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Marfella R, D'Onofrio N, Sardu C, Scisciola L, Maggi P, Coppola N, Romano C, Messina V, Turriziani F, Siniscalchi M, Maniscalco M, Boccalatte M, Napolitano G, Salemme L, Marfella LV, Basile E, Montemurro MV, Papa C, Frascaria F, Papa A, Russo F, Tirino V, Papaccio G, Galdiero M, Sasso FC, Barbieri M, Rizzo MR, Balestrieri ML, Angelillo IF, Napoli C, Paolisso G. Does poor glycaemic control affect the immunogenicity of the COVID-19 vaccination in patients with type 2 diabetes: The CAVEAT study. Diabetes Obes Metab 2022; 24:160-165. [PMID: 34494705 PMCID: PMC8653151 DOI: 10.1111/dom.14547] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/06/2021] [Accepted: 09/06/2021] [Indexed: 12/30/2022]
Affiliation(s)
- Raffaele Marfella
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
- Mediterranea CardiocentroNaples
| | - Nunzia D'Onofrio
- Department of Precision MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Celestino Sardu
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Paolo Maggi
- Department of Infectious DiseasesSant'Anna HospitalCasertaItaly
| | - Nicola Coppola
- Department of Mental and Physical Health and Preventive MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Ciro Romano
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | | | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Mario Siniscalchi
- Rehabilitation Cardiology UnitAORN “A. Cardarelli ”of NaplesNaplesItaly
| | - Mauro Maniscalco
- Rehabilitation Pneumology UnitICS Maugeri‐IRCCS of TeleseTelese TermeItaly
| | - Marco Boccalatte
- Cardiology‐UTIC‐Hemodynamic Unit“S.M. delle Grazie” Pozzuoli, ASL Napoli 2 NordPozzuoliItaly
| | - Giovanni Napolitano
- Cardiology‐UTIC Unit“San Giuliano” Hospital of Giugliano in Campania, ASL Napoli2 NordGiugliano in CampaniaItaly
| | - Luigi Salemme
- Hemodynamics Laboratory Unit“Montevergine” Clinic of Mercogliano (AV)MercoglianoItaly
| | | | | | | | | | | | | | | | - Virginia Tirino
- Department of Experimental MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Gianpaolo Papaccio
- Department of Experimental MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Marilena Galdiero
- Department of Experimental MedicineUniversity of Campania “Luigi Vanvitelli”NaplesItaly
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | | | | | - Claudio Napoli
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical SciencesUniversity of Campania “Luigi Vanvitelli”Naples
- Mediterranea CardiocentroNaples
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2
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Sardu C, Massetti M, Testa N, Martino LD, Castellano G, Turriziani F, Sasso FC, Torella M, De Feo M, Santulli G, Paolisso G, Marfella R. Effects of Sodium-Glucose Transporter 2 Inhibitors (SGLT2-I) in Patients With Ischemic Heart Disease (IHD) Treated by Coronary Artery Bypass Grafting via MiECC: Inflammatory Burden, and Clinical Outcomes at 5 Years of Follow-Up. Front Pharmacol 2021; 12:777083. [PMID: 34867407 PMCID: PMC8634684 DOI: 10.3389/fphar.2021.777083] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 09/14/2021] [Accepted: 10/22/2021] [Indexed: 02/03/2023] Open
Abstract
Introduction: Minimally invasive extracorporeal circulation (MiECC) reduced inflammatory burden, leading to best clinical outcomes in patients treated with coronary artery bypass grafting (CABG). Despite this, the patients with type 2 diabetes mellitus (T2DM) vs those without T2DM (non-T2DM) have a worse prognosis, caused by over-inflammation and modulated by sodium-glucose transporter 2 receptors. However, we evaluated the inflammatory burden and clinical outcomes in non-T2DM vs T2DM patients under sodium-glucose transporter 2 inhibitors (SGLT2-I users) vs non-SGLT2-I users at 5 years of follow-up post-CABG via MiECC. Materials and methods: In a multicenter study, we screened consecutive patients with indications to receive CABG. The study endpoints were the inflammatory burden (circulating serum levels of tumor necrosis factor-alpha (TNF-α), interleukin 1 and 6 (IL-1 and IL-6), C-reactive protein (CRP), and leucocytes count) and the clinical outcomes at follow-up of 5 years in non-T2DM vs SGLT2-I users, in non-T2DM vs non-SGLT2-I users, and SGLT2-I users vs non-SGLT2-I users. Results: At baseline, and at one year and 5 years of follow-up, the non-T2DM vs SGLT2-I users, non-T2DM vs non-SGLT2-I users, and SGLT2-I users vs non-SGLT2-I users had the lowest values of IL-1, IL-6, and TNF-α (p < 0.05). At one year of follow-up, SGLT2-I users vs non-T2DM and non-SGLT2-I users vs non-T2DM users had a higher rate of all deaths, cardiac deaths, re-myocardial infarction, repeat revascularization, and stroke, and of the composite endpoint (p < 0.05). In a multivariate Cox regression analysis, the composite endpoint was predicted by IL-1 [2.068 (1.367-3.129)], TNF-α [1.989 (1.081-2.998)], and SGLT2-I [0.504 (0.078-0.861)]. Conclusion: In T2DM patients, the SGLT2-I significantly reduced the inflammatory burden and ameliorated clinical outcomes at 5 years of follow-up post-CABG via MiECC.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Department of Cardiovascular and Arrhythmias, Campobasso, Italy
| | - Massimo Massetti
- Department of Cardiovascular and Arrhythmias, Campobasso, Italy.,Department of Cardio-thoracic Surgery, Catholic University of Sacred Heart, Rome, Italy
| | - Nicola Testa
- Department of Cardiovascular and Arrhythmias, Campobasso, Italy
| | | | | | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Michele Torella
- Department of Cardiothoracic Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marisa De Feo
- Department of Cardiothoracic Surgery, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Gaetano Santulli
- Department of Advanced Biomedical Sciences, International Translational Research and Medical Education Academic Research Unit (ITME), Federico II University, Naples, Italy.,Department of Medicine, Division of Cardiology, Albert Einstein College of Medicine, Wilf Family Cardiovascular Research Institute, New York, NY, United States.,Department of Molecular Pharmacology, Fleischer Institute for Diabetes and Metabolism (FIDAM), Montefiore University Hospital, New York, NY, United States
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania Luigi Vanvitelli, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
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3
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D'Onofrio N, Sardu C, Trotta MC, Scisciola L, Turriziani F, Ferraraccio F, Panarese I, Petrella L, Fanelli M, Modugno P, Massetti M, Marfella LV, Sasso FC, Rizzo MR, Barbieri M, Furbatto F, Minicucci F, Mauro C, Federici M, Balestrieri ML, Paolisso G, Marfella R. Sodium-glucose co-transporter2 expression and inflammatory activity in diabetic atherosclerotic plaques: Effects of sodium-glucose co-transporter2 inhibitor treatment. Mol Metab 2021; 54:101337. [PMID: 34500107 PMCID: PMC8473552 DOI: 10.1016/j.molmet.2021.101337] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [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: 05/31/2021] [Revised: 08/25/2021] [Accepted: 09/02/2021] [Indexed: 12/19/2022] Open
Abstract
Objective We evaluated sodium-glucose co-transporter2 (SGLT2) expression and the effect of SGLT2 inhibitor (SGLT2i) therapies on carotid plaques of asymptomatic diabetic and non-diabetic patients. Methods Plaques were obtained from 296 non-diabetic patients and 227 patients with type 2 diabetes undergoing carotid endarterectomy. 