Azienda Ulss 9 Scaligera, Legnago, Italy
| | - Maria Fontana
- Department of Mental Health, Azienda Sanitaria Locale Lecce, Lecce, Italy
| | - Cesare Moro
- Department of Mental Health and Addictions, ASST Bergamo Ovest, Treviglio, Italy
| | - Bernardo Carpiniello
- Psychiatric Clinical Unit, University Hospital of Cagliari, Cagliari, Italy.,Department of Medical Sciences and Public Health, Unit of Psychiatry, University of Cagliari, Cagliari, Italy
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Di Trani N, Jain P, Chua CYX, Ho JS, Bruno G, Susnjar A, Pons-Faudoa FP, Sizovs A, Hood RL, Smith ZW, Ballerini A, Filgueira CS, Grattoni A. Nanofluidic microsystem for sustained intraocular delivery of therapeutics. Nanomedicine 2018; 16:1-9. [PMID: 30468870 DOI: 10.1016/j.nano.2018.11.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 10/03/2018] [Accepted: 11/06/2018] [Indexed: 02/07/2023]
Abstract
Globally, 145.2 million people suffer from moderate to severe vision impairment or blindness due to preventable or treatable causes. However, patient adherence to topical or intravitreal treatment is a leading cause of poor outcomes. To address this issue, we designed an intraocularly implantable device called the nanofluidic Vitreal System for Therapeutic Administration (nViSTA) for continuous and controlled drug release based on a nanochannel membrane that obviates the need for pumps or actuation. In vitro release analysis demonstrated that our device achieves sustained release of bimatoprost (BIM) and dexamethasone (DEX) at concentrations within clinically relevant therapeutic window. In this proof of concept study, we constructed an anatomically similar in silico human eye model to simulate DEX release from our implant and gain insight into intraocular pharmacokinetics profile. Overall, our drug-agnostic intraocular implant represents a potentially viable platform for long-term treatment of various chronic ophthalmologic diseases, including diabetic macular edema and uveitis.
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Affiliation(s)
- Nicola Di Trani
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; University of Chinese Academy of Science (UCAS), Shijingshan, Beijing, China
| | - Priya Jain
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Jeremy S Ho
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Weill Cornell Medical College, Weill Cornell Medicine, New York, NY, USA
| | - Giacomo Bruno
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Antonia Susnjar
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Fernanda Paola Pons-Faudoa
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Tecnologico de Monterrey, School of Medicine and Health Sciences, Monterrey, NL, Mexico
| | - Antons Sizovs
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - R Lyle Hood
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Zachary W Smith
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Carly S Filgueira
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Cardiovascular Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Surgery, Houston Methodist Hospital, Houston, TX, USA; Department of Radiation Oncology, Houston Methodist Hospital, Houston, TX, USA.
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Chiarello F, Marini E, Ballerini A, Ricca V. Optic neuropathy due to nutritional deficiency in a male adolescent with Avoidant/Restrictive Food Intake Disorder: a case report. Eat Weight Disord 2018; 23:533-535. [PMID: 28620702 DOI: 10.1007/s40519-017-0409-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 05/31/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Francesca Chiarello
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla 3, 50134, Florence, Italy.
| | - Elisa Marini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Andrea Ballerini
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Valdo Ricca
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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Pietrini F, D’Anna G, Tatini L, Talamba GA, Andrisano C, Calderani E, Manetti M, Rossi Prodi P, Ricca V, Ballerini A. Changes in attitude towards LAI antipsychotic maintenance treatment: A two-year follow-up study. Eur Psychiatry 2018; 53:58-65. [DOI: 10.1016/j.eurpsy.2018.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/31/2018] [Accepted: 06/11/2018] [Indexed: 12/31/2022] Open
Abstract
AbstractBackground:To present real-world evidence on the effects of switching from oral to long-acting injectable (LAI) antipsychotic maintenance treatment (AMT) in a sample of clinically stable patients with schizophrenia, with regard to subjective experience of treatment, attitude towards drug and quality of life.Methods:50 clinically stable adult schizophrenic outpatients were recruited. At the time of enrolment (T0), all patients were under a stabilized therapy with a single oral second-generation antipsychotic (SGA) and were switched to the equivalent maintenance regimen with the long-acting formulation of the same antipsychotic. 43 patients completed the 24-month prospective, longitudinal, open-label, observational study. Participants were assessed at baseline (T0), after 12 (T1) and 24 months (T2), using psychometric scales (PANSS, YMRS and MDRS) and patient-reported outcome measures (SWN-K, DAI-10 and SF-36).Results:The switch to LAI-AMT was associated with a significant clinical improvement at T1 and T2 compared to baseline (T0). All of the psychometric indexes, as well as patients’ subjective experience of treatment (SWN-K), and quality of life (SF-36) showed a significant improvement after one year of LAI-AMT, with stable results after two years. Patients’ attitude towards drug (DAI-10) increased throughout the follow-up period, with a further improvement during the second year.Conclusions:The switch to LAI-AMT may help to address the subjective core of an optimal recovery in stabilized schizophrenic patients. A sustained improvement in patients’ attitude towards drug may help to achieve patient’s compliance. The size of this study needs to be expanded to produce more solid and generalizable results.
