Lombardy diagnostic and therapeutic network of thrombotic microangiopathy

Background

Thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy (TMA) requiring urgent treatment. Standardization of its diagnosis and optimal management is challenging. This study aimed to evaluate the role of centralized, rapid testing of ADAMTS13 in patients experiencing acute TMAs requiring plasma-exchange (PEX) and to estimate the incidence of TTP in a large Italian Region.

Methods

We perfomed a cohort study in the frame of the project “Set-up of a Lombardy network for the study and treatment of patients undergoing apheresis”, including 11 transfusion centers in the Region. Consecutive patients referred from 2014 to 2016 with acute TMAs requiring PEX were enrolled. Centralized ADAMTS13 activity testing was performed at the Milan Hemophilia and Thrombosis Center within 24 h.

Results

Forty-three TMA patients (44 events) were enrolled, of whom 35 (81%) had severe ADAMTS13 deficiency. Patients with severe ADAMTS13 deficiency were younger, mainly women, with a higher prevalence of autoimmune disorders and a lower prevalence of cancer. Clinical and laboratory characteristics of patients with and without severe ADAMTS13 deficiency largely overlapped, with a lower platelet count being the only baseline marker that significantly differed between the two patient groups (ADAMTS13 activity < 10% vs ≥ 10%: median difference of -27 × 10⁹/l, 95% CI − 37 to − 3). PEX treatment was initiated in all patients, but soon discontinued in cases without severe ADAMTS13 deficiency. In this group, the mortality rate was higher and no episode exacerbations or relapses within 6 months occured. The estimated average annual incidence of acute acquired TTP events was 1.17 [0.78–1.55] per million people.

Conclusions

Severe ADAMTS13 deficiency distinguished two groups of patients with largely overlapping clinical features but different treatment and disease course. This study provides a feasible model implemented in a large Italian region for the practical clinical approach to TMAs and underlines the importance of urgent ADAMTS13 activity testing for an accurate differential diagnosis and therapeutic approach.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13023-022-02400-y.

Gut-derived bacterial toxins impair memory CD4+ T cell mitochondrial function in HIV-1 infection

People living with HIV (PLWH) who are immune nonresponders (INRs) are at greater risk of comorbidity and mortality than are immune responders (IRs) who restore their CD4+ T cell count after antiretroviral therapy (ART). INRs have low CD4+ T cell counts (<350 c/μL), heightened systemic inflammation, and increased CD4+ T cell cycling (Ki67+). Here, we report the findings that memory CD4+ T cells and plasma samples of INRs from several cohorts are enriched in gut-derived bacterial solutes p-cresol sulfate (PCS) and indoxyl sulfate (IS) that both negatively correlated with CD4+ T cell counts. In vitro PCS or IS blocked CD4+ T cell proliferation, induced apoptosis, and diminished the expression of mitochondrial proteins. Electron microscopy imaging revealed perturbations of mitochondrial networks similar to those found in INRs following incubation of healthy memory CD4+ T cells with PCS. Using bacterial 16S rDNA, INR stool samples were found enriched in proteolytic bacterial genera that metabolize tyrosine and phenylalanine to produce PCS. We propose that toxic solutes from the gut bacterial flora may impair CD4+ T cell recovery during ART and may contribute to CD4+ T cell lymphopenia characteristic of INRs.

Human β-Defensin-3 is Associated With Platelet-Derived Extracellular Vesicles and is a Potential Contributor to Endothelial Dysfunction