97 patients with type 2 diabetes were treated with SGLT2 inhibitors for 16 ± 4 months before endarterectomy. After propensity score matching analysis, patients with type 2 diabetes were categorized without (n = 87) and with SGLT2i therapy (n = 87). To investigate SGLT2 expression levels' effects on major adverse endpoints (MACE = stroke, transient ischemic attack, myocardial infarction, and death), we evaluated MACE outcomes at a 2-year follow-up. Results Compared to plaques from patients without diabetes, plaques from patients with diabetes had higher SGLT2 expression, inflammation, and oxidative stress, along with lower SIRT6 expression and collagen content. Compared with plaques from patients with diabetes, SGLT2i-treated patients with type 2 diabetes presented increased SIRT6 expression and collagen content and lowered inflammation and ion and oxidative stress, thus indicating a more stable plaque phenotype. These results supported in vitro observations on human aorta endothelial cells (EC) (TeloHAEC-cells). Indeed, EC treated with high glucose (25 mM) in the presence of SGLT2i (100 nM canagliflozin) presented higher SIRT6 expression and decreased mRNA and protein SGLT2 levels, nuclear factor-kappa B (NF-B(NF-κB), and matrix metallopeptidase 9 (MMP-9) expression compared to cells treated only with high glucose. After two years following endarterectomy, a multivariable Cox regression analysis showed significantly higher 2-year overall survival from MACE in patients without diabetes (P < 0.01). Among patient with diabetes, the current SGLT2i users presented a significantly lower rate of MACE through 2 years compared to non-SGLT2i users (P < 0.05). Conclusions These findings unveil a critical involvement of the SGLT2/SIRT6 pathway in the inflammatory process of diabetic atherosclerotic lesions and suggest its possible favorable modulation by SGLT2i. The identification of novel molecular targets of atherosclerosis progression is of utmost importance in diabetic patients. The occurrence of SGLT2 receptors on the endothelial cells of atherosclerotic plaques may be an attractive therapeutic option for atherosclerosis in patients with diabetes. SGLT2/SIRT6 represents an attractive option, given its crucial involvement in atherosclerosis progression. The endothelial SGLT2 inhibition increases the endothelial expression of SIRT6, yielding an improved atherosclerotic plaque phenotype and 2-year outcome. The impairment of the endothelial SGLT2/SIRT6 pathway worsens outcomes in atherosclerotic patients with diabetes; this may be a potential preventive target.
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Affiliation(s)
- Nunzia D'Onofrio
- Department of Precision Medicine, the University of Campania "Luigi Vanvitelli,", Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, Section of Pharmacology, University of Campania "Luigi Vanvitelli,", Italy
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Franca Ferraraccio
- Department of Mental Health and Public Medicine, Section of Statistic, the University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Iacopo Panarese
- Department of Mental Health and Public Medicine, Section of Statistic, the University of Campania "Luigi Vanvitelli,", Naples, Italy
| | - Lella Petrella
- Laboratory of Molecular Oncology, Gemelli Molise SpA, Campobasso, Italy
| | - Mara Fanelli
- Department of Cardiovascular Medicine, Gemelli Molise SpA, Campobasso, Italy
| | - Piero Modugno
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Massimo Massetti
- Department of Cardiovascular Medicine, Gemelli Molise SpA, Campobasso, Italy
| | | | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy
| | - Fulvio Furbatto
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Fabio Minicucci
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Massimo Federici
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | | | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy; Mediterranea Cardiocentro, Naples, Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli,", Italy; Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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4
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Marfella R, Paolisso P, Sardu C, Palomba L, D'Onofrio N, Cesaro A, Barbieri M, Rizzo MR, Sasso FC, Scisciola L, Turriziani F, Galdiero M, Pignataro D, Minicucci F, Trotta MC, D'Amico M, Mauro C, Calabrò P, Balestrieri ML, Signioriello G, Barbato E, Galdiero M, Paolisso G. SARS-COV-2 colonizes coronary thrombus and impairs heart microcirculation bed in asymptomatic SARS-CoV-2 positive subjects with acute myocardial infarction. Crit Care 2021; 25:217. [PMID: 34167575 PMCID: PMC8222703 DOI: 10.1186/s13054-021-03643-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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] [Received: 04/21/2021] [Accepted: 06/14/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The viral load of asymptomatic SAR-COV-2 positive (ASAP) persons has been equal to that of symptomatic patients. On the other hand, there are no reports of ST-elevation myocardial infarction (STEMI) outcomes in ASAP patients. Therefore, we evaluated thrombus burden and thrombus viral load and their impact on microvascular bed perfusion in the infarct area (myocardial blush grade, MBG) in ASAP compared to SARS-COV-2 negative (SANE) STEMI patients. METHODS This was an observational study of 46 ASAP, and 130 SANE patients admitted with confirmed STEMI treated with primary percutaneous coronary intervention and thrombus aspiration. The primary endpoints were thrombus dimension + thrombus viral load effects on MBG after PPCI. The secondary endpoints during hospitalization were major adverse cardiovascular events (MACEs). MACEs are defined as a composite of cardiovascular death, nonfatal acute AMI, and heart failure during hospitalization. RESULTS In the study population, ASAP vs. SANE showed a significant greater use of GP IIb/IIIa inhibitors and of heparin (p < 0.05), and a higher thrombus grade 5 and thrombus dimensions (p < 0.05). Interestingly, ASAP vs. SANE patients had lower MBG and left ventricular function (p < 0.001), and 39 (84.9%) of ASAP patients had thrombus specimens positive for SARS-COV-2. After PPCI, a MBG 2-3 was present in only 26.1% of ASAP vs. 97.7% of SANE STEMI patients (p < 0.001). Notably, death and nonfatal AMI were higher in ASAP vs. SANE patients (p < 0.05). Finally, in ASAP STEMI patients the thrombus viral load was a significant determinant of thrombus dimension independently of risk factors (p < 0.005). Thus, multiple logistic regression analyses evidenced that thrombus SARS-CoV-2 infection and dimension were significant predictors of poorer MBG in STEMI patients. Intriguingly, in ASAP patients the female vs. male had higher thrombus viral load (15.53 ± 4.5 vs. 30.25 ± 5.51 CT; p < 0.001), and thrombus dimension (4.62 ± 0.44 vs 4.00 ± 1.28 mm2; p < 0.001). ASAP vs. SANE patients had a significantly lower in-hospital survival for MACE following PPCI (p < 0.001). CONCLUSIONS In ASAP patients presenting with STEMI, there is strong evidence towards higher thrombus viral load, dimension, and poorer MBG. These data support the need to reconsider ASAP status as a risk factor that may worsen STEMI outcomes.
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Affiliation(s)
- Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy.
- Mediterranea Cardiocentro, Naples, Italy.
| | - Pasquale Paolisso
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Cardiovascular Center Aalst, Aalst, Belgium
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Luciana Palomba
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Nunzia D'Onofrio
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - Arturo Cesaro
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Danilo Pignataro
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Fabio Minicucci
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michele D'Amico
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Luisa Balestrieri
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - Giuseppe Signioriello
- Department of Mental Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Emanuele Barbato
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
- Cardiovascular Center Aalst, Aalst, Belgium
| | - Marilena Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Naples, Piazza Miraglia, 2, 80138, Naples, Italy
- Mediterranea Cardiocentro, Naples, Italy
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5
