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Parrella A, Iannuzzi A, Annunziata M, Covetti G, Cavallaro R, Aliberti E, Tortori E, Iannuzzo G. Haematological Drugs Affecting Lipid Metabolism and Vascular Health. Biomedicines 2022; 10:biomedicines10081935. [PMID: 36009482 PMCID: PMC9405726 DOI: 10.3390/biomedicines10081935] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023] Open
Abstract
Many drugs affect lipid metabolism and have side effects which promote atherosclerosis. The prevalence of cancer-therapy-related cardiovascular (CV) disease is increasing due to development of new drugs and improved survival of patients: cardio-oncology is a new field of interest and research. Moreover, drugs used in transplanted patients frequently have metabolic implications. Increasingly, internists, lipidologists, and angiologists are being consulted by haematologists for side effects on metabolism (especially lipid metabolism) and arterial circulation caused by drugs used in haematology. The purpose of this article is to review the main drugs used in haematology with side effects on lipid metabolism and atherosclerosis, detailing their mechanisms of action and suggesting the most effective therapies.
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Affiliation(s)
- Antonio Parrella
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy
| | | | - Giuseppe Covetti
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Raimondo Cavallaro
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy
| | - Emilio Aliberti
- North Tees University Hospital, Stockton-on-Tees TS19 8PE, UK
| | - Elena Tortori
- Pharmacy Unit, Ospedale del Mare, 80147 Naples, Italy
| | - Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
- Correspondence:
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Iannuzzi A, Annunziata M, Fortunato G, Giacobbe C, Palma D, Bresciani A, Aliberti E, Iannuzzo G. Case Report: Genetic Analysis of PEG-Asparaginase Induced Severe Hypertriglyceridemia in an Adult With Acute Lymphoblastic Leukaemia. Front Genet 2022; 13:832890. [PMID: 35237305 PMCID: PMC8882989 DOI: 10.3389/fgene.2022.832890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/21/2022] [Indexed: 01/19/2023] Open
Abstract
PEG-Asparaginase (also known as Pegaspargase), along with glucocorticoids (predominantly prednisolone or dexamethasone) and other chemotherapeutic agents (such as cyclophosphamide, idarubicin, vincristine, cytarabine, methotrexate and 6-mercaptopurine) is the current standard treatment for acute lymphoblastic leukaemia in both children and adults. High doses of PEG-asparaginase are associated with side effects such as hepatotoxicity, pancreatitis, venous thrombosis, hypersensitivity reactions against the drug and severe hypertriglyceridemia. We report a case of a 28-year-old male who was normolipidemic at baseline and developed severe hypertriglyceridemia (triglycerides of 1793 mg/dl) following treatment with PEG-asparaginase for acute lymphoblastic leukaemia. Thorough genetic analysis was conducted to assess whether genetic variants could suggest a predisposition to this drug-induced metabolic condition. This genetic analysis showed the presence of a rare heterozygous missense variant c.11G > A-p.(Arg4Gln) in the APOC3 gene, classified as a variant of uncertain significance, as well as its association with four common single nucleotide polymorphisms (SNPs; c.*40C > G in APOC3 and c.*158T > C; c.162-43G > A; c.-3A > G in APOA5) related to increased plasma triglyceride levels. To our knowledge this is the first case that a rare genetic variant associated to SNPs has been related to the onset of severe drug-induced hypertriglyceridemia.
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Iannuzzo G, Tripaldella M, Mallardo V, Morgillo M, Vitelli N, Iannuzzi A, Aliberti E, Giallauria F, Tramontano A, Carluccio R, Calcaterra I, Di Minno MND, Gentile M. Lipoprotein(a) Where Do We Stand? From the Physiopathology to Innovative Terapy. Biomedicines 2021; 9:838. [PMID: 34356902 PMCID: PMC8301358 DOI: 10.3390/biomedicines9070838] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 06/09/2021] [Revised: 07/02/2021] [Accepted: 07/09/2021] [Indexed: 12/24/2022] Open
Abstract
A number of epidemiologic studies have demonstrated a strong association between increasing lipoprotein a [Lp(a)] and cardiovascular disease. This correlation was demonstrated independent of other known cardiovascular (CV) risk factors. Screening for Lp(a) in the general population is not recommended, although Lp(a) levels are predominantly genetically determined so a single assessment is needed to identify patients at risk. In 2019 ESC/EAS guidelines recommend Lp(a) measurement at least once a lifetime, fo subjects at very high and high CV risk and those with a family history of premature cardiovascular disease, to reclassify patients with borderline risk. As concerning medications, statins play a key role in lipid lowering therapy, but present poor efficacy on Lp(a) levels. Actually, treatment options for elevated serum levels of Lp(a) are very limited. Apheresis is the most effective and well tolerated treatment in patients with high levels of Lp(a). However, promising new therapies, in particular antisense oligonucleotides have showed to be able to significantly reduce Lp(a) in phase II RCT. This review provides an overview of the biology and epidemiology of Lp(a), with a view to future therapies.
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Affiliation(s)
- Gabriella Iannuzzo
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Maria Tripaldella
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Vania Mallardo
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Mena Morgillo
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Nicoletta Vitelli
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy;
| | - Emilio Aliberti
- North Tees University Hospital Stockton-on-Tees, Stockton TS19 8PE, UK;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (A.T.); (R.C.)
| | - Anna Tramontano
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (A.T.); (R.C.)
| | - Raffaele Carluccio
- Department of Translational Medical Sciences, “Federico II” University of Naples, Via S. Pansini 5, 80131 Naples, Italy; (F.G.); (A.T.); (R.C.)
| | - Ilenia Calcaterra
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
| | - Marco Gentile
- Department of Clinical Medicine and Surgery, “Federico II” University, 80131 Naples, Italy; (M.T.); (V.M.); (M.M.); (N.V.); (I.C.); (M.N.D.D.M.); (M.G.)
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Iannuzzi A, Rubba P, Gentile M, Mallardo V, Calcaterra I, Bresciani A, Covetti G, Cuomo G, Merone P, Di Lorenzo A, Alfieri R, Aliberti E, Giallauria F, Di Minno MND, Iannuzzo G. Carotid Atherosclerosis, Ultrasound and Lipoproteins. Biomedicines 2021; 9:biomedicines9050521. [PMID: 34066616 PMCID: PMC8148516 DOI: 10.3390/biomedicines9050521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022] Open
Abstract
Carotid artery plaques are considered a measure of atherosclerosis and are associated with an increased risk of atherosclerotic cardiovascular disease, particularly ischemic strokes. Monitoring of patients with an elevated risk of stroke is critical in developing better prevention strategies. Non-invasive imaging allows us to directly see atherosclerosis in vessels and many features that are related to plaque vulnerability. A large body of evidence has demonstrated a strong correlation between some lipid parameters and carotid atherosclerosis. In this article, we review the relationship between lipids and atherosclerosis with a focus on carotid ultrasound, the most common method to estimate atherosclerotic load.
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Affiliation(s)
- Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
- Correspondence:
| | - Paolo Rubba
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Marco Gentile
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Vania Mallardo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Ilenia Calcaterra
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Alessandro Bresciani
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Giuseppe Covetti
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Pasquale Merone
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Roberta Alfieri
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Emilio Aliberti
- North Tees University Hospital, Stockton-on Tees TS19 8PE, UK;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
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Aiezza M, Bresciani A, Guglielmi G, Massa M, Tortori E, Marfella R, Aliberti E, Iannuzzi A. Medication review versus usual care to improve drug therapies in hospitalised older patients admitted to internal medicine wards. Eur J Hosp Pharm 2020. [DOI: 10.1136/ejhpharm-2019-002072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Chiariello G, Cavallaro R, Covetti G, Pisano MCA, Schettini A, D'Aniello T, Nappo R, Aliberti E, Iannuzzi A. An interesting case of atypical venous thrombosis with low red blood cells. Ital J Med 2019. [DOI: 10.4081/itjm.2019.1212] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sex: F Age: 65 years. Recent abdominal colic. Petechial-like manifestations with painful discolored skin lesions (suggestive of dermal veins thromboses) on the chest and abdomen. Blood levels of glucose, electrolytes, amylase, lipase, total protein, renal-function tests, the prothrombin time, the international normalized ratio, the partial-thromboplastin time and albumin were normal. Laboratory testing revealed hemolytic anemia: red cells 2.94×106/UL; hemoglobin 8.9 g/dL; lactate dehydrogenase 950 IU/L. Computed tomography of the abdomen and pelvis performed after the administration of intravenous contrast material, revealed a central filling defect in the hepatic veins and their branches that was compatible with acute thrombosis of the hepatic veins and their branches. It was suspected paroxysmal nocturnal hemoglobinuria for which flow cytometric analysis was requested.
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Abstract
OBJECTIVE To determine the validity of the Pra instrument in predicting the use of health-related services by older enrollees in a managed care plan. DESIGN Cohort study. At baseline, a survey was administered by mail. Responses were entered into the Pra formula to estimate each person's probability of using health-related services heavily in the future. The subjects' use of services during the following year was monitored through claims submitted to their managed care organization. SETTING Urban and suburban areas of Southern California. PARTICIPANTS Persons aged 65 years and older enrolled in a Medicare risk health plan (n = 6802). MEASUREMENTS Baseline data included demographic, health-related, social, functional, and previous-use-of-service characteristics. Follow-up data included the use of and claims for payment for inpatient hospital care, emergency room services, nursing home services, home care, ambulance services, outpatient surgery, and durable medical equipment. RESULTS High-risk subjects (highest quartile of Pra values) incurred hospital admissions and claims that were 2.5 and 2.7 times greater than those of low-risk subjects (lower three quartiles). CONCLUSIONS The Pra formula is recommended for screening older adults enrolled in managed care organizations (as well as for screening those in the fee-for-service environment). It identifies older people who may benefit from interventions designed to avert health crises and the need for expensive care.
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Affiliation(s)
- J T Pacala
- Department of Family Practice and Community Health, University of Minnesota, Minneapolis 55414-3034, USA
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