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Girardi P, Del Casale A, Rapinesi C, Kotzalidis GD, Splendori F, Verzura C, Trovini G, Sorice S, Carrus D, Mancinelli I, Comparelli A, De Filippis S, Francomano A, Ballerini A, Marcellusi A, Mennini FS, Ducci G, Sani G, Pompili M, Brugnoli R. Predictive factors of overall functioning improvement in patients with chronic schizophrenia and schizoaffective disorder treated with paliperidone palmitate and aripiprazole monohydrate. Hum Psychopharmacol 2018; 33:e2658. [PMID: 29766576 DOI: 10.1002/hup.2658] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/22/2018] [Accepted: 04/09/2018] [Indexed: 11/11/2022]
Abstract
BACKGROUND Long-acting injectable (LAI) antipsychotics can improve medication adherence and reduce hospitalisation rates compared with oral treatments. Paliperidone palmitate (PAL) and aripiprazole monohydrate (ARI) LAI treatments were associated with improvements in global functioning in patients with schizophrenia. OBJECTIVE The objective of this study was to assess the predictive factors of better overall functioning in patients with chronic schizophrenia and schizoaffective disorder treated with PAL and ARI. METHOD Enrolled were 143 (97 males, 46 females, mean age 38.24 years, SD = 12.65) patients with a diagnosis of schizophrenia or schizoaffective disorder, whom we allocated in two groups (PAL and ARI treatments). We assessed global functioning, amount of oral medications, adherence to oral treatment, and number of hospitalisations before LAI introduction and at assessment time point. RESULTS Longer treatment time with LAIs (p < .001), lower number of oral drugs (p < .001), and hospitalisations (p = .002) before LAI introduction, and shorter duration of illness (p = .038) predicted better Global Assessment of Functioning scores in the whole sample (R2 = 0.337). CONCLUSION Early administration and longer duration of ARI or PAL treatments could play a significant role in improving global functioning of patients with schizophrenia and schizoaffective disorder. Better improvement in functioning could be achieved with ARI in young individuals with recent illness onset and PAL in patients at risk for recurrent hospitalisations.
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Affiliation(s)
- Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Francesca Splendori
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Claudio Verzura
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Giada Trovini
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Rome, Italy
| | - Dario Carrus
- Mental Health Department, Azienda Sanitaria Locale Viterbo, Viterbo, Italy
| | - Iginia Mancinelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Anna Comparelli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | | | - Antonio Francomano
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Palermo, Italy
| | - Andrea Ballerini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence, Florence, Italy
| | - Andrea Marcellusi
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Francesco S Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), Tor Vergata University, Rome, Italy
| | - Giuseppe Ducci
- Mental Health Department, Azienda Sanitaria Locale Roma 1, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
| | - Roberto Brugnoli
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Sapienza University, Faculty of Medicine and Psychology, Sant'Andrea University Hospital, Rome, Italy
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Brugnoli R, Rapinesi C, Kotzalidis GD, Marcellusi A, Mennini FS, De Filippis S, Carrus D, Ballerini A, Francomano A, Ducci G, Del Casale A, Girardi P. Model of Management (Mo.Ma) for the patient with schizophrenia: crisis control, maintenance, relapse prevention, and recovery with long-acting injectable antipsychotics (LAIs). Riv Psichiatr 2017; 51:47-59. [PMID: 27183509 DOI: 10.1708/2246.24194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Schizophrenia is a severe mental disease that affects approximately 1% of the population with a relevant chronic impact on social and occupational functioning and daily activities. People with schizophrenia are 2-2.5 times more likely to die early than the general population. Non-adherence to antipsychotic medications, both in chronic and first episode schizophrenia, is one of the most important risk factors for relapse and hospitalization, that consequently contributes to increased costs due to psychiatric hospitalization. Atypical long-acting injectable (LAI) antipsychotics can improve treatment adherence and decrease re-hospitalization rates in patients with schizophrenia since its onset. The primary goals in the management of schizophrenia are directed not only at symptom reduction in the short and long term, but also at maintaining physical and mental functioning, improving quality of life, and promoting patient recovery. AIM To propose a scientific evidence-based integrated model that provides an algorithm for recovery of patients with schizophrenia and to investigate the effectiveness and safety of antipsychotics LAI in the treatment, maintenance, relapse prevention, and recovery of schizophrenia. METHODS After an accurate literature review we identified, collected and analyzed the crucial points in taking care schizophrenia patients, through which we defined the steps described in the model of management and the choice of the better treatment option. Results. In the management model we propose, the choice of a second generation long acting antipsychotic, could allow from the earliest stages of illness better patient management, especially for young individuals with schizophrenia onset, a better recovery and significant reductions of relapse and health care costs. LAI formulations of antipsychotics are valuable, because they help patients to remain adherent to their medication through regular contact with healthcare professionals and to prevent covert non-adherence. CONCLUSIONS The proposed schizophrenia model of management could allow better patient management and recovery, in which the treatment with LAI formulation is a safe and effective therapeutic option. This new therapeutic approach could change the cost structure of schizophrenia by decreasing costs with efficient economic resource allocation guaranteed from efficient diagnostic and therapeutic pathways.
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Affiliation(s)
- Roberto Brugnoli
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Chiara Rapinesi
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
| | - Andrea Marcellusi
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Italy
| | - Francesco S Mennini
- Faculty of Economics, Centre for Economic and International Studies (CEIS)-Economic Evaluation and HTA (EEHTA), University of Rome, Italy
| | - Sergio De Filippis
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - Villa von Siebenthal Neuropsychiatric, Clinic and Hospital Rome, Italy
| | - Dario Carrus
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - ASL VT, Viterbo, Italy
| | - Andrea Ballerini
- Department of Neuroscience, Psychology, Drug Research and Child Health, Section of Neuroscience, University of Florence, Italy
| | - Antonio Francomano
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Italy
| | | | - Antonio Del Casale
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy - Department of Psychiatric Rehabilitation, Fondazione ''P. Alberto Mileno Onlus'', Vasto (CH), Italy
| | - Paolo Girardi
- NESMOS Department (Neurosciences, Mental Health, and Sensory Organs), Sapienza University of Rome, School of Medicine and Psychology; Sant'Andrea Hospital, Rome, Italy
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Farina M, Ballerini A, Fraga DW, Nicolov E, Hogan M, Demarchi D, Scaglione F, Sabek OM, Horner P, Thekkedath U, Gaber OA, Grattoni A. 3D Printed Vascularized Device for Subcutaneous Transplantation of Human Islets. Biotechnol J 2017; 12. [PMID: 28734022 DOI: 10.1002/biot.201700169] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/12/2017] [Indexed: 12/17/2022]
Abstract
Transplantation of pancreatic islets or stem cell derived insulin secreting cells is an attractive treatment strategy for diabetes. However, islet transplantation is associated with several challenges including function-loss associated with dispersion and limited vascularization as well as the need for continuous immunosuppression. To overcome these limitations, here we present a novel 3D printed and functionalized encapsulation system for subcutaneous engraftment of islets or islet like cells. The devices were 3D printed with polylactic acid and the surfaces treated and patterned to increase the hydrophilicity, cell attachment, and proliferation. Surface treated encapsulation systems were implanted with growth factor enriched platelet gel, which helped to create a vascularized environment before loading human islets. The device protected the encapsulated islets from acute hypoxia and kept them functional. The adaptability of the encapsulation system was demonstrated by refilling some of the experimental groups transcutaneously with additional islets.