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D'Onofrio N, Scisciola L, Sardu C, Trotta MC, De Feo M, Maiello C, Mascolo P, De Micco F, Turriziani F, Municinò E, Monetti P, Lombardi A, Napolitano MG, Marino FZ, Ronchi A, Grimaldi V, Hermenean A, Rizzo MR, Barbieri M, Franco R, Campobasso CP, Napoli C, Municinò M, Paolisso G, Balestrieri ML, Marfella R. Glycated ACE2 receptor in diabetes: open door for SARS-COV-2 entry in cardiomyocyte. Cardiovasc Diabetol 2021; 20:99. [PMID: 33962629 PMCID: PMC8104461 DOI: 10.1186/s12933-021-01286-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [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: 03/19/2021] [Accepted: 04/23/2021] [Indexed: 02/06/2023] Open
Abstract
Rationale About 50% of hospitalized coronavirus disease 2019 (COVID-19) patients with diabetes mellitus (DM) developed myocardial damage. The mechanisms of direct SARS-CoV-2 cardiomyocyte infection include viral invasion via ACE2-Spike glycoprotein-binding. In DM patients, the impact of glycation of ACE2 on cardiomyocyte invasion by SARS-CoV-2 can be of high importance. Objective To evaluate the presence of SARS-CoV-2 in cardiomyocytes from heart autopsy of DM cases compared to Non-DM; to investigate the role of DM in SARS-COV-2 entry in cardiomyocytes. Methods and results We evaluated consecutive autopsy cases, deceased for COVID-19, from Italy between Apr 30, 2020 and Jan 18, 2021. We evaluated SARS-CoV-2 in cardiomyocytes, expression of ACE2 (total and glycosylated form), and transmembrane protease serine protease-2 (TMPRSS2) protein. In order to study the role of diabetes on cardiomyocyte alterations, independently of COVID-19, we investigated ACE2, glycosylated ACE2, and TMPRSS2 proteins in cardiomyocytes from DM and Non-DM explanted-hearts. Finally, to investigate the effects of DM on ACE2 protein modification, an in vitro glycation study of recombinant human ACE2 (hACE2) was performed to evaluate the effects on binding to SARS-CoV-2 Spike protein. The authors included cardiac tissue from 97 autopsies. DM was diagnosed in 37 patients (38%). Fourth-seven out of 97 autopsies (48%) had SARS-CoV-2 RNA in cardiomyocytes. Thirty out of 37 DM autopsy cases (81%) and 17 out of 60 Non-DM autopsy cases (28%) had SARS-CoV-2 RNA in cardiomyocytes. Total ACE2, glycosylated ACE2, and TMPRSS2 protein expressions were higher in cardiomyocytes from autopsied and explanted hearts of DM than Non-DM. In vitro exposure of monomeric hACE2 to 120 mM glucose for 12 days led to non-enzymatic glycation of four lysine residues in the neck domain affecting the protein oligomerization. Conclusions The upregulation of ACE2 expression (total and glycosylated forms) in DM cardiomyocytes, along with non-enzymatic glycation, could increase the susceptibility to COVID-19 infection in DM patients by favouring the cellular entry of SARS-CoV2. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01286-7.
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Affiliation(s)
- Nunzia D'Onofrio
- Department of Precision Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marisa De Feo
- Department of Cardio-Thoracic Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ciro Maiello
- Unit of Cardiac Surgery and Transplants, AORN Ospedali dei Colli-Monaldi Hospital, 80131, Naples, Italy
| | - Pasquale Mascolo
- Department of Experimental Medicine Forensic Pathology Service, University of Campania L. Vanvitelli, Naples, Italy
| | - Francesco De Micco
- Department of Experimental Medicine Forensic Pathology Service, University of Campania L. Vanvitelli, Naples, Italy
| | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Emilia Municinò
- Department of Forensic, Evaluative and Necroscopic Medicine, ASL Napoli 2 NORD, Naples, Italy
| | - Pasquale Monetti
- Department of Forensic, Evaluative and Necroscopic Medicine, ASL Napoli 2 NORD, Naples, Italy
| | - Antonio Lombardi
- Department of Forensic, Evaluative and Necroscopic Medicine, ASL Napoli 2 NORD, Naples, Italy
| | | | - Federica Zito Marino
- Department of Mental and Physical Health and Preventive Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Andrea Ronchi
- Department of Mental and Physical Health and Preventive Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Vincenzo Grimaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Anca Hermenean
- Institute of Life Science, Vasile Goldis Western University, Arad, Romania
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Renato Franco
- Department of Mental and Physical Health and Preventive Medicine, University of Campania L. Vanvitelli, Naples, Italy
| | - Carlo Pietro Campobasso
- Department of Experimental Medicine Forensic Pathology Service, University of Campania L. Vanvitelli, Naples, Italy
| | - Claudio Napoli
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy
| | - Maurizio Municinò
- Department of Forensic, Evaluative and Necroscopic Medicine, ASL Napoli 2 NORD, Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | | | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania L. Vanvitelli, Piazza Miraglia, 2, 80138, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
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Sardu C, Consiglia Trotta M, Santella B, D'Onofrio N, Barbieri M, Rizzo MR, Sasso FC, Scisciola L, Turriziani F, Torella M, Portoghese M, Loreni F, Mureddu S, Lepore MA, Galdiero M, Franci G, Folliero V, Petrillo A, Boatti L, Minicucci F, Mauro C, Calabrò P, Feo MD, Balestrieri ML, Ercolini D, D'Amico M, Paolisso G, Galdiero M, Marfella R. Microbiota thrombus colonization may influence athero-thrombosis in hyperglycemic patients with ST segment elevation myocardialinfarction (STEMI). Marianella study. Diabetes Res Clin Pract 2021; 173:108670. [PMID: 33453294 DOI: 10.1016/j.diabres.2021.108670] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/30/2020] [Accepted: 01/08/2021] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We examined the association of the coronary thrombus microbiota and relative metabolites with major adverse cardiovascular events (MACE) in hyperglycemic patients with ST segment elevation myocardial infarction (STEMI). BACKGROUND Hyperglycemia during STEMI may affect both development and progression of coronary thrombus via gut and thrombus microbiota modifications. METHODS We undertook an observational cohort study of 146 first STEMI patients treated with primary percutaneous coronary intervention (PPCI) and thrombus-aspiration (TA). Patients were clustered, based on admission blood glucose levels, in hyperglycemic (≥140 mg/dl) and normoglycemic (<140 mg/dl). We analyzed gut and thrombus microbiota in all patients. Moreover, we assessed TMAO, CD40L and von Willebrand Factor (vWF) in coronary thrombi. Cox regressions were used for the association between Prevotellaspp. and TMAO terziles and MACE. MACE endpoint at 1 year included death, re-infarction, unstable angina. RESULTS In fecal and thrombus samples, we observed a significantly different prevalence of both Prevotellaspp. and Alistipesspp. between patients with hyperglycemia (n = 56) and those with normal glucose levels (n = 90). The abundance of Prevotella increased in hyperglycemic vs normoglycemic patients whereas the contrary was observed for Alistipes. Interestingly, in coronary thrombus, the content of Prevotella was associated with admission blood glucose levels (p < 0.01), thrombus dimensions (p < 0.01), TMAO, CDL40 (p < 0.01) and vWF (p < 0.01) coronary thrombus contents. Multivariate Cox-analysis disclosed a reduced survival in patients with high levels of Prevotella and TMAO in coronary thrombus as compared to patients with low levels of Prevotella and TMAO, after 1-year follow up. CONCLUSIONS Hyperglycemia during STEMI may increase coronary thrombus burden via gut and thrombus microbiota dysbiosis characterized by an increase of Prevotella and TMAO content in thrombi. CLINICAL TRIAL REGISTRATION NCT03439592. September 30, 2016. Ethic Committee Vanvitelli University: 268/2016.
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Affiliation(s)
- Celestino Sardu
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy.
| | - Maria Consiglia Trotta
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Biagio Santella
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Nunzia D'Onofrio
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Italy
| | - Michelangela Barbieri
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Maria Rosaria Rizzo
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Ferdinando Carlo Sasso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Lucia Scisciola
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Fabrizio Turriziani
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Michele Torella
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Michele Portoghese
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Francesco Loreni
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Simone Mureddu
- Department of Cardiac Surgery, Santissima Annunziata Hospital, Sassari, Italy
| | - Maria Antonietta Lepore
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Gianluigi Franci
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Veronica Folliero
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Arianna Petrillo
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Lara Boatti
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Fabio Minicucci
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Ciro Mauro
- Department of Cardiology, Hospital Cardarelli, Naples, Italy
| | - Paolo Calabrò
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Marisa De Feo
- Department of Cardio-Thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli," Naples, Italy
| | | | - Danilo Ercolini
- Department of Agricultural Sciences, University of Naples Federico II, Italy; Task Force on Microbiome Studies, University of Naples Federico II, Italy
| | - Michele D'Amico
- Department of Experimental Medicine, University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Giuseppe Paolisso
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
| | - Marilena Galdiero
- Department of Precision Medicine, University of Campania "Luigi Vanvitelli," Italy
| | - Raffaele Marfella
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli" Italy, Italy
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Reginelli A, Belfiore MP, Russo A, Turriziani F, Moscarella E, Troiani T, Brancaccio G, Ronchi A, Giunta E, Sica A, Iovino F, Ciardiello F, Franco R, Argenziano G, Grassi R, Cappabianca S. A Preliminary Study for Quantitative Assessment with HFUS (High- Frequency Ultrasound) of Nodular Skin Melanoma Breslow Thickness in Adults Before Surgery: Interdisciplinary Team Experience. Curr Radiopharm 2020; 13:48-55. [DOI: 10.2174/1874471012666191007121626] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 04/24/2019] [Accepted: 07/17/2019] [Indexed: 11/22/2022]
Abstract
Background:
Cutaneous melanoma is one of the most severe skin diseases. Nodular melanoma
is the second melanoma subtype in order of frequency. The prognosis of skin melanoma depends
on the vertical growth of the tumor (Breslow index). For this measurement, excisional biopsy is
strongly recommended. This is, however, an invasive procedure and may cause damage to the lymphatic
drainage system. The HFUS system, , can be extremely useful for determining tumor thickness
in the preoperative phase, given its high resolution capacity. The aim of this preliminary study is to
define the role of HFUS for the nodular skin melanoma Breslow thickness in adults before surgery by
making a comparison with histological features.
Methods:
In this study, 14 melanocytic lesions (8 male and 6 female) were evaluated with dermatoscopic
clinical features strongly indicative of nodular melanoma. Out of these, excisional biopsy of 7
lesions was requested. The ultrasounds were performed preoperatively. The images were acquired
through the first ultrasound scanner with ultra-high frequency probes (range from 50MHz to 70 MHz)
available on the market under the EEC mark (Vevo "MD, FUJIFILM Visual Sonics, Amsterdam, the
Netherlands) equipped with a linear probe of 50-70 MHz.
Results:
From the ultrasonographic analysis of 14 nodular melanoma thickness was determined for the
presence of two hyperechogenic laminae, separated by a hypo / anechoic space. The twelve lesions
were in situ while the other two lesions showed ultrasonography for example; the satellite lesions (less
than two centimeters from the primary lesion) and in transit (localizable to more than two centimeters
from the primary lesion). Four of these lesions were ulcerated. A comparsion was made the 7 lesions
on between the thickness calculated with this method, and that obtained on the bioptic piece. The presence
of a positive concordance has been evident in all of the cases.
Conclusions:
If further studies are needed to support its widespread clinical use, its is believed that, in
expert hands and with an interdisciplinary team, HFUS is already capable to reliably calculate a
Breslow index in a large majority of patients with cutaneous melanoma.
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Affiliation(s)
- Alfonso Reginelli
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Maria P. Belfiore
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Anna Russo
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Fabrizio Turriziani
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Elvira Moscarella
- Section of Dermatology, Department of Preventive Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Teresa Troiani
- Section of Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Gabriella Brancaccio
- Section of Dermatology, Department of Preventive Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Andrea Ronchi
- Section of Pathological Anatomy, Department of Preventive Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Emilio Giunta
- Section of Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Antonello Sica
- Section of Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Francesco Iovino
- Section of General Surgery, Department of Cardiothoracic Surgery, University of Campania “L:Vanvitelli”, Naples, Italy
| | - Fortunato Ciardiello
- Section of Medical Oncology, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Renato Franco
- Section of Pathological Anatomy, Department of Preventive Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Giuseppe Argenziano
- Section of Dermatology, Department of Preventive Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Roberto Grassi
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
| | - Salvatore Cappabianca
- Section of Radiology and Radiotherapy, Department of Precision Medicine, University of Campania “L. Vanvitelli”; Naples, Italy
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