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Gentile L, Mazzeo A, Briani C, Casagrande S, De Luca M, Fabrizi GM, Gagliardi C, Gemelli C, Forcina F, Grandis M, Guglielmino V, Iabichella G, Leonardi L, Lozza A, Manganelli F, Mussinelli R, My F, Occhipinti G, Fenu S, Russo M, Romano A, Salvalaggio A, Tagliapietra M, Tozza S, Palladini G, Obici L, Luigetti M. Long-term treatment of hereditary transthyretin amyloidosis with patisiran: multicentre, real-world experience in Italy. Neurol Sci 2024:10.1007/s10072-024-07494-9. [PMID: 38622453 DOI: 10.1007/s10072-024-07494-9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/23/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Hereditary transthyretin (ATTRv, v for variant) amyloidosis with polyneuropathy is a rare disease caused by mutations in the transthyretin gene. In ATTRv amyloidosis, multisystem extracellular deposits of amyloid cause tissue and organ dysfunction. Patisiran is a small interfering RNA molecule drug that reduces circulating levels of mutant and wild-type TTR proteins. Prior to its regulatory approval, patisiran was available in Italy through a compassionate use programme (CUP). The aim of this study was to analyse the long-term outcomes of patients who entered into the CUP. METHODS This was a multicentre, observational, retrospective study of patients with ATTRv amyloidosis treated with patisiran. The analysis included change from baseline to 12, 24, 36 and 48 months in familial amyloid polyneuropathy (FAP) stage, polyneuropathy disability (PND) class, neuropathy impairment score (NIS), modified body mass index (mBMI), Compound Autonomic Dysfunction Test (CADT), Karnofsky Performance Status (KPS) scale and Norfolk Quality of Life-Diabetic Neuropathy (QoL-DN) questionnaire. Safety data were also analysed. RESULTS Forty patients from 11 Italian centres were enrolled: 23 in FAP 1 (6 in PND 1 and 17 in PND 2) and 17 in FAP 2 (8 in PND 3a and 9 in PND 3b) stage. In this population, the mean NIS at baseline was 71.4 (± 27.8); mBMI, 917.1 (± 207) kg/m2; KPS, 67.1 (± 14.0); Norfolk QoL-DN, 62.2 (± 25.2); and CADT, 13.2 (± 3.3). Statistical analysis showed few significant differences from baseline denoting disease stability. No new safety signals emerged. CONCLUSIONS Patisiran largely stabilised disease in patients with ATTRv amyloidosis.
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Affiliation(s)
- Luca Gentile
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Anna Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Chiara Briani
- Department of Neurosciences, Neurology Unit, University of Padova, Padua, Italy
| | - Silvia Casagrande
- Department of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Marcella De Luca
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Gian Maria Fabrizi
- Department of Neurological Sciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Christian Gagliardi
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria of Bologna, Bologna, Italy
| | | | - Francesca Forcina
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Marina Grandis
- IRCCS Policlinico San Martino Hospital, Genoa, Italy
- Dipartimento Di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università Di Genova, Genoa, Italy
| | - Valeria Guglielmino
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Iabichella
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Luca Leonardi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Alessandro Lozza
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Filomena My
- Department of Neurology, "Vito Fazzi" Hospital, Lecce, Italy
| | - Giuseppe Occhipinti
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Silvia Fenu
- S.C. Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Massimo Russo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Angela Romano
- Dipartimento Di Neuroscienze, Organi Di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Matteo Tagliapietra
- Department of Neurological Sciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Giovanni Palladini
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Centre, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
| | - Marco Luigetti
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
- Dipartimento Di Neuroscienze, Organi Di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Bertini A, Manganelli F, Fabrizi GM, Schenone A, Santoro L, Cavallaro T, Tagliapietra M, Grandis M, Previtali SC, Falzone YM, Allegri I, Padua L, Pazzaglia C, Tramacere I, Cavalca E, Saveri P, Quattrone A, Valentino P, Tozza S, Gentile L, Russo M, Mazzeo A, Vita G, Prada V, Zuccarino R, Ferraro F, Pisciotta C, Pareyson D. Use, tolerability, benefits and side effects of orthotic devices in Charcot-Marie-Tooth disease. J Neurol Neurosurg Psychiatry 2024; 95:434-441. [PMID: 37918904 DOI: 10.1136/jnnp-2023-332422] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/10/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Shoe inserts, orthopaedic shoes, ankle-foot orthoses (AFOs) are important devices in Charcot-Marie-Tooth disease (CMT) management, but data about use, benefits and tolerance are scanty. METHODS We administered to Italian CMT Registry patients an online ad hoc questionnaire investigating use, complications and perceived benefit/tolerability/emotional distress of shoe inserts, orthopaedic shoes, AFOs and other orthoses/aids. Patients were also asked to fill in the Quebec User Evaluation of Satisfaction with assistive Technology questionnaire, rating satisfaction with currently used AFO and related services. RESULTS We analysed answers from 266 CMT patients. Seventy per cent of subjects were prescribed lower limb orthoses, but 19% did not used them. Overall, 39% of subjects wore shoe inserts, 18% orthopaedic shoes and 23% AFOs. Frequency of abandonment was high: 24% for shoe inserts, 28% for orthopaedic shoes and 31% for AFOs. Complications were reported by 59% of patients and were more frequently related to AFOs (69%). AFO users experienced greater emotional distress and reduced tolerability as compared with shoe inserts (p<0.001) and orthopaedic shoes (p=0.003 and p=0.045, respectively). Disease severity, degree of foot weakness, customisation and timing for customisation were determinant factors in AFOs' tolerability. Quality of professional and follow-up services were perceived issues. CONCLUSIONS The majority of CMT patients is prescribed shoe inserts, orthopaedic shoes and/or AFOs. Although perceived benefits and tolerability are rather good, there is a high rate of complications, potentially inappropriate prescriptions and considerable emotional distress, which reduce the use of AFOs. A rational, patient-oriented and multidisciplinary approach to orthoses prescription must be encouraged.