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Affiliation(s)
- Marco Farina
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Daniel W Fraga
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Eugenia Nicolov
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Matthew Hogan
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Danilo Demarchi
- Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Philip Horner
- Center for Neuroregeneration, Houston Methodist Research Institute, Houston, TX, USA
| | - Usha Thekkedath
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Osama A Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
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Ballerini A, Moro F, Nerini IF, Marzo CM, Di Clemente A, Ferrari M, D'Incalci M, Biondi A, Colombini A, Conter V, Porcu L, Cervo L, Rizzari C, Zucchetti M. Pharmacodynamic effects in the cerebrospinal fluid of rats after intravenous administration of different asparaginase formulations. Cancer Chemother Pharmacol 2017; 79:1267-1271. [PMID: 28424964 DOI: 10.1007/s00280-017-3307-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 04/11/2017] [Indexed: 01/27/2023]
Abstract
PURPOSE Asparaginase (ASNase) is used to treat various hematological malignancies for its capacity to deplete asparagine (ASN) in serum and cerebrospinal fluid (CSF). Since the biological mechanisms underlying CSF asparagine depletion in humans are not yet fully elucidated, this study compared, for the first time, the pharmacological properties of three clinically used ASNase formulations in a rodent model. METHODS Male Wistar rats were treated with E.coli-ASNase, PEG-ASNase, or ERW-ASNase at different doses. Serum and CSF amino-acid levels and ASNase activities were evaluated at 1 and 24 h after the intravenous administration of different ASNase doses. RESULTS All the ASNase formulations showed higher activities in serum after 1 h than 24 h and completely deplete ASN. Mean ASNase activity in the CSF at 1 h was higher with ERW-ASNase compared to PEG-ASNase (36 ± 29 vs 8 ± 7 U/L, p < 0.037) and similar to E.coli-ASNase (21 ± 9 U/L, ns). ERW-ASNase and E.coli-ASNase at the highest doses were able to deplete ASN in the CSF after 1 h. This effect was transient and not evident at 24 h after treatment. CONCLUSIONS Together with the ASN depletion in serum and CSF, a never before demonstrated transient penetration of ASNases into the CSF, more evident for non-pegylated formulations, was detected when the ASNases were administered at high dose.
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Affiliation(s)
- Andrea Ballerini
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy.,Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Federico Moro
- Experimental Psychopharmacology, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Ilaria Fuso Nerini
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy
| | - Claudio Marcello Marzo
- Experimental Psychopharmacology, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Angelo Di Clemente
- Experimental Psychopharmacology, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Mariella Ferrari
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy
| | - Maurizio D'Incalci
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy
| | - Andrea Biondi
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza, Monza, Italy
| | - Antonella Colombini
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza, Monza, Italy
| | - Valentino Conter
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza, Monza, Italy
| | - Luca Porcu
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy
| | - Luigi Cervo
- Experimental Psychopharmacology, Department of Neuroscience, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Carmelo Rizzari
- Pediatric Hematology-Oncology Unit, Department of Pediatrics, University of Milano-Bicocca, MBBM Foundation, ASST Monza, Monza, Italy
| | - Massimo Zucchetti
- Clinical Cancer Pharmacology Unit, Department of Oncology, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156, Milan, Italy.
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Mallardo L, Campone B, Tofani T, Ciampi E, Corsi E, Baschirotto C, Appignanesi C, Lelli L, Pietrini F, Rotella F, Ricca V, Ballerini A. Is There an Association Between Body Uneasiness and Aberrant Salience in Anorexic Patients? A Preliminary Study. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.142] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The process whereby objects and representations come to be attention grabbing and capture thought and behaviour is called salience, and it is defined as aberrant when a significance is allocated to neutral stimuli. The Aberrant Salience Inventory (ASI) is a scale to measure aberrant salience, characterized by 29 dichotomic items. By now, a correlation between aberrant salience and eating disorders is unknown. Aim of this study is to evaluate an alteration of salience in patients with anorexia nervosa, to estimate the existance of a correlation between aberrant salience and the experience of body shape.MethodsTwenty-six female patients with AN (diagnosed using DSM-5) were enrolled at the Psychiatry Department of Florence. Psychopathological features were assessed at the time of enrollment using the following scales: SCL-90-R, BUT, EDE-Q. Salience alteration was assessed by the means of the ASI. Statistical analysis were realized using SPSS 20.0 with Spearman bivariate correlation.ResultsMean age was (mean ± SD) 26.2 ± 8.72 and mean Body Mass Index (BMI) 16.1 ± 2.46. Global Severity Index (GSI), Positive Symptom Total (PST) and Positive Symptom Distress Symptom Index (PSDI) were estimated for BUT and SCL-90-R and compared to total value of ASI. Thus, we found a statistical significant (P < 0.05) direct correlation between ASI and BUTpsdi and ASI and SCL-90-Rgsi (correlation coefficient of 0.446 and 0.398, respectively).ConclusionIn this study, we found a significant direct correlation between Aberrant Salience Inventory (ASI) values and one dimension of body uneasiness in anorexic patients. These preliminary data need further studies with a wider sample to confirm the above-mentioned data.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Marcellusi A, Mennini F, Brugnoli R, Rapinesi C, Kotzalidis G, De Filippis S, Carrus D, Ballerini A, Francomano A, Ducci G, Del Casale A, Girardi P. Economic Aspects in the Treatment of Schizophrenia in Italy: Cost Consequences of an Early Long-acting Injectable Anti-Psychotics (lais) Approach. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.02.101] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PurposeThe aim of this analysis was to evaluate the economic consequences of a new treatment approach in the treatment of schizophrenia in the Italian setting. In terms of direct costs, in Italy was estimated that the main driver were represented by hospitalization and residential cost (71% of total direct cost per patient), followed by semi-residential services (13%), anti-psychotic and other drugs (8%) and ambulatory services (8).MethodsA probabilistic cost consequence model was developed to estimate the potential cost reductions derived from an early treatment with atypical long-acting injectable anti-psychotics (aLAIs) drugs. A systematic literature review was carried out to identify direct and indirect costs associated to the management of schizophrenic patients in Italy. The model projects a scenario analysis in order to estimate potential cost reductions applying a new model management (MoMa) based on patient recovery and early aLAIs treatment.ResultsOverall, the total economic burden associated with schizophrenia was estimated at €2.7 billion per year. A total of 50.5% of the economic burden was related to indirect costs and 49.5% to direct costs. Drug costs correspond to 10% of the total expenditure in terms of direct costs, while hospitalization and residential costs accounts for 81%. Scenario analysis demonstrate a potential cost reduction between 200 million and 300 million based on the effects of MoMa over the reduction of hospitalization and residential costs.ConclusionsThis analysis was the first attempt to translate clinical management aspects in economic consequences and will be a useful instruments for decision maker.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Calderani E, Pietrini F, Burian I, Chiarello F, Dahlke D, Gemignani S, Marino P, Talamba G, Poli L, Santangelo A, Ricca V, Ballerini A. Long acting antipsychotics treatment of schizophrenia: A 24-month prospective study on patient's attitude towards treatment. Eur Psychiatry 2017. [DOI: 10.1016/j.eurpsy.2017.01.2111] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
IntroductionLong-acting injectable (LAI) second-generation antipsychotics (SGAs) are considered an alternative to oral antipsychotics for schizophrenic patients with low adherence to therapy. However, it is still a matter of debate whether LAI-SGAs are able to significantly improve patient's attitudes towards treatment (ATT) [1].ObjectiveTo investigate the impact of LAI on ATT over 24 months.MethodsNineteen schizophrenic patients were switched from either oral olanzapine (11) or paliperidone (8) to the corresponding LAI. Patients were assessed at baseline (T0), after 6 (T1), 12 (T2) and 24 months (T3). Drug Attitude Inventory-10 (DAI-10) [2] was used to assess ATT. Young Mania Rating Scale (YMRS), Montgomery-Asberg Depression Rating Scale (MADRS), Positive and Negative Syndrome Scale (PANSS), and Short Form Health Survey (SF-36) were used for psychopathology evaluations.ResultsEleven patients reached T3. Eight patients were excluded (4 olanzapine, 4 paliperidone): 4 required a significant change in concomitant treatment, 4 a change of antipsychotic (metabolic comorbidity). No changes in psychopathology occurred between T2 and T3, some scales improved from baseline to T2. DAI-10 mean scores were improved after 12 months, thus not significantly, and were further improved at 24 months (P = .008 vs baseline).ConclusionsATT keeps improving after one year of LAI treatment, unrelated to clinical response.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Filgueira CS, Ballerini A, Nicolov E, Chua CYX, Jain P, Smith ZW, Gilbert AL, Scaglione F, Grattoni A. A pharmacokinetic study of GC-1 delivery using a nanochannel membrane device. Nanomedicine 2017; 13:1739-1744. [PMID: 28259802 DOI: 10.1016/j.nano.2017.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Revised: 01/20/2017] [Accepted: 02/14/2017] [Indexed: 12/25/2022]
Abstract
This study demonstrated a nanochannel membrane device (NMD) for controlled and sustained release of GC-1 in rats, in the context of the treatment of metabolic syndrome. Release profiles were established in vitro both with and without 5% labrasol for over 2 months. In vivo pharmacokinetic evaluation showed effective GC-1 plasma concentrations, which resulted in significant reductions in body weight after just one week of treatment when compared to the NMD releasing vehicle only (PBS). We also provided evidence that rats treated with NMD-GC-1 present sub-active thyroids and clear differences in the morphology of the epithelium and follicles as compared to the controls, while the heart showed changes in weight. Moreover, body temperatures remained stable throughout treatment, and glucose, pancreatic islet size, and liver histology appeared similar between the treated and control groups. Prolonged constant administration of GC-1 from the NMD proved to be a valid strategy to facilitate weight loss.
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Affiliation(s)
- Carly S Filgueira
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Andrea Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Eugenia Nicolov
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | | | - Priya Jain
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Zachary W Smith
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - April L Gilbert
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Alessandro Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.
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Ballerini A, S. Filgueira C, Nicolov E, Jain P, Bruno G, L. Hood R, Scaglione F, Grattoni A. Sustained Delivery of Tamoxifen from a Nanofluidic Delivery Platform. ACTA ACUST UNITED AC 2017. [DOI: 10.2174/2210303106666161129163850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Filgueira CS, Nicolov E, Hood RL, Ballerini A, Garcia-Huidobro J, Lin JZ, Fraga D, Webb P, Sabek OM, Gaber AO, Phillips KJ, Grattoni A. Sustained zero-order delivery of GC-1 from a nanochannel membrane device alleviates metabolic syndrome. Int J Obes (Lond) 2016; 40:1776-1783. [PMID: 27460601 DOI: 10.1038/ijo.2016.129] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 06/16/2016] [Accepted: 06/25/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Our objective was to assess the sustained, low-dose and constant administration of the thyroid receptor-β (TRβ)-selective agonist GC-1 (sobetirome) from a novel nanochannel membrane device (NMD) for drug delivery. As it known to speed up metabolism, accomplish weight loss, improve cholesterol levels and possess anti-diabetic effects, GC-1 was steadily administered by our NMD, consisting of an implantable nanochannel membrane, as an alternative to conventional daily administration, which is subject to compliance issues in clinical settings. SUBJECTS/METHODS Diet-induced obese C57BL/J6 male mice were fed a very high-fat diet (VHFD) and received NMD implants subcutaneously. Ten mice per group received capsules containing GC-1 or phosphate-buffered saline (control). Weight, lean and fat mass, as well as cholesterol, triglycerides, insulin and glucose, were monitored for 24 days. After treatment, plasma levels of thyroid-stimulating hormone (TSH) and thyroxine were compared. mRNA levels of a panel of thermogenic markers were examined using real-time PCR in white adipose tissue (WAT) and brown adipose tissue (BAT). Adipose tissue, liver and local inflammatory response to the implant were examined histologically. Pancreatic islet number and β-cell area were assessed. RESULTS GC-1 released from the NMD reversed VHFD-induced obesity and normalized serum cholesterol and glycemia. Significant reductions in body weight and fat mass were observed within 10 days, whereas reductions in serum cholesterol and glucose levels were seen within 7 days. The significant decrease in TSH was consistent with TRβ selectivity for GC-1. Levels of transcript for Ucp1 and thermogenic genes PGC1a, Cidea, Dio2 and Cox5a showed significant upregulation in WAT in NMD-GC-1-treated mice, but decreased in BAT. Although mice treated by NMD-GC-1 showed a similar number of pancreatic islets, they exhibited significant increase in β-cell area. CONCLUSIONS Our data demonstrate that the NMD implant achieves steady administration of GC-1, offering an effective and tightly controlled molecular delivery system for treatment of obesity and metabolic disease, thereby addressing compliance.
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Affiliation(s)
- C S Filgueira
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - E Nicolov
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - R L Hood
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
| | - A Ballerini
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - J Garcia-Huidobro
- Deparment of Human Genetics, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - J Z Lin
- Department of Biochemistry, Boston University School of Medicine, Boston, MA, USA
| | - D Fraga
- Department of Surgery, The Methodist Hospital, Houston, TX, USA
| | - P Webb
- Genomic Medicine Program, Houston Methodist Research Institute, Houston, TX, USA
| | - O M Sabek
- Department of Surgery, The Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - A O Gaber
- Department of Surgery, The Methodist Hospital, Houston, TX, USA.,Department of Surgery, Weill Cornell Medical College, New York, NY, USA
| | - K J Phillips
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, TX, USA
| | - A Grattoni
- Department of Nanomedicine, Houston Methodist Research Institute, Houston, TX, USA
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Pietrini F, Spadafora M, Tatini L, Talamba GA, Andrisano C, Boncompagni G, Manetti M, Ricca V, Ballerini A. LAI versus oral: A case-control study on subjective experience of antipsychotic maintenance treatment. Eur Psychiatry 2016; 37:35-42. [PMID: 27442981 DOI: 10.1016/j.eurpsy.2016.05.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/05/2016] [Accepted: 05/13/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To present real-world evidence on the differences between long-acting injectable (LAI) and oral antipsychotic maintenance treatment (AMT) in terms of subjective well-being, attitudes towards drug and quality of life in a sample of remitted schizophrenic subjects. METHODS Twenty outpatients with remitted schizophrenia treated with either olanzapine or paliperidone and switching from the oral to the LAI formulation of their maintenance treatment were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matching main sociodemographic, clinical and treatment variables made up the control group (oral-AMT group). All participants were assessed in terms of objective (PANSS, YMRS, MADRS) and subjective (SWN-K, DAI-10, SF-36) treatment outcomes at baseline (T0) and after 6 months (T1). RESULTS Between T0 and T1, general psychopathology of the PANSS, DAI-10, and all but one of the SWN-K dimensions (except for social integration), showed significantly higher percentages of improvement in the LAI-AMT group compared to the oral-AMT group. A generalized expansion of health-related quality of life, with better functioning in almost all areas of daily living, was reported by the LAI-AMT group after the 6-month period. In contrast, the oral-AMT group reported a significant worsening of health-related quality of life in the areas of emotional role and social functioning in the same period. CONCLUSIONS Our study indicates possible advantages of LAI over oral antipsychotic formulation in terms of subjective experience of maintenance treatment in remitted schizophrenic patients. Size and duration of this study need to be expanded in order to produce more solid and generalizable results.
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Affiliation(s)
- F Pietrini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy.
| | - M Spadafora
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - L Tatini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - G A Talamba
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - C Andrisano
- Department of biomedical and neuromotor sciences, university of Bologna, Bologna, Italy
| | - G Boncompagni
- Department of mental health and substance abuse, local health trust of Bologna, Bologna, Italy
| | - M Manetti
- Therapeutic psychiatric community, Campo del Vescovo Union, La Spezia, Italy
| | - V Ricca
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
| | - A Ballerini
- Psychiatric unit, department of neuroscience, psychology, drug research and child health, section of neuroscience, university of Florence, Via delle Gore 2H, 50134 Florence, Italy
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Filgueira CS, Nicolov E, Ballerini A, Hood RL, Jain P, Bruno G, Grattoni A. Abstract 1320: Local and sustained delivery of tamoxifen for the prevention of ER+ breast cancer using a nanochannel delivery platform. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1320] [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: 11/16/2022]
Abstract
Abstract
A high incidence (∼75%) of primary breast cancers are estrogen receptor positive (ER+), and a large fraction of these patients can pursue chemopreventive therapies. However, due to adverse side effects, only 5% to 20% of the women at high risk who could benefit from chemotherapeutics enroll in preventive treatment. There is a clear need for alternative preventive strategies that minimize side effects and improve enrollment and compliance. Selective estrogen receptor modulators, such as tamoxifen (TMX), have been shown to reduce ER+ breast cancer incidence by up to 50% among high-risk women. Importantly, along with raloxifene, it is one of only two FDA-approved drugs for breast cancer prevention. TMX has been in use for over 40 years and has a proven record in pre- and post-menopausal women. However, the drug is marred by side effects, the most common being symptoms of menopause. Further, women treated systemically and chronically with TMX were found to have an increased incidence of endometrial carcinoma. Although rare, this side effect, along with other serious adverse effects (such as blood clots, strokes, and cataracts), has resulted in a debate concerning TMX use in cancer prevention. As the key for breast cancer chemoprevention relies upon long-term delivery of drugs while circumventing side effects, we have developed a novel local delivery strategy for the constant and sustained administration of TMX. We maintain a long-term, local release of TMX in mammary tissues by utilizing a novel implantable nanochannel Delivery System (nDS). The nDS consists of a bioinert, implantable, and mechanically robust silicon membrane which houses an exact number of densely packed slit-nanochannels as small as 2.5 nm with tight tolerances on size, geometry, and surface properties. Providing steady levels of TMX at the mammary gland target through nDS delivery maximizes the therapeutic index while limiting the unwanted secondary effects, which will ultimately improve patient compliance. In this work we chemically induced tumorigenesis in Sprague-Dawley rats by N-methyl-N-nitrosourea (NMU) injection to promote development of estrogen-dependent tumors. We performed ovariectomies seven days after NMU injection to mimic post-menopausal biology. nDS implants loaded with either TMX or PEG400 (negative control) were inserted under the left abdominal mammary gland to determine effects of nDS-TMX on tumor growth and biomarkers. Utilizing LC/MS we were able to determine the amount of TMX released from the nDS. Rats were examined for palpable tumors to assess breast tumor incidence, latency to onset, and multiplicity. Our results show that the nDS implant enables the effective delivery of TMX in this breast tumor model. Further, this technology has the potential to rapidly provide long-term breast cancer protection with significant improvement in the quality of life of patients at high risk, thereby saving thousands of lives every year.
Citation Format: Carly S. Filgueira, Eugenia Nicolov, Andrea Ballerini, R. Lyle Hood, Priya Jain, Giacomo Bruno, Alessandro Grattoni. Local and sustained delivery of tamoxifen for the prevention of ER+ breast cancer using a nanochannel delivery platform. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1320.
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Affiliation(s)
| | | | | | - R. Lyle Hood
- Houston Methodist Research Institute, Houston, TX
| | - Priya Jain
- Houston Methodist Research Institute, Houston, TX
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Sabek OM, Farina M, Fraga DW, Afshar S, Ballerini A, Filgueira CS, Thekkedath UR, Grattoni A, Gaber AO. Three-dimensional printed polymeric system to encapsulate human mesenchymal stem cells differentiated into islet-like insulin-producing aggregates for diabetes treatment. J Tissue Eng 2016; 7:2041731416638198. [PMID: 27152147 PMCID: PMC4843232 DOI: 10.1177/2041731416638198] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Accepted: 02/18/2016] [Indexed: 01/19/2023] Open
Abstract
Diabetes is one of the most prevalent, costly, and debilitating diseases in the world. Pancreas and islet transplants have shown success in re-establishing glucose control and reversing diabetic complications. However, both are limited by donor availability, need for continuous immunosuppression, loss of transplanted tissue due to dispersion, and lack of vascularization. To overcome the limitations of poor islet availability, here, we investigate the potential of bone marrow–derived mesenchymal stem cells differentiated into islet-like insulin-producing aggregates. Islet-like insulin-producing aggregates, characterized by gene expression, are shown to be similar to pancreatic islets and display positive immunostaining for insulin and glucagon. To address the limits of current encapsulation systems, we developed a novel three-dimensional printed, scalable, and potentially refillable polymeric construct (nanogland) to support islet-like insulin-producing aggregates’ survival and function in the host body. In vitro studies showed that encapsulated islet-like insulin-producing aggregates maintained viability and function, producing steady levels of insulin for at least 4 weeks. Nanogland—islet-like insulin-producing aggregate technology here investigated as a proof of concept holds potential as an effective and innovative approach for diabetes cell therapy.
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Affiliation(s)
- Omaima M Sabek
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Marco Farina
- Department of Nanomedicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Electronics and Telecommunications, Politecnico di Torino, Torino, Italy
| | - Daniel W Fraga
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Solmaz Afshar
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
| | - Andrea Ballerini
- Department of Nanomedicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA; Department of Biotechnology and Translational Medicine, The University of Milan, Milan, Italy
| | - Carly S Filgueira
- Department of Nanomedicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Usha R Thekkedath
- Department of Nanomedicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - Alessandro Grattoni
- Department of Nanomedicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, TX, USA
| | - A Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA
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Moneglia M, Santangelo A, Ballerini A, Ricca V, Zignego A. New interferon-free therapies on HCV+ chronic hepatitis: Overcoming psychiatric side effects in a real world setting. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.1412] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IntroductionInterferon-alpha (IFNα) was the backbone therapy for HCV+ related chronic hepatitis (CH-C). However, it was associated with significant neuropsychiatric side effects and impaired health-related quality of life. Second Generation IFNα-free direct-acting antiviral agents (DAAs) seem to be associated with fewer side effects, better tolerability, high efficacy rates and better patient reported outcomes (PROs) [Younoussi, 2014].AimsTo describe the neuropsychiatric symptoms and PROs during Second Generation DAAs plus ribavirin oral treatment in a group of CH-C real world patients.MethodsNineteen CH-C outpatients, scheduled for IFNα-free treatment, were assessed at enrolment (T0), at 4 (T1) and at 12 (T2) weeks, the end of treatment, by means of MDRS, HAM-D, HAM-A, MRS, Y-BOCS and SF-36. A pharmacological therapy, based on clinical evidence, was provided at psychiatric symptoms onset.ResultsDuring the treatment, we didn’t report any worsening in the administred psychometric scales. Furthermore, we observed a general improvement at week 12 (T2), statistically significant only for MRS (P < 0.05). Any statistically significant difference was found for SF-36 mean scores comparing T0, T1 and T2. However, SF-36 cluster analysis showed between T0 and T2 a meaningful and significant rise of global health clusters “General health perceptions” (P < 0.05), “Change in overall health status” (P < 0.001) and a significant impairment in cluster “Emotional role functioning” (P < 0.05).ConclusionsOur real world data are consistent with trial setting results [Younoussi, 2014]. Contrary to previous IFNα-based therapy, new regimens don’t seem to be associated with psychiatric side effects and suggest an immediate gain in general health PROs over the treatment period.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Pietrini F, Spadafora M, Tatini L, Talamba G, Burchi E, Calderani E, Gemignani S, Mallardo L, Andrisano C, Boncompagni G, Manetti M, Ballerini A, Ricca V. LAI versus oral antipsychotic maintenance treatment of schizophrenia: A case-control study on subjective experience of treatment. Eur Psychiatry 2016. [DOI: 10.1016/j.eurpsy.2016.01.2165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
IntroductionLimited research has been devoted to the subjective impact of switching antipsychotic maintenance treatment (AMT) from oral to LAI formulation in schizophrenia.ObjectiveTo compare LAI AMT with oral AMT in terms of subjective experience of treatment, taking into account the effects on psychopathology.MethodsTwenty outpatients (7 males, mean age 40.55 ± 11.00 years) with remitted schizophrenia treated with either olanzapine or paliperidone and switching from oral to LAI AMT were recruited before the switch (LAI-AMT group). A group of 20 remitted schizophrenic subjects with oral AMT and matched for the main socio-demographic, clinical and treatment variables made up the controls (oral-AMT group). All participants were assessed by means of the PANSS and of the SWN-K at baseline (T0) and after 6 months (T1).ResultsBetween T0 and T1, general psychopathology of the PANSS and all but one of the SWN-K dimensions (except for “social integration”), showed significantly higher percent improvements in the LAI-AMT group compared to the oral-AMT group. After 6 months (T1), the LAI-AMT group showed significantly lower PANSS total and general psychopathology scores, as well as higher mean score of perceived “mental functioning” compared to the oral-AMT group. Item analysis of the general PANSS at T1 showed significant differences between the two groups in anxiety, tension, depression, guilt feelings, poor attention, and active social avoidance.ConclusionsOur data on switching from oral to LAI AMT in remitted schizophrenia suggest a better efficacy of the latter in terms of improvement of general psychopathology and subjective experience of treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.
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Light D, Griffin M, Srivastava K, Danelli P, Ballerini A, Leone N, Bondurri A, Khare R, Shabbir A, Wijerathne S, So JBY, Clara E, Tang SW, Tan WB, Hu J, Lomanto D, Ji Z, Li J, East B, Pazdirek F, Hoch J, Ji ZL, Malik D, Reddy P, Sahu D, Forgione U, Gianatiempo M, Xiong M, Chen B, Zhang JW, Li T, Luo XG, Li Q, Yu X, Zhao XD, Chen HY, Sun FX, Feng GZ, Zhang JP, Yu CZ, Aboulwafa A, Mahfouz A, Khairat M, Althani H, Albosoum E, Alebrahim H. Rare & Special Cases. Hernia 2015; 19 Suppl 1:S19-24. [PMID: 26518798 DOI: 10.1007/bf03355321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- D Light
- Royal Victoria Infimrary, Newcastle upon Tyne, UK
| | | | | | | | | | | | | | - R Khare
- Al Zahra Hospital, Dubai, United Arab Emirates
| | - A Shabbir
- National University Health System, Singapore, Singapore
| | - S Wijerathne
- National University Health System, Singapore, Singapore
| | - J B Y So
- National University Health System, Singapore, Singapore
| | - E Clara
- National University Health System, Singapore, Singapore
| | - S W Tang
- National University Health System, Singapore, Singapore
| | - W B Tan
- National University Health System, Singapore, Singapore
| | - J Hu
- National University Health System, Singapore, Singapore
| | - D Lomanto
- National University Health System, Singapore, Singapore
| | - Z Ji
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - J Li
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - B East
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - F Pazdirek
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - J Hoch
- Motol Faculty Hospital, Surgery Departmet of 2nd medical Faculty of Charles University, Prague, Czech Republic
| | - Z L Ji
- Department of General Surgery, Zhongda Hospital, Southeast University, Nanjing, China
| | - D Malik
- Metro MAS Heart Care & Multispecialty Hospital, Jaipur, India
| | - P Reddy
- Apollo Hospital, Chennai, India
| | | | - U Forgione
- Hospital General de Agudos Dr Teodoro Alvarez, Buenos Aires, Argentina
| | | | - M Xiong
- Department of General Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | | | | | | | | | | | | | - X D Zhao
- Department of Thoracic surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - H Y Chen
- Department of Anesthesiology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - F X Sun
- Department of Intensive Care Unit, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - G Z Feng
- Department of Respiratory, Second Affiliated Hospital of Nanjing Medical University, Nanjing, Nanjing, China
| | | | - C Z Yu
- Department of General Surgery, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China
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DeAsis F, Gitelis M, Chao S, Lapin B, Linn J, Denham W, Haggerty S, Carbray J, Ujiki M, Olory-Togbe JL, Gbessi DG, Dossou FM, Lawani I, Souaibou YI, Gnangnon I, Denakpo M, Soton RR, Djrouo G, Gogan P, Trukhalev W, Kukosh M, Panyushkin A, Safronova E, Jairam A, Kaufmann R, Jeekel J, Lange JF, Volmer U, Kersten CC, Arlt G, Skach J, Harcubova R, Petrakova V, Mandoboy JD, Ngom G, Faye AL, Ndour O, Sankale AA, Ndoye M, Daneiii P, Leone N, Ballerini A, Bondurri A, Cavallaro G, Silecchia G, Raparelli L, Greco F, Iorio O, Iossa A, De Angelis F, Rizzello M, Olmi S, Cesana G, Baldazzi G, Manoocheri F, Campanile FC, Munipalle P, Khan S, Gwiti P, Kanakala V, Viswanath Y, Kokotovic D, Sjølander H, Gögenur I, Helgstrand F, Devadhar S, Hounnou G, Elegbede OTA, Hadonou AA, Mensah ED, Agossou-Voyeme AK, Konate I, Toure AO, Cisse M, Zaki M, Diao ML, Tendeng JN, Toure FB, Toure CT, Subramanian V, Froghi F, de Carvalho FC, Salimin L, Drabble E. Humbilical & Epigastric Hernia. Hernia 2015; 19 Suppl 1:S35-42. [PMID: 26518843 DOI: 10.1007/bf03355324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- F DeAsis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Gitelis
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - S Chao
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - B Lapin
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - J Linn
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - W Denham
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - S Haggerty
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | - J Carbray
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA
| | - M Ujiki
- Department of Surgery, NorthShore University HealthSystem, Evanston, USA.,Department of Surgery, University of Chicago Pritzker School of Medicine, Chicago, USA
| | | | - D G Gbessi
- Faculté des sciences de la Santé, Foto, Benin
| | - F M Dossou
- Faculté des sciences de la Santé, Foto, Benin
| | - I Lawani
- Faculté des sciences de la Santé, Foto, Benin
| | | | - I Gnangnon
- Faculté des sciences de la Santé, Foto, Benin
| | - M Denakpo
- Faculté des sciences de la Santé, Foto, Benin
| | - R R Soton
- Faculté des sciences de la Santé, Foto, Benin
| | - G Djrouo
- Faculté des sciences de la Santé, Foto, Benin
| | - P Gogan
- Faculté des sciences de la Santé, Foto, Benin
| | - W Trukhalev
- State Medical Academy, Nizhnij Novgorod, Russia
| | - M Kukosh
- State Medical Academy, Nizhnij Novgorod, Russia
| | | | | | - A Jairam
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - R Kaufmann
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus Medical Centre, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus Medical Centre, Rotterdam, Netherlands
| | - U Volmer
- Department of Surgery, Park-Klinik Weissensee, Berlin, Germany
| | | | | | - J Skach
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - R Harcubova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - V Petrakova
- Hernia Center, Regional Hospital Liberec, Liberec, Czech Republic
| | - J Danga Mandoboy
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - G Ngom
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A L Faye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - O Ndour
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - A A Sankale
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | - M Ndoye
- Pediatric surgery service of Aristide Le Dantec Hospital, Dakar, Senegal
| | | | | | | | | | - G Cavallaro
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - G Silecchia
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - L Raparelli
- General Surgery Unit, GB Grassi Hospital, Rome, Italy
| | - F Greco
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - O Iorio
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - A Iossa
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - F De Angelis
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - M Rizzello
- Department of Medico - Surgical Sciences and Biotechnologies & Bariatric Center of Excellence, Sapienza University, Rome, Italy
| | - S Olmi
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Cesana
- General and Oncologic Surgery Unit, San Marco Hospital, Zingonia, BG, Italy
| | - G Baldazzi
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F Manoocheri
- General and Mini-invasive Surgery Unit, Abano Terme Hospital, Abano Terme, PD, Italy
| | - F C Campanile
- General Surgery Unit, Andosilla Hospital, Civita Castellana, VT, Italy
| | - P Munipalle
- James Cook University Hospital, Middlesbrough, UK
| | | | | | | | | | - D Kokotovic
- Dept. of Surgery, Køge Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - S Devadhar
- Department of Surgery, Pune India, Devadhar Nursing Home, Pune, India
| | - G Hounnou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - O T A Elegbede
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - A A Hadonou
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - E D Mensah
- CHD/B, Service de Chirurgie Générale, Parakou, Benin
| | - A K Agossou-Voyeme
- CNHU, Clinique Universitaire de Chirurgie Pédiatrique, 03 BP 386, Cotonou, Benin
| | - I Konate
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - A O Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Cisse
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M Zaki
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | - M L Diao
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - J N Tendeng
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - F B Toure
- Departement of Surgery, University Gaston Berger, Saint Louis, Senegal
| | - C T Toure
- Departement of Surgery, University Cheikh Anta Diop, Dakar, Senegal
| | | | - F Froghi
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | | | - L Salimin
- Plymouth Hospitals NHS Trust, Plymouth, UK
| | - E Drabble
- Plymouth Hospitals NHS Trust, Plymouth, UK
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