While platelets are the essential mediators of hemostasis, they are being increasingly recognized for their potential of contributing to host defenses. Here, using immunofluorescent microscopy, western blot, and ELISA, we found that human β-defensin 3 (hBD-3), an important antimicrobial peptide produced by epithelial cells, can be detected in human platelets and megakaryocytes. Flow cytometry and immuno-electron microscopy revealed hBD-3 on the surface of thrombin activated platelets. Moreover, hBD-3 was also found in platelet derived extracellular vesicles (p-EVs), isolated from platelet poor plasma and from platelet supernatants following thrombin stimulation. Incubation of platelets with hBD-3 peptide resulted in modest platelet activation and pre-incubation of platelets with synthetic hBD-3 prior to exposure to thrombin appeared to increase hBD-3 content in platelet lysates as well as in p-EVs, suggesting that hBD-3 can be initially taken up by platelets, perhaps via their open canalicular system. Interestingly, in vitro exposure of primary human endothelial cells to either hBD-3 peptide or purified p-EVs, caused significant endothelial dysfunction as documented by diminished levels of phosphorylated endothelial nitric oxide synthase (eNOS), Krüppel like factor-2 (KLF-2), and elevated relative expression of von Willebrand Factor (vWF). Pre-incubation of platelets with hBD-3 appeared to augment endothelial dysfunction caused by p-EVs. Overall, the current study provides evidence that hBD-3 enriched EVs can be released by activated platelets and may play a role in positive feedback of platelet activation as well as in endothelial dysfunction. Theoretically, these effects could contribute to both cellular recruitment to the endothelium creating a pro-thrombotic vascular microenvironment which serve as a bridge between innate immunity and hemostasis.

CD8+ CD73+ T cells in the tumor microenvironment of head and neck cancer patients are linked to diminished T cell infiltration and activation in tumor tissue

Recent studies have implicated a role for adenosine-dependent immunosuppression in head and neck tumor microenvironments. We describe expression of CD73, an enzyme critical to the generation of adenosine from extracellular AMP, in T cells and other cell types within human head and neck tumors. Flow cytometric analyses of tumor-infiltrating cells indicate that CD3⁺ cells are the predominant source of CD73 among immune infiltrating cells and that CD73 expression, especially among CD8⁺ T cells, is inversely related to indices of T cell infiltration and T cell activation in the microenvironment of head and neck tumors. We provide evidence that CD73 expression on peripheral T cells and levels of soluble CD73 in circulation are correlated with CD73 expression on CD8⁺ T cells in tumors. Moreover, fluorescent microscopy studies reveal that CD8⁺ CD73⁺ cells are observed in close proximity to tumor cells as well as in surrounding tissue. In vitro studies with peripheral blood T cells indicate that anti-CD3-stimulation causes loss of CD73 expression, especially among cells that undergo proliferation and that exogenous AMP can impair T cell proliferation, while sustaining CD73 expression. These data suggest that CD8⁺ CD73⁺ T cells may be especially important mediators of immunosuppression in human head and neck cancer.

Human immunoglobulin G responses to Cimex lectularius L. saliva

AIMS

To investigate the immunoglobulin (Ig) G response after being fed upon by Cimex lectularius L.

METHODS AND RESULTS

Participants were fed upon by three male C lectularius insects weekly for a month. Blood was obtained before the feeding and at the last feeding, which was used for immunoblots against bed bug salivary gland extract, with antihuman Immunoglobulin G (IgG) secondary antibodies. No consistent IgG changes developed in 11 humans serially fed upon by C lectularius. Two participants had new IgG responses to proteins at molecular weights of approximately 12-13 kDa, and one had an IgG response to a protein at approximately 40 kDa. At the last study visit, more intense IgG bands to proteins at molecular weights of 12-13 kDa had developed in 55% of participants (6/11) and at molecular weights of ≈30, ≈40 and ≈70 kDa in 45% (5/11) compared with the first study visit. Nitrophorin and apyrase were the most common C lectularius proteins identified with liquid chromatography-tandem mass spectrometry in both crushed bed bug salivary gland extract and post-bed bug feeding extract.

CONCLUSIONS

Human participants did not have consistent IgG responses to crushed C lectularius salivary gland extract.

Development of biocompatible and fully bioabsorbable PLA/Mg films for tissue regeneration applications

During recent years, Mg reinforced polylactic acid (PLA) composites have emerged as potential biocompatible and bioabsorbable materials for biomedical applications. It has been shown that Mg particles added to a matrix based on a biodegradable polymer can address the lack of bioactivity and the low mechanical properties of the polymers and, furthermore, it can counteract the detrimental effects associated to the high degradation rate of Mg, as alkalinization and elevated H₂ release. Additionally, the polymer can protect the Mg particles, by tailoring their degradation rate. Former processing of these composites performed by extrusion, compression and injection molding employed Mg contents up to 10 wt%. Higher amounts of Mg resulted in heterogeneous materials and thermally degraded matrices, with the corresponding higher degradation rate. In the present work, Mg reinforced PLA films with Mg content as high as 50 wt% were obtained without compromising the thermal stability of the polymer. Firstly, a successful dispersion of Mg microparticles was achieved by a breakthrough in processing introducing a colloidal step where organic additives were added to modify the Mg particle surface and promote a chemically stable suspension. The resulting colloidal suspension was then used as feedstock to obtain composite films by tape casting. The films show advantageous in vitro behaviour in terms of degradation, hydrogen release and oxygen permeability. In addition, the viability with fibroblast cells (MEF) opens a window of opportunity for these composite films as bioabsorbable material for tissue engineering and wound dressing applications. STATEMENT OF SIGNIFICANCE: Magnesium materials have extraordinary biodegradable properties and bioactive behavior due to release of Mg²⁺ ions, which offer a promising opportunity for their applicability as biomaterials for tissue regeneration. However, Mg is one of the most reactive metals with a high degradation rate. In contact with water produces H₂, associated with a risk of failure of the implant. One alternative to minimize this drawback is the use of Mg particles surrounded by a biodegradable biocompatible polymer such as polylactic acid (PLA) to obtain PLA/Mg composites. In this work we processed Mg reinforced PLA in the shape of films that would be suitable for tissue regeneration. In vitro behavior of PLA/Mg films demonstrated that Mg²⁺ ions increase the fibroblast cells growth.

Dermoscopic and reflectance confocal microscopy features of cutaneous squamous cell carcinoma

BACKGROUND

Squamous cell carcinoma (SCC) of the skin is a highly prevalent neoplasm. The management and the prognosis of this tumour are dependent on its invasiveness and its grade of differentiation.

OBJECTIVES

To evaluate whether specific dermoscopic and reflectance confocal microscopy (RCM) criteria can predict the diagnosis of invasive SCC vs. in situ SCC and poorly differentiated compared with well- and moderately differentiated SCC.

METHODS

Dermoscopic and RCM images of SCC were retrospectively evaluated for the presence of predefined criteria.

RESULTS

Among 143 SCCs, 121 cases had a complete set of images and thus were included in the study set. The head and neck area was the most frequently involved body site (74/121; 61.1%) followed by extremities (36/121, 29.7%) and trunk (11/121, 9.1%). Seventy tumours were in situ (57.8%), while 51 were invasive (42.1%), of these 11 were poorly differentiated (21.5%), 16 were moderately differentiated (31.3%), and 24 were well differentiated (47.0%). Chi-squared analysis demonstrated that invasive SCCs were characterized by polymorphic vessels, erosion/ulceration, architectural disarrangement, speckled nucleated cells in the dermis, irregularly dilated vessels and absence of hyperkeratosis. Buttonhole vessels, white structureless areas and dotted or glomerular vessels were significantly associated with in situ lesions. Poorly differentiated SCCs were typified by red areas, erosion/ulceration and architectural disarrangement. Well- or moderately differentiated SCCs were associated with white areas and speckled nucleated cells in the epidermis.

CONCLUSION

Clinical, dermoscopic and RCM images provide useful information that should be integrated in order to achieve the optimal therapeutic management for the patient.

Immunochip analysis identifies novel susceptibility loci in the human leukocyte antigen region for acquired thrombotic thrombocytopenic purpura

Essentials Genetic predisposition to acquired thrombotic thrombocytopenic purpura (aTTP) is mainly unknown. Genetic risk factors for aTTP were studied by Immunochip analysis and replication study. Human leukocyte antigen (HLA) variant rs6903608 conferred a 2.5-fold higher risk of developing aTTP. rs6903608 and HLA-DQB1*05:03 may explain most of the HLA association signal in aTTP. Click to hear Dr Cataland's presentation on acquired thrombotic thrombocytopenic purpura SUMMARY: Background Acquired thrombotic thrombocytopenic purpura (TTP) is a rare, life-threatening thrombotic microangiopathy associated with the development of autoantibodies against the von Willebrand factor-cleaving protease ADAMTS-13. Similarly to what has been found for other autoimmune disorders, there is evidence of a genetic contribution, including the association of the human leukocyte antigen (HLA) class II complex with disease risk. Objective To identify novel genetic risk factors in acquired TTP. Patients/Methods We undertook a case-control genetic association study in 190 European-origin TTP patients and 1255 Italian healthy controls by using the Illumina Immunochip. Replication analysis in 88 Italian cases and 456 controls was performed with single-nucleotide polymorphism (SNP) TaqMan assays. Results and conclusion We identified one common variant (rs6903608) located within the HLA class II locus that was independently associated with acquired TTP at genome-wide significance and conferred a 2.6-fold increased risk of developing a TTP episode (95% confidence interval [CI] 2.02-3.27, P = 1.64 × 10-14 ). We also found five non-HLA variants mapping to chromosomes 2, 6, 8 and X that were suggestively associated with the disease: rs9490550, rs115265285, rs5927472, rs7823314, and rs1334768 (nominal P-values ranging from 1.59 × 10-5 to 7.60 × 10-5 ). Replication analysis confirmed the association of HLA variant rs6903608 with acquired TTP (pooled P = 3.95 × 10-19 ). Imputation of classic HLA genes followed by stepwise conditional analysis revealed that the combination of rs6903608 and HLA-DQB1*05:03 may explain most of the HLA association signal in acquired TTP. Our results refined the association of the HLA class II locus with acquired TTP, confirming its importance in the etiology of this autoimmune disease.

Abstract P1-14-22: Neo-adjuvant chemotherapy for the treatment of breast cancer exterts a selection pressure toward luminal phenotype

The effect of anthracycline and taxane based chemotherapy on biological features of residual disease after neo-adjuvant therapies in breast cancer patients is poorly described.

PATIENTS AND METHODS: We collected information through the institutional clinical database on all consecutive breast cancer patients treated with neo-adjuvant chemotherapy at INT, Milan, Italy, between January 2010 and March 2015. We selected patients who did not achieve pathological complete response at final surgery. All patients had a pathological evaluation including the shrinking pattern (scattered or concentric); ER, PgR, HER2 and Ki-67 expression were evaluated both at diagnostic biopsy and at final surgery. McNemar's test was used to compare paired proportions.

RESULTS: We identified a total of 325 patients. Median age was 51 yrs (range: 23 - 85 yrs). 304 (93%) pts received anthracycline and taxane containing chemotherapy for a median number of 6 (range 2-18) cycles. Radical modified mastectomy was performed in 68% of cases. Scattered residual disease was diagnosed in 112 (34%) cases. HER2 over-expression in diagnostic biopsy was significantly associated to scattered response (OR 1.94, CI 1.13 – 3.36, p= 0.017). 11/220 pts (5%) with ER-positive diagnostic biopsy had ER-negative residual tumor; 9/54 pts (17%) with initial ER-negative tumors became ER-positive. 34/183 (19%) pts with initial positive PgR at diagnostic biopsy had PgR-negative residual tumor; whereas, 17/86 pts (20%) with negative PgR became positive. The HER2 expression changed from positive to negative in 9/49 (18%) cases and from negative to positive in 7/190 (4%) cases. The Ki-67 expression changed from &gt; or =20% to &lt;20% in 63/175 (36%) cases and vice-versa in 14/54 (26%) cases. Compared to diagnostic biopsy, the rate of PgR-positive tumors decreased from 68 to 62% (p= 0.024) and the rate of Ki67&lt;20% tumors increased from 24 to 45% (p=&lt;0.001) in surgical specimen. Subtype changes at surgery occurred in 37/245 (15%) of cases, i.e. none in triple negative, 8/20 (10%) in HER2 positive, and 29/202 (14%) in luminal tumors. 73% of cases that changed after treatment showed a trend towards luminal differentiation. There was no significant correlation between pre- and post-treatment biological characteristics and the type of tumor shrinkage.

CONCLUSION: Anthracycline and taxane-based neo-adjuvant chemotherapy induces loss of PgR and Ki-67 in breast cancer. These changes are independent of the pattern of tumor shrinkage. The subtype switching toward more luminal phenotype suggest an endocrine effect of chemotherapy and paves the way to possible combinatorial approach of chemo- and hormone-therapy.

Citation Format: Galli G, Porcu L, Baili P, Hade A, Di Salvo F, Bregni G, Agresti R, Gennaro M, De Santis MC, Ferrari B, de Braud F, Di Cosimo S. Neo-adjuvant chemotherapy for the treatment of breast cancer exterts a selection pressure toward luminal phenotype. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-22.

Thrombotic microangiopathy without renal involvement: two novel mutations in complement-regulator genes

ESSENTIALS: The differential diagnosis among thrombotic microangiopathies (TMAs) is challenging. We studied a case of TMA with neurologic symptoms, no renal impairment and normal ADAMTS-13 levels. Two novel mutations in complement factor I and thrombomodulin genes were identified. Complement-regulator genes can be involved in TMAs with normal ADAMTS-13 regardless of renal damage.

BACKGROUND

Thrombotic microangiopathies (TMAs) often represent a challenge for clinicians, because clinical, laboratory, and even genetic features are not always sufficient to distinguish among different TMAs.

OBJECTIVES

The aim of this study was to investigate the pathogenetic mechanisms underlying an acute case of TMA with features of both thrombotic thrombocytopenic purpura (TTP) and atypical hemolytic uremic syndrome (aHUS).

PATIENTS/METHODS

We report the case of a 49-year-old woman who developed an acute TMA with neurologic involvement and no renal impairment. ADAMTS-13, von Willebrand factor, and complement-system biochemical characterization was performed on acute phase samples. Exome sequencing and direct Sanger sequencing of previously aHUS-associated genes were performed. The functional consequences of the thrombomodulin (THBD) mutation were investigated by in vitro expression studies.

RESULTS

Despite a clinical diagnosis of TTP, the patient had normal ADAMTS-13 levels and increased VWF antigen levels with ultra-large von Willebrand factor multimers. C3, C4, and complement factors H and I (CFI) were normal. Molecular analysis confirmed two novel heterozygous mutations in CFI (c.805G>A, p.G269S) and THBD (c.1103C>T, p.P368L), and in vitro expression studies showed a reduction in the generation of activated thrombin-activatable fibrinolysis inhibitor (TAFIa) caused by mutated THBD. This proinflammatory condition, associated with the p.G269S mutation in CFI, probably leads to a complement-mediated endothelial activation, with a relevant prothrombotic potential in case of transient environmental triggers.

CONCLUSIONS

This study identified the first case of acute TMA without renal involvement but with neurological damage carrying two novel mutations in complement-regulator genes, highlighting the possible role of the complement system as a common pathogenetic mechanism in TMAs.

Influence of ultrasound on the instantaneous synthesis of tridimensional α-Ni(OH)2 nanostructures and derived NiO nanoparticles

Nickel hydroxides present an extraordinary importance in the development of electrochemical devices.

Dermoscopic difficult lesions: an objective evaluation of reflectance confocal microscopy impact for accurate diagnosis

BACKGROUND

Early detection of melanoma is the main objective to ensure a high survival rate. In some cases melanoma diagnosis still remain difficult and this leads to unnecessary excisions.

OBJECTIVE

The aim of this study was to detect the most relevant Reflectance confocal microscopy (RCM) features for the detection of dermoscopic difficult melanomas.

METHOD

A total of 322 lesions were selected from database and were evaluated on dermoscopy according to the 7-point checklist score, in blind from histological diagnosis. We classified the lesions into three categories: (i) 'featureless' lesions with score ranging between 0 and 2; (ii) 'positive-borderline' moles with score between 3 and 4 and (iii) 'positive-clear cut' lesions with score from 5 to 10. We evaluated confocal features of the 'featureless' lesions and of the 'positive-borderline' lesions. Evaluated confocal features were as follows: presence of pagetoid cells, cell shape (roundish or dendritic) and number (< 5 or >5 cells per mm(2) ), overall architecture (ringed, meshwork, clods and non-specific pattern); architectural disorder, presence of cytological atypia (>5 cells per mm(2) ) and cells arranged in nests.

RESULTS

Among 322 lesions 70 were melanomas and 252 were nevi. According to the classification based on the 7-point checklist score, 130 'featureless lesions' (score 0-2) including six melanomas, and 102 'positive-borderline' moles (score 3-4) including 17 melanomas, were identified. Round pagetoid cells >5 cells per mm(2) and/or architectural disorder on RCM were found in all of six melanomas with featureless dermoscopy. Round pagetoid infiltration and five or more atypical cells at the DEJ were found in 16 positive 'borderline melanomas'.

CONCLUSIONS

RCM represents a rapid non-invasive technique that can aid early diagnosis of dermoscopic difficult melanomas. Use of RCM on lesions with clinical and/or dermoscopic suspect of malignancy may reduce the number of unnecessary excision increasing the rate of accurate diagnoses.

First Report of Races 11 and 12 of Cercospora sojina, the Causal Agent of Soybean Frogeye Leaf Spot, in Argentina

During the growing seasons of 2008 to 2009 and 2009 to 2010, severe outbreaks of soybean (Glycine max (L.) Merr.) frogeye leaf spot, a disease caused by Cercospora sojina Hara, occurred in several areas in Argentina (1). Two surveys were conducted in soybean fields, one in 2008 that included the provinces of Buenos Aires, Córdoba, and Santa Fe, and another that was performed in 2009 in the same provinces plus three others: Entre Ríos, Santiago del Estero, and Tucumán. In both surveys, plants presented circular lesions with reddish brown-to-gray spots and bordered by typical, narrow, reddish purple margins (3). To promote sporulation and to enable identification of the causal agent, leaves of diseased plants were collected and placed in a moist chamber for 24 h with a 12-h light cycle at 25°C. Conidia were plated on potato dextrose agar medium amended with streptomycin and were incubated at 25°C and 12 h of fluorescent light. Isolated cultures sporulated in 10 days and, on the basis of their morphology, were identified as C. sojina. A total of 147 isolates were deposited at the Culture Collection of CEREMIC (Centro de Referencia de Micología). They produced one- to nine-septate hyaline, elongate to fusiform conidia that measured 54.9 ± 16.2 × 5.7 ± 1.0 μm. Six isolates of C. sojina, each representing a province, were inoculated on a set of 12 differential soybean cultivars: Lee, Davis, Hood, Richland, Lincoln, Kent, Tracy, S 100, Palmetto, Peking, CNS, and Blackhawk (2). Fifteen plants of each differential were sprayed at V3 growth stage with a suspension of 6 × 10⁴ conidia/ml. The test was conducted twice in a complete randomized design with three replicates. Control plants were sprayed with sterile distilled water. After inoculation, plants were placed in a greenhouse bench humidity chamber at 26 to 28°C for 72 h. Disease was rated 14 days after inoculation; plants with numerous lesions were considered susceptible and each of the 15 plants was given a score of 1. Plants with small or no lesions were classified as resistant and given a score of 0. Control plants remained healthy. The pathogen was reisolated from symptomatic plants and morphological characteristics were consistent with C. sojina. Based on the response of the differentials to each isolate and on the race designations, the isolates from Buenos Aires, Córdoba, Santa Fe, and Tucumán belong to race 11, while those from Santiago del Estero and Entre Ríos province to race 12. The finding of these two races threatening soybean cultivars in Argentina may be indicative of additional races. Thus, the incorporation of multiple resistance genes may reduce the impact of the disease on soybean. To our knowledge, this is the first report of the identification of races of C. sojina in Argentina. References: (1) M. A. Carmona et al. Plant Dis. 93:966, 2009. (2) M. A. R. Mian et al. Crop Sci. 48:14, 2008. (3) D.V. Phillips. Page 20 in: Compendium of Soybean Diseases. 4th ed. APS Press, St. Paul, MN, 1999.

Contribution of the central dopaminergic system in the anti-hypertensive effect of kinin B1 receptor antagonists in two rat models of hypertension

Kinins are neuroactive peptides that could play a role in central autonomic control of blood pressure. Whereas kinin B1R binding sites were increased in specific brain areas of spontaneously hypertensive rats (SHR) and Angiotensin II (AngII)-hypertensive rats, the contribution of kinin B1R in hypertension remains controversial. The aims of the study were to determine: (a) the effects on mean arterial blood pressure (MAP) of centrally and peripherally administered B1R antagonists in SHR (16weeks) and AngII-hypertensive rats (200ng/kg/minx2weeks, s.c.); (b) the contribution of central dopamine in the effects of SSR240612. The rationale is based on the overactivity of the dopaminergic system in hypertension. In both models, SSR240612 (1, 5 and 10mg/kg, gavage) reduced dose-dependently MAP (-75mm Hg at least up to 6-8h) and this therapeutic effect was resolved after 24h. At the dose of 5mg/kg, SSR240612-induced anti-hypertension was prevented by two dopamine receptor blockers, namely raclopride (0.16mg/kg, i.v.) and haloperidol (10mg/kg, s.c.). I.c.v. SSR240612 (1mug) decreased rapidly MAP in both models (1-6h) via a raclopride sensitive mechanism. In comparison, peripherally acting B1R antagonists (R-715 and R-954, 2mg/kg, s.c.) caused shorter and very modest decreases of MAP (from -20 to -30mm Hg). Centrally or peripherally administered B1R antagonists had no effect on MAP in control Wistar-Kyoto rats. Data provide the first pharmacological evidence that the up-regulated brain kinin B1R contributes through a central dopaminergic mechanism (DA-D2R) to the maintenance of arterial hypertension in genetic and experimental animal models of hypertension.

Depression, Cognitive Impairment, Somatic Complaints and Disability. Data from the “Faenza Community Aging Study”

Aim:

To evaluate the relationship between depression, somatic symptoms, cognitive impairment and disability in an elderly population.

Methods:

216 subjects (65-84 years) were clinically examined for somatic symptoms, and underwent a mental health examination. Depression was defined by Geriatric Depression Scale scores >11/30; cognitive impairment by Mini-Mental State Examination scores < 24/30; functional status by Instrumental Activities of Daily Living Scale. Associations between depression, cognitive impairment or somatic symptoms and disability were evaluated by logistic regression analyses, estimating Odds Ratios (ORs) and 95% confidence intervals (95%CI) adjusted by sex, age, education.

Results:

Disability was common among depressed individuals (OR(95%CI)=3.60(1.63-7.96)) and among cognitively impaired subjects (OR(95%CI)=7.35(3.07-17.60)). An increasing number of somatic complaints increased the probability of functional impairment: compared with presence of 1-2 somatic symptoms, complaint of 3-6 and 7-12 symptoms were related to disability with OR(95%CI)=3.30(1.11-9.80) and OR (95%CI)=4.20 (1.17-15.09) respectively. Distinguishing pain, gastrointestinal, pseudo-neurological and general symptoms, only general somatic symptoms (palpitations, fatigue, sleep disturbances) were associated with disability (OR(95%CI)=1.81(1.25-2.62), independently by medical conditions (OR(95%CI)=1.57(0.98-2.52)). An additive effect toward disability was observed when general somatic complaints and cognitive impairment were co-existing (OR(95%CI)=23.68(5.50-101.86)). Including simultaneously cognitive impairment, somatic complaints and depression in the model, only cognitive impairment was still significantly related (OR(95%CI)=5.87(2.66-12.96)).

Conclusions:

Among many possible causes of disability in the elderly, an important role could be attributed to cognitive deficits.

Suicidal Ideation in Italian Elderly. Preliminar data from the “Faenza Project”

Aims:

To evaluate prevalence rate of suicidal ideation among Italian elderly and to investigate possible socio-demographic and psychopathological features of suicide attempters in a population-based study.

Methods:

461 subjects (mean age 85 years; 52.9% women; 49.2% widow) were interviewed using the Revised Cambridge Examination for Mental Disorders in the Elderly. the presence of suicidal ideation was assessed by the Scale for Suicide Ideation. the association between suicidal ideation and its correlates was analysed by Logistic Regression Model estimating Odds Ratios and 95% Confidence Intervals (OR, 95%CI).

Results:

Eighteen (3,8%) persons refused to answer to questions concerning suicide thoughts. Only one participant declared to have attempted suicide (a 92 years-old men, widow, living on his own and complaining about depressive feelings). Overall suicidal ideation prevalence was 7.3%: wish to die (3.8%) and not worth living (13%). Gender, age, education, marital and socio-economic status were similar in subjects with and without suicidal ideation. Subjects with suicidal ideation had fewer family contacts, were less satisfied of their general health status and had a higher number of depressive and anxiety symptoms. However, when all these conditions were tested in the same model, only depressive symptoms were still significantly associated with suicidal ideation (OR, 95%CI=9.6, 3.3-27.9).

Conclusion:

The worldwide aging of the population deserves attention to psycho-geriatric medicine. Study on suicide in late-life are of interest to detect elderly at risk and to emphasize this increasing phenomenon.