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Affiliation(s)
- Alessandro Bertini
- Unità di Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Fiore Manganelli
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Napoli, Italy
| | - Gian Maria Fabrizi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Angelo Schenone
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno-infantili, Università di Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Genova, Italy
| | - Lucio Santoro
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Napoli, Italy
| | - Tiziana Cavallaro
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Matteo Tagliapietra
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Marina Grandis
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno-infantili, Università di Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Genova, Italy
| | | | - Yuri Matteo Falzone
- INSPE and Divisione di Neuroscienze, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Isabella Allegri
- Dipartimento di Neurologia, Azienda Ospedaliera di Parma, Parma, Italy
| | - Luca Padua
- Università Cattolica del Sacro Cuore, Rome, Italy
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Irene Tramacere
- Dipartimento Gestionale di Ricerca e Sviluppo Clinico, Direzione Scientifica, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Eleonora Cavalca
- Unità di Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Paola Saveri
- Unità di Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Andrea Quattrone
- Centro di Ricerche Neuroscienze, e Istituto di Neurologia, Università Magna Graecia, Catanzaro, Italy, Catanzaro, Italy
| | - Paola Valentino
- Dipartimento di Scienze Mediche, Università Magna Grecia, Catanzaro, Italy
| | - Stefano Tozza
- Dipartimento di Neuroscienze, Scienze Riproduttive ed Odontostomatologiche, Università Federico II di Napoli, Napoli, Italy
| | - Luca Gentile
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Massimo Russo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Anna Mazzeo
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Giuseppe Vita
- Unità di Neurologia e Malattie Neuromuscolari, Dipartimento di Medicina Clinica e Sperimentale, Università di Messina, Messina, Italy
| | - Valeria Prada
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno-infantili, Università di Genova, Genova, Italy
- Fondazione Italiana Sclerosi Multipla, Genova, Italy
| | | | - Francesco Ferraro
- Struttura Complessa di Riabilitazione Neuromotoria ASST Mantova Presidio di Bozzolo, Mantova, Italy
| | - Chiara Pisciotta
- Unità di Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
| | - Davide Pareyson
- Unità di Malattie Neurologiche Rare, Dipartimento di Neuroscienze Cliniche, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milano, Italy
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Tagliapietra M, Incensi A, Ferrarini M, Mesiano N, Furia A, Rizzo G, Liguori R, Cavallaro T, Monaco S, Fabrizi GM, Donadio V. Clinical and pathology characterization of small nerve fiber neuro(no)pathy in cerebellar ataxia with neuropathy and vestibular areflexia syndrome. Eur J Neurol 2023; 30:3834-3841. [PMID: 37531261 DOI: 10.1111/ene.16018] [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: 04/27/2023] [Revised: 07/13/2023] [Accepted: 07/27/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND PURPOSE Biallelic mutation/expansion of the gene RFC1 has been described in association with a spectrum of manifestations ranging from isolated sensory neuro(no)pathy to a complex presentation as cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS). Our aim was to define the frequency and characteristics of small fiber neuropathy (SFN) in RFC1 disease at different stages. METHODS RFC1 cases were screened for SFN using the Neuropathic Pain Symptom Inventory and Composite Autonomic Symptom Score 31 questionnaires. Clinical data were retrospectively collected. If available, lower limb skin biopsy samples were evaluated for somatic epidermal and autonomic subepidermal structure innervation and compared to healthy controls (HCs). RESULTS Forty patients, median age at onset 54 years (interquartile range [IQR] 49-61) and disease duration 10 years (IQR 6-16), were enrolled. Mild-to-moderate positive symptoms (median Neuropathic Pain Symptom Inventory score 12.1/50, IQR 5.5-22.3) and relevant autonomic disturbances (median Composite Autonomic Symptom Score 31 37.0/100, IQR 17.7-44.3) were frequently reported and showed scarce correlation with disease duration. A non-length-dependent impairment in nociception was evident in both clinical and paraclinical investigations. An extreme somatic denervation was observed in all patients at both proximal (fibers/mm, RFC1 cases 0.0 vs. HCs 20.5, p < 0.0001) and distal sites (fibers/mm, RFC1 cases 0.0 vs. HCs 13.1, p < 0.0001); instead only a slight decrease was observed in cholinergic and adrenergic innervation of autonomic structures. CONCLUSIONS RFC1 disease is characterized by a severe and widespread somatic SFN. Skin denervation may potentially represent the earliest feature and drive towards the suspicion of this disorder.
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Affiliation(s)
- Matteo Tagliapietra
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Alex Incensi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Moreno Ferrarini
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Nazarena Mesiano
- Dipartimento di Scienze Chirurgiche, Odontostomatologiche e Materno-infantili, UOC Otorinolaringoiatria, Verona, Italy
| | - Alessandro Furia
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
| | - Tiziana Cavallaro
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Salvatore Monaco
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Dipartimento di Neuroscienze, Biomedicina e Movimento, Università di Verona, Verona, Italy
| | - Vincenzo Donadio
- IRCCS Istituto delle Scienze Neurologiche di Bologna, UOC Clinica Neurologica, Bologna, Italy
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Gasparotti R, Salvalaggio A, Corbo D, Agazzi G, Cacciavillani M, Lozza A, Fenu S, De Vigili G, Tagliapietra M, Fabrizi GM, Pareyson D, Obici L, Briani C. Magnetic resonance neurography and diffusion tensor imaging of the sciatic nerve in hereditary transthyretin amyloidosis polyneuropathy. J Neurol 2023; 270:4827-4840. [PMID: 37329346 PMCID: PMC10511361 DOI: 10.1007/s00415-023-11813-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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/06/2023] [Accepted: 06/06/2023] [Indexed: 06/19/2023]
Abstract
The therapeutic advance in hereditary transthyretin amyloidosis (ATTRv amyloidosis) requires quantitative biomarkers of nerve involvement in order to foster early diagnosis and monitor therapy response. We aimed at quantitatively assessing Magnetic Resonance Neurography (MRN) and Diffusion Tensor Imaging (DTI) properties of the sciatic nerve in subjects with ATTRv-amyloidosis-polyneuropathy (ATTRv-PN) and pre-symptomatic carriers (ATTRv-C). Twenty subjects with pathogenic variants of the TTR gene (mean age 62.20 ± 12.04 years), 13 ATTRv-PN, and 7 ATTRv-C were evaluated and compared with 20 healthy subjects (mean age 60.1 ± 8.27 years). MRN and DTI sequences were performed at the right thigh from the gluteal region to the popliteal fossa. Cross-sectional-area (CSA), normalized signal intensity (NSI), and DTI metrics, including fractional anisotropy (FA), mean (MD), axial (AD), and radial diffusivity (RD) of the right sciatic nerve were measured. Increased CSA, NSI, RD, and reduced FA of sciatic nerve differentiated ATTRv-PN from ATTRv-C and healthy subjects at all levels (p < 0.01). NSI differentiated ATTRv-C from controls at all levels (p < 0.05), RD at proximal and mid-thigh (1.04 ± 0.1 vs 0.86 ± 0.11 p < 0.01), FA at mid-thigh (0.51 ± 0.02 vs 0.58 ± 0.04 p < 0.01). According to receiver operating characteristic (ROC) curve analysis, cutoff values differentiating ATTRv-C from controls (and therefore identifying subclinical sciatic involvement) were defined for FA, RD, and NSI. Significant correlations between MRI measures, clinical involvement and neurophysiology were found. In conclusion, the combination of quantitative MRN and DTI of the sciatic nerve can reliably differentiate ATTRv-PN, ATTRv-C, and healthy controls. More important, MRN and DTI were able to non-invasively identify early subclinical microstructural changes in pre-symptomatic carriers, thus representing a potential tool for early diagnosis and disease monitoring.
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Affiliation(s)
- Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy.
| | - Alessandro Salvalaggio
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padova, Padua, Italy
| | - Daniele Corbo
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and ASST Spedali Civili Hospital, P.Le Spedali Civili 1, 25123, Brescia, Italy
| | - Giorgio Agazzi
- Neuroradiology Unit, ASST Santi Paolo e Carlo Hospital, Milan, Italy
| | | | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Silvia Fenu
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Grazia De Vigili
- Parkinson and Movement Disorders Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Matteo Tagliapietra
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Davide Pareyson
- Rare Neurological Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Briani
- Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy
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Cotti Piccinelli S, Tagliapietra M, Cavallaro T, Labella B, Risi B, Caria F, Damioli S, Poli L, Padovani A, Ferrari S, Filosto M. Leprosy Neuropathy in a Non-Endemic Area: A Clinical and Pathological Study. Biomedicines 2023; 11:2468. [PMID: 37760909 PMCID: PMC10525615 DOI: 10.3390/biomedicines11092468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 08/13/2023] [Accepted: 08/17/2023] [Indexed: 09/29/2023] Open
Abstract
The extent of nerve involvement in leprosy is highly variable in distribution and clinical presentation. Mononeuropathies, multiple mononeuropathies, and polyneuropathies can present both in the context of a cutaneous and/or systemic picture and in the form of pure neuritic leprosy (PNL). The differential diagnosis of leprosy neuropathy remains challenging because it is a very rare condition and, especially in Western countries, is often overlooked. We report one case of the polyneuropathic form of PNL (P-PNL) and one case of multiple mononeuropathy in paucibacillary leprosy. In both cases, the diagnosis was achieved by performing a sural nerve biopsy, which showed subverted structure, severe infiltration of inflammatory cells in nerve fascicles, granulomatous abnormalities, and the presence of alcohol-acid-resistant, Ziehl-Neelsen-positive bacilli inside the nerve bundles. Leprosy remains an endemic disease in many areas of the world, and globalization has led to the spread of cases in previously disease-free countries. In this perspective, our report emphasizes that the diagnostic possibility of leprosy neuropathy should always be taken into account, even in Western countries, in the differential diagnostic process of an acquired sensory polyneuropathy or multineuropathy and confirms that nerve biopsy remains a useful procedure in working up neuropathies with unknown etiology.
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Affiliation(s)
- Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Matteo Tagliapietra
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Tiziana Cavallaro
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Beatrice Labella
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Barbara Risi
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Filomena Caria
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Simona Damioli
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
| | - Loris Poli
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Alessandro Padovani
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- Unit of Neurology, ASST Spedali Civili, 25100 Brescia, Italy;
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, 37100 Verona, Italy; (M.T.); (T.C.); (S.F.)
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia, 25100 Brescia, Italy; (S.C.P.); (B.L.); (B.R.); (A.P.)
- NeMO-Brescia Clinical Center for Neuromuscular Diseases, Guusago, 25064 Brescia, Italy; (F.C.); (S.D.)
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6
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Doneddu PE, Briani C, Cocito D, Manganelli F, Fabrizi GM, Matà S, Mazzeo A, Fazio R, Benedetti L, Luigetti M, Inghilleri M, Ruiu E, Siciliano G, Cosentino G, Marfia GA, Carpo M, Filosto M, Antonini G, Notturno F, Sotgiu S, Cucurachi L, Dell'Aquila C, Bianchi E, Rosso T, Giordano A, Fernandes M, Campagnolo M, Peci E, Spina E, Tagliapietra M, Sperti M, Gentile L, Strano C, Germano F, Romozzi M, Moret F, Zarbo IR, Viola DV, Vegezzi E, Mataluni G, Piccinelli SC, Leonardi L, Carta A, Nobile-Orazio E. Risk of disease relapse, safety and tolerability of SARS-CoV-2 vaccination in patients with chronic inflammatory neuropathies. Eur J Neurol 2023. [PMID: 37000158 DOI: 10.1111/ene.15811] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/27/2023] [Accepted: 03/23/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND To evaluate the risk of relapse after SARS-CoV-2 vaccination, and its safety and tolerability, in patients with chronic inflammatory neuropathies. METHODS In this multicenter, cohort, and case-crossover study, the risk of relapse associated with SARS-CoV-2 vaccination was assessed by comparing frequency of relapse in CIDP and MMN patients who underwent or did not undergo vaccination. Frequency of relapse in the three months prior and after vaccination, and safety and tolerability of SARS-CoV-2 vaccination were also assessed. RESULTS 336 patients were included (278 CIDP; 58 MMN). 307 (91%) patients underwent SARS-CoV-2 vaccination. Twenty-nine patients (9%) did not undergo vaccination. Mild and transient relapses were observed in 16 (5%) patients (13 CIDP; 3 MMN) after SARS-CoV-2 vaccination and in none of the patients who did not undergo vaccination (RR= 3.21, 95% CI, 0.19-52.25). There was no increase in the specific risk of relapse associated with type of vaccine or diagnosis. Comparison with the 3-month control period preceding vaccination revealed an increased risk of relapse after vaccination (RR= 4.00; 95% CI, 1.35-11.82), which was restricted to CIDP patients (RR= 3.25, 95% CI, 1.07-9.84). The safety profile of SARS-CoV-2 vaccination was characterized by short-term, mild-to-moderate local and systemic adverse events. CONCLUSIONS SARS-CoV-2 vaccination in CIDP and MMN patients does not seem to be associated with an increased risk of relapse at primary endpoint, although a slightly increased risk in CIDP patients was found compared to the 3 months before vaccination.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano -, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090 Pieve Emanuele -, Milan, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Dario Cocito
- SSD Patologie Neurologiche Specialistiche, AOU San Luigi, Torino, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Gian Maria Fabrizi
- UOC Neurology B, Department of Neuroscience, University Hospital GB Rossi, AOUI and University of Verona, Verona, Italy
| | - Sabrina Matà
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | | | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS. UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore. Sede di Roma, Roma, Italy
| | | | - Elisa Ruiu
- Neurology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Cosentino
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Girolama Alessandra Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | | | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-, Brescia, Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Giovanni Antonini
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, 'Sapienza' University of Rome, Sant'Andrea Hospital, Roma, Italy
| | | | - Stefano Sotgiu
- Child Neuropsychiatry Division, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | | | | | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Tiziana Rosso
- UOC di Neurologia, Ospedale San Bassiano, Bassano del Grappa, Vicenza, Italy
| | - Andrea Giordano
- Neuromuscular and Neuroimmunology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano -, Milan, Italy
| | - Marco Fernandes
- Neuromuscular and Neuroimmunology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano -, Milan, Italy
| | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Erdita Peci
- SSD Patologie Neurologiche Specialistiche, AOU San Luigi, Torino, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Matteo Tagliapietra
- UOC Neurology B, Department of Neuroscience, University Hospital GB Rossi, AOUI and University of Verona, Verona, Italy
| | - Martina Sperti
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Camilla Strano
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | | | - Marina Romozzi
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS. UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore. Sede di Roma, Roma, Italy
| | - Federica Moret
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Ignazio Roberto Zarbo
- Neurology Unit, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Divina Valeria Viola
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giorgia Mataluni
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Stefano Cotti Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-, Brescia, Clinical Center for Neuromuscular Diseases, Brescia, Italy
| | - Luca Leonardi
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, 'Sapienza' University of Rome, Sant'Andrea Hospital, Roma, Italy
| | - Alessandra Carta
- Child Neuropsychiatry Division, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano -, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
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7
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Briani C, Ferrari S, Tagliapietra M, Trentin L, Visentin A. Vasculitic flare in a patient with anti-myelin-associated glycoprotein (MAG) antibody following mRNA-1273 SARS-CoV-2 vaccine. J Neurol 2023; 270:1207-1210. [PMID: 36355184 PMCID: PMC9647246 DOI: 10.1007/s00415-022-11452-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Chiara Briani
- Neurology Unit, Department of Neurosciences, University of Padova, Via Giustiniani 5, 35128, Padua, Italy.
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Tagliapietra
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Livio Trentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
| | - Andrea Visentin
- Hematology and Clinical Immunology Unit, Department of Medicine, University of Padova, Padua, Italy
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8
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Bongianni M, Catalan M, Perra D, Fontana E, Janes F, Bertolotti C, Sacchetto L, Capaldi S, Tagliapietra M, Polverino P, Tommasini V, Bellavita G, Kachoie EA, Baruca R, Bernardini A, Valente M, Fiorini M, Bronzato E, Tamburin S, Bertolasi L, Brozzetti L, Cecchini MP, Gigli G, Monaco S, Manganotti P, Zanusso G. Correction: Olfactory swab sampling optimization for α-synuclein aggregate detection in patients with Parkinson's disease. Transl Neurodegener 2022; 11:38. [PMID: 35962443 PMCID: PMC9373435 DOI: 10.1186/s40035-022-00312-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Matilde Bongianni
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Mauro Catalan
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Daniela Perra
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Elena Fontana
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Francesco Janes
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | - Claudio Bertolotti
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134, Verona, Italy
| | - Stefano Capaldi
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134, Verona, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Paola Polverino
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Valentina Tommasini
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Giulia Bellavita
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Elham Ataie Kachoie
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134, Verona, Italy
| | - Roberto Baruca
- Otolaryngology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Andrea Bernardini
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | | | - Michele Fiorini
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Erika Bronzato
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Laura Bertolasi
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Lorenzo Brozzetti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Maria Paola Cecchini
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Gianluigi Gigli
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Paolo Manganotti
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy.
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9
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Bongianni M, Catalan M, Perra D, Fontana E, Janes F, Bertolotti C, Sacchetto L, Capaldi S, Tagliapietra M, Polverino P, Tommasini V, Bellavita G, Kachoie EA, Baruca R, Bernardini A, Valente M, Fiorini M, Bronzato E, Tamburin S, Bertolasi L, Brozzetti L, Cecchini MP, Gigli G, Monaco S, Manganotti P, Zanusso G. Olfactory swab sampling optimization for α-synuclein aggregate detection in patients with Parkinson's disease. Transl Neurodegener 2022; 11:37. [PMID: 35902902 PMCID: PMC9330656 DOI: 10.1186/s40035-022-00311-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 05/20/2022] [Accepted: 07/18/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In patients with Parkinson's disease (PD), real-time quaking-induced conversion (RT-QuIC) detection of pathological α-synuclein (α-syn) in olfactory mucosa (OM) is not as accurate as in other α-synucleinopathies. It is unknown whether these variable results might be related to a different distribution of pathological α-syn in OM. Thus, we investigated whether nasal swab (NS) performed in areas with a different coverage by olfactory neuroepithelium, such as agger nasi (AN) and middle turbinate (MT), might affect the detection of pathological α-syn. METHODS NS was performed in 66 patients with PD and 29 non-PD between September 2018 and April 2021. In 43 patients, cerebrospinal fluid (CSF) was also obtained and all samples were analyzed by RT-QuIC for α-syn. RESULTS In the first round, 72 OM samples were collected by NS, from AN (NSAN) or from MT (NSMT), and 35 resulted positive for α-syn RT-QuIC, including 27/32 (84%) from AN, 5/11 (45%) from MT, and 3/29 (10%) belonging to the non-PD patients. Furthermore, 23 additional PD patients underwent NS at both AN and MT, and RT-QuIC revealed α-syn positive in 18/23 (78%) NSAN samples and in 10/23 (44%) NSMT samples. Immunocytochemistry of NS preparations showed a higher representation of olfactory neural cells in NSAN compared to NSMT. We also observed α-syn and phospho-α-syn deposits in NS from PD patients but not in controls. Finally, RT-QuIC was positive in 22/24 CSF samples from PD patients (92%) and in 1/19 non-PD. CONCLUSION In PD patients, RT-QuIC sensitivity is significantly increased (from 45% to 84%) when NS is performed at AN, indicating that α-syn aggregates are preferentially detected in olfactory areas with higher concentration of olfactory neurons. Although RT-QuIC analysis of CSF showed a higher diagnostic accuracy compared to NS, due to the non-invasiveness, NS might be considered as an ancillary procedure for PD diagnosis.
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Affiliation(s)
- Matilde Bongianni
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Mauro Catalan
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Daniela Perra
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Elena Fontana
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Francesco Janes
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | - Claudio Bertolotti
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134, Verona, Italy
| | - Stefano Capaldi
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134, Verona, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Paola Polverino
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Valentina Tommasini
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Giulia Bellavita
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Elham Ataie Kachoie
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134, Verona, Italy
| | - Roberto Baruca
- Otolaryngology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Andrea Bernardini
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | | | - Michele Fiorini
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Erika Bronzato
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Laura Bertolasi
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Lorenzo Brozzetti
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Maria Paola Cecchini
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Gianluigi Gigli
- Neurology Unit, University of Udine Academic Hospital, 33100, Udine, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy
| | - Paolo Manganotti
- Neurology Unit, Department of Medicine, Surgery and Health Sciences, Ospedale Cattinara, University of Trieste, 34128, Trieste, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, Policlinico G. B. Rossi, University of Verona, 37134, Verona, Italy.
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Di Stefano V, Fava A, Gentile L, Guaraldi P, Leonardi L, Poli L, Tagliapietra M, Vastola M, Fanara S, Ferrero B, Giorgi M, Perfetto F, Russo M, Russo D. Italian Real-Life Experience of Patients with Hereditary Transthyretin Amyloidosis Treated with Patisiran. Pharmgenomics Pers Med 2022; 15:499-514. [PMID: 35592550 PMCID: PMC9113125 DOI: 10.2147/pgpm.s359851] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/22/2022] [Indexed: 12/02/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv) is a multisystemic, rare, inherited, progressive and adult-onset disease, affecting the sensorimotor nerves, heart, autonomic function and other organs. The actual scenario of pharmaceutical approaches for ATTRv amyloidosis includes five main groups: TTR stabilizers, TTR mRNA silencers, TTR fibril disruptors, inhibitor of TTR fibril seeding and gene therapy. Patisiran is a small, double-stranded interfering RNA encapsulated in a lipid nanoparticle, able to penetrate into hepatocytes, where it selectively targets TTR mRNA, reducing TTR production. We report and discuss 9 cases of different patients with ATTRv amyloidosis successfully managed with patisiran in the real clinical practice. Literature data, as well as the above presented case reports, show that this drug is effective and safe in improving both neurological and cardiovascular symptoms of ATTRv amyloidosis, and to maintain a good QoL, independently form the stage of the disease and the involved mutation. Recent studies correlated improved functional and biochemical outcomes with a regression of amyloid burden, especially at the cardiac level. Today, patisiran can be considered a valid therapeutic option for the management of patients with ATTRv amyloidosis and polyneuropathy and cardiovascular symptoms.
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Affiliation(s)
- Vincenzo Di Stefano
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
- Correspondence: Vincenzo Di Stefano, Department of Biomedicine, Neuroscience and advanced Diagnostic (BIND), University of Palermo Palermo, Italy, Via del Vespro 143, Palermo, 90127, Italy, Tel +39 3285781786, Fax +390916552974, Email
| | - Antonella Fava
- Division of Cardiology, Heart Vascular and Thoracic Department, Città della Salute e della Scienza (Molinette Hospital- University of Turin), Turin, Italy
| | - Luca Gentile
- Unit of Neurology and Neuromuscular Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Pietro Guaraldi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Leonardi
- Department of Neuroscience, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome Sant’Andrea Hospital, Rome, Italy
| | - Loris Poli
- Department of Neurology, ASST Spedali Civili, Brescia, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Vastola
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
- Neurosciences Department, Florence University, Rome, Italy
| | - Salvatore Fanara
- Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, Palermo, Italy
| | - Bruno Ferrero
- SC Neurology 2U, Department of Neuroscience “Rita Levi Montalcini”, Città della Salute e della Scienza (Molinette Hospital -University of Turin), Turin, Italy
| | - Mauro Giorgi
- Division of Cardiology, Heart Vascular and Thoracic Department, Città della Salute e della Scienza (Molinette Hospital- University of Turin), Turin, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Massimo Russo
- Unit of Neurology and Neuromuscular Disease, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Domitilla Russo
- Division of Cardiology, Department of Clinical and Molecular Medicine, St. Andrea Hospital, Sapienza University, Rome, Italy
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11
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Luigetti M, Antonini G, Di Paolantonio A, Gentile L, Grandis M, Leonardi L, Lozza A, Manganelli F, Mazzeo A, Mussinelli R, My F, Obici L, Pennisi EM, Romozzi M, Russo M, Sabatelli M, Salvalaggio A, Tagliapietra M, Tozza S. Real-life experience with inotersen in hereditary transthyretin amyloidosis with late-onset phenotype: data from an early-access program in Italy. Eur J Neurol 2022; 29:2148-2155. [PMID: 35289020 PMCID: PMC9314115 DOI: 10.1111/ene.15325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 02/07/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Hereditary transthyretin (TTR) amyloidosis (ATTRv) is a dominantly inherited, adult‐onset, progressive, and fatal disease caused by mutations in the transthyretin gene. Therapeutic agents approved for this disease include the TTR stabilizer tafamidis and the gene‐silencing drugs patisiran and inotersen. Inotersen is an antisense oligonucleotide that suppresses the hepatic production of transthyretin. After European Medical Agency approval in 2018, an early‐access program was opened in Italy, and in this article, we present the long‐term outcome of a cohort of Italian ATTRv patients who received inotersen within this program. Methods This is a multicenter, observational, retrospective study of patients affected by ATTRv that started inotersen during the early‐access program. The primary end point was safety. Secondary end points included change from baseline in familial amyloid polyneuropathy (FAP) stage, Polyneuropathy Disability, Neuropathy Impairment Scale, Compound Autonomic Dysfunction Test, Norfolk Quality of Life–Diabetic Neuropathy, troponin, N‐terminal pro–brain natriuretic peptide, interventricular septum thickness, and body mass index. Results In total, 23 patients were enrolled. No patient permanently discontinued the treatment because of thrombocytopenia, and no cases of severe thrombocytopenia were observed. Five patients discontinued the treatment permanently because of voluntary withdrawal (two patients), renal failure after infective pyelonephritis, not related to inotersen, drug‐related hypotension, and amyloid‐negative crescentic glomerulonephritis. In seven patients, dosing frequency was reduced to every 2 weeks due to recurrent thrombocytopenia. Considering the FAP stage, only two patients worsened, whereas the other 21 patients remained stable until the last follow‐up available. Conclusions The long‐term safety profile of inotersen is favorable. Neurologic disease severity at baseline is the main factor associated with progression.
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Affiliation(s)
- Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS. UOC Neurologia, Rome, Italy.,Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giovanni Antonini
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | | | - Luca Gentile
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Marina Grandis
- University of Genova, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics and Maternal Infantile Sciences, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Leonardi
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Alessandro Lozza
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
| | - Anna Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Roberta Mussinelli
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Filomena My
- UOC Neurologia Ospedale Vito Fazzi Lecce, Italy
| | - Laura Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Elena Maria Pennisi
- Neuromuscular and Rare Neurological Diseases - Neurology Unit, San Filippo Neri Hospital Rome, Italy
| | - Marina Romozzi
- Fondazione Policlinico Universitario A. Gemelli IRCCS. UOC Neurologia, Rome, Italy.,Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Massimo Russo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, 98125, Messina, Italy
| | - Mario Sabatelli
- Centro Clinico NEMO - Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy
| | | | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Science, University of Naples "Federico II", Naples, Italy
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Peretti A, Squintani G, Taioli F, Tagliapietra M, Cavallaro T, Fabrizi GM. Neuropathic pain in Charcot-Marie-Tooth Disease. Eur J Pain 2022; 26:929-936. [PMID: 35129250 DOI: 10.1002/ejp.1922] [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] [Received: 08/15/2021] [Revised: 02/12/2022] [Accepted: 02/06/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Pain, either nociceptive or neuropathic (NP), is a common symptom in Charcot-Marie-Tooth (CMT) disease. METHODS We investigated small fibers involvement and its correlation with pain in different CMT subtypes through a systematic clinical and neurophysiological study. We enrolled 50 patients: 19 with duplication of PMP22 (CMT1A), 11 with mutation of MPZ (CMT1B, CMT2I/J or CMTDID), 12 with mutation of GJB1 (CMTX1) and 8 with mutation of MFN2 (CMT2A and CMT2A2B). Pain was rated with the 11-point Numerical Rating Scale and characterized through Neuropathic Pain Symptoms Inventory). Laser evoked potentials (LEPs) were recorded after right foot and hand stimulation and N2-P2 complex amplitude and latency were compared with those of 41 controls. RESULTS Overall pain prevalence was 36%. NP was present in 14,6 % of patients, with a length-dependent distribution in 85,7% of cases and it was significantly more frequent in CMT1A (p<0,001). Aδ fibers involvement greatly varies between CMT subtypes, reflecting differences in molecular pathology and pathophysiologic mechanisms. Prolonged N2 latency from foot stimulation was noted in 11 CMT1A patients, 5 of which report NP. MPZ-CMTs displayed different neurophysiological phenotypes and a very low prevalence of NP. LEPs were normal in all but one CMTX1 patients, although lower limbs N2-P2 amplitude was significantly reduced in males (p=0,043). MFN2-CMTs were NP free and LEPs recordings were all normal. NP strictly correlated with LEPs alterations (p=0,017). CONCLUSIONS NP prevalence varies among CMTs subtypes and is mainly related to Aδ fibers impairment.
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Affiliation(s)
- A Peretti
- Department of Neurology, Ospedale San Bortolo, Azienda ULSS8 Berica, Vicenza, Italy
| | - G Squintani
- Department of Neurology, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Veneto, Italy
| | - F Taioli
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - M Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - T Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
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13
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Tagliapietra M. Aducanumab for the treatment of Alzheimer's disease. Drugs Today (Barc) 2022; 58:465-477. [DOI: 10.1358/dot.2022.58.10.3422314] [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: 11/03/2022]
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14
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Monaco S, Tagliapietra M, Turri G, Bortolotti F, Mansueto G. Ischemic stroke due to sporadic and genetic pulmonary arteriovenous malformations: Case report. Brain Circ 2022; 8:57-60. [PMID: 35372731 PMCID: PMC8973452 DOI: 10.4103/bc.bc_66_21] [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] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/28/2021] [Accepted: 12/16/2021] [Indexed: 11/04/2022] Open
Abstract
Pulmonary arteriovenous malformations (PAVMs) encompass congenital and genetic vascular anomalies characterized by complex interlacing of arteries and veins connected by fistulas, which allow rapid and continuous extracardiac right-to-left shunting (RLS). Presenting neurologic manifestations of PAVM include brain abscess and stroke, as the consequence of paradoxical embolism. Although rare, PAVM represents an overlooked cause of cryptogenic ischemic stroke in young adults, being misdiagnosed as patent foramen ovale and a preventable trigger of silent cerebral ischemic changes. In the emergency clinical setting, the recommended ischemic stroke workup in patients with RLS should include the influence of postural changes and the effect of Valsalva maneuver on the entity of the RLS on contrast-enhanced transcranial color Doppler ultrasound and the delay in the right inferior pulmonary vein and left heart opacification on contrast-enhanced transthoracic echocardiography. This is in addition to the evaluation of chest X-rays or thoracic computed tomography. We here describe two patients with ischemic stroke due to sporadic and genetic PAVM-associated paradoxical embolism.
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15
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Cavallaro T, Tagliapietra M, Fabrizi GM, Bai Y, Shy ME, Vallat J. Featured Cover. J Peripher Nerv Syst 2021. [DOI: 10.1111/jns.12475] [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: 11/30/2022]
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16
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Tagliapietra M, Cardellini D, Ferrarini M, Testi S, Ferrari S, Monaco S, Cavallaro T, Fabrizi GM. Clinical and pathological characterization of RFC1 AAGGG expansion presenting as chronic axonal polyneuropathy. J Neurol Sci 2021. [DOI: 10.1016/j.jns.2021.117739] [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: 10/20/2022]
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17
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Tagliapietra M, Frasson E, Cardellini D, Mariotto S, Ferrari S, Zanusso G, Plebani M, Monaco S. Hypothalamic-Bulbar MRI Hyperintensity in Anti-IgLON5 Disease with Serum-Restricted Antibodies: A Case Report and Systematic Review of Literature. J Alzheimers Dis 2021; 79:683-691. [PMID: 33337376 DOI: 10.3233/jad-201105] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Anti-IgLON5 disease is a rare neurodegenerative tauopathy that displays heterogeneity in clinical spectrum, disease course, cerebrospinal fluid (CSF) findings, and variable response to immunotherapy. Sleep disorders, bulbar dysfunction, and gait abnormalities are common presenting symptoms, and conventional brain MRI scanning is often unrevealing. OBJECTIVE To provide a comprehensive overview of the literature and to assess the frequency of symptoms, MRI findings, and treatment response in patients with IgLON5 autoimmunity in the serum and CSF or restricted to serum. METHODS We examined a 65-year-old woman with bulbar-onset IgLON5 disease with serum-restricted antibodies, and we also performed a systematic review of all confirmed cases reported in the English literature. RESULTS We identified 93 patients, included our case. Clinical data were obtained in 58 subjects, in whom the most frequent symptoms were sleep-disordered breathing, dysphagia, parasomnias, dysarthria, limb or gait ataxia, stridor or vocal cord paresis, movement disorders, and postural instability. Distinct MRI alterations were identified in 12.5% of cases, as opposed to unspecific or unremarkable changes in the remaining patients. T2-hyperintense non-enhancing signal alterations involving the hypothalamus and the brainstem tegmentum were observed only in the present case. Inflammatory CSF was found in half of the cases and serum-restricted antibodies in 4 patients. Treatment with immunosuppressant or immunomodulatory drugs led to sustained clinical response in 19/52 patients. CONCLUSION Anti-IgLON5 autoimmunity should be considered in patients with sleep disorders, bulbar syndrome, autonomic involvement, and movement disorders, and high-field brain MRI can be of diagnostic help.
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Affiliation(s)
- Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emma Frasson
- Neurology Ward, Ospedale di Cittadella, Cittadella, Italy
| | - Davide Cardellini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sara Mariotto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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18
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Cavallaro T, Tagliapietra M, Fabrizi GM, Bai Y, Shy ME, Vallat JM. Hereditary neuropathies: A pathological perspective. J Peripher Nerv Syst 2021; 26 Suppl 2:S42-S60. [PMID: 34499384 DOI: 10.1111/jns.12467] [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] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/30/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022]
Abstract
Hereditary neuropathies may result from mutations in genes expressed by Schwann cells or neurons that affect selectively the peripheral nervous system (PNS) or may represent a minor or major component of complex inherited diseases that involve also the central nervous system and/or other organs and tissues. The chapter is constantly expanding and reworking, thanks to advances of molecular genetics; next-generation sequencing is identifying a plethora of new genes and is revolutionizing the diagnostic approach. In the past, diagnostic sural nerve biopsies paved the way to the discovery and elucidation of major genes and molecular pathways associated to most frequent hereditary motor-sensory neuropathies. Nowadays, a sural nerve biopsy may prove useful in selected cases for the differential diagnosis of an acquired neuropathy when clinical examination, nerve conduction studies, and molecular tests are not sufficiently informative. Skin biopsy has emerged as a minimally invasive window on the PNS, which may provide biomarkers of progression and clues to the physiopathology and molecular pathology of inherited neuropathies. The aim of our review is to illustrate the pathological features of more frequent and paradigmatic hereditary neuropathies and to highlight their correlations with the roles of the involved genes and functional consequences of related molecular defects.
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Affiliation(s)
- Tiziana Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, VR, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, VR, Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, VR, Italy
| | - Yunhong Bai
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Michael E Shy
- Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for "Rare Peripheral Neuropathies", CHU Dupuytren, Limoges, France
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19
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Tagliapietra M, Cardellini D, Ferrarini M, Testi S, Ferrari S, Monaco S, Cavallaro T, Fabrizi GM. RFC1 AAGGG repeat expansion masquerading as Chronic Idiopathic Axonal Polyneuropathy. J Neurol 2021; 268:4280-4290. [PMID: 33884451 PMCID: PMC8505379 DOI: 10.1007/s00415-021-10552-3] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/01/2021] [Accepted: 04/08/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND A biallelic intronic AAGGG repeat expansion in the Replication Factor C subunit 1 (RFC1) gene has been recently associated with Cerebellar Ataxia, Neuropathy, Vestibular Areflexia Syndrome, a disorder often presenting as a slowly evolving sensory neuropathy at the onset. "Chronic Idiopathic Axonal Polyneuropathy" (CIAP) is a common indolent axonal neuropathy of adulthood which remains without an identifiable cause despite thorough investigations. METHODS We screened 234 probands diagnosed with CIAP for a pathogenic biallelic RFC1 AAGGG repeat expansion. Patients were selected from 594 consecutive patients with neuropathy referred to our tertiary-care center for a sural nerve biopsy over 10 years. RESULTS The RFC1 AAGGG repeat expansion was common in patients with pure sensory neuropathy (21/40, 53%) and less frequent in cases with predominantly sensory (10/56, 18%, P < 0.001) or sensorimotor (3/138, 2%, P < 0.001) neuropathy. The mutation was associated with sensory ataxia (τb = 0.254, P < 0.001), autonomic disturbances (35% vs 8%, Prevalence Odds Ratio-POR 6.73 CI 95% 2.79-16.2, P < 0.001), retained deep tendon reflexes (score 18.0/24 vs 11.5/24, R = 0.275, P < 0.001). On pathology, we observed absent/scant regenerative changes (τb = - 0.362, P < 0.001), concomitant involvement of large (100% and 99%, n.s.), small myelinated (97% vs 81%, POR 7.74 CI 95% 1.03-58.4, P = 0.02) and unmyelinated nerve fibers (85% vs 41%, POR 8.52 CI 95% 3.17-22.9, P < 0.001). Cerebellar or vestibular involvement was similarly rare in the two groups. CONCLUSIONS This study highlights the frequent occurrence of the RFC1 AAGGG repeat expansion in patients diagnosed with CIAP and characterizes the clinical and pathological features of the related neuro(no)pathy.
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Affiliation(s)
- Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Davide Cardellini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Moreno Ferrarini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Silvia Testi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy
| | - Gian Maria Fabrizi
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134, Verona, VR, Italy.
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20
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Magliano L, Obici L, Sforzini C, Mazzeo A, Russo M, Cappelli F, Fenu S, Luigetti M, Tagliapietra M, Gemelli C, Leonardi L, Tozza S, Pradotto LG, Citarelli G, Mauro A, Manganelli F, Antonini G, Grandis M, Fabrizi GM, Sabatelli M, Pareyson D, Perfetto F, Merlini G, Vita G. Psychosocial burden and professional and social support in patients with hereditary transthyretin amyloidosis (ATTRv) and their relatives in Italy. Orphanet J Rare Dis 2021; 16:163. [PMID: 33827635 PMCID: PMC8028211 DOI: 10.1186/s13023-021-01812-6] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 03/31/2021] [Indexed: 12/27/2022] Open
Abstract
Background Hereditary transthyretin amyloidosis (hATTR), alias ATTR variant (ATTRv) is a severe and disabling disease causing sensory and motor neuropathy, autonomic dysfunction, and cardiomyopathy. The progressive decline of patient’s functional autonomy negatively affects the patient’s quality of life and requires increasing involvement of relatives in the patient’s daily life. Family caregiving may become particularly demanding when the patient is no longer able to move independently. This study is focused on the psychosocial aspects of ATTRv from the patient and relative perspectives. In particular, it explored: the practical and psychological burdens experienced by symptomatic patients with ATTRv and their key relatives and the professional and social network support they may rely on; whether burden varied in relation to patients’ and relatives’ socio-demographic variables, patients’ clinical variables, and perceived professional and social network support; and, any difference in burden and support between patients and their matched relatives. Methods The study was carried out on symptomatic patients included in the ATTRv Italian national registry and living with at least one adult relative not suffering from severe illness and being free from ATTRv symptoms. Patients and relatives’ assessments were performed using validated self-reported tools. Results Overall, 141 patients and 69 relatives were evaluated. Constraints of leisure activities, feelings of loss and worries for the future were the consequences of ATTRv most frequently reported by patients and relatives. Both in patients and their relatives, the burden increased with the duration of symptoms and the level of help in daily activities needed by the patient. In the 69 matched patient-relative pairs, the practical burden was significantly higher among the patients than among their relatives, while the psychological burden was similar in the two groups. Moreover, compared to their relatives, patients with ATTRv reported higher levels of professional and social network support. Conclusions These results show that ATTRv is a disease affecting quality of life of both patients and their families. Supporting interventions should be guaranteed to patients, to facilitate their adaptation to the disease, and to their families, to cope as best as possible with the difficulties that this pathology may involve. Supplementary Information The online version contains supplementary material available at 10.1186/s13023-021-01812-6.
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Affiliation(s)
- Lorenza Magliano
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy.
| | - Laura Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Claudia Sforzini
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Massimo Russo
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Cappelli
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Silvia Fenu
- Rare Neurodegenerative and Neurometabolic Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS. UOC Neurologia, Rome, Italy.,Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Tagliapietra
- Department of Neuroscience, Biomedicine and Movement Sciences, University and AOUI Verona, Verona, Italy
| | - Chiara Gemelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Leonardi
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Tozza
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Luca Guglielmo Pradotto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Unit of Neurology and Neurorehabilitation, IRCCS - Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - Giulia Citarelli
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, 81100, Caserta, Italy
| | - Alessandro Mauro
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Unit of Neurology and Neurorehabilitation, IRCCS - Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive Sciences and Odontostomatology, University of Naples, Federico II, Naples, Italy
| | - Giovanni Antonini
- Department of Neurosciences, Mental Health and Sensory Organs, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marina Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Movement Sciences, University and AOUI Verona, Verona, Italy
| | - Mario Sabatelli
- Dipartimento Di Neuroscienze, Università Cattolica del Sacro Cuore, Rome, Italy.,NEuroMuscular Omnicentre (NEMO), Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Davide Pareyson
- Rare Neurodegenerative and Neurometabolic Diseases Unit, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Federico Perfetto
- Tuscan Regional Amyloidosis Centre, Careggi University Hospital, Florence, Italy
| | - Giampaolo Merlini
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Giuseppe Vita
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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21
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Perra D, Bongianni M, Novi G, Janes F, Bessi V, Capaldi S, Sacchetto L, Tagliapietra M, Schenone G, Morbelli S, Fiorini M, Cattaruzza T, Mazzon G, Orrù CD, Catalan M, Polverino P, Bernardini A, Pellitteri G, Valente M, Bertolotti C, Nacmias B, Maggiore G, Cavallaro T, Manganotti P, Gigli G, Monaco S, Nobili F, Zanusso G. Alpha-synuclein seeds in olfactory mucosa and cerebrospinal fluid of patients with dementia with Lewy bodies. Brain Commun 2021; 3:fcab045. [PMID: 33870192 PMCID: PMC8042247 DOI: 10.1093/braincomms/fcab045] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/08/2021] [Accepted: 02/10/2021] [Indexed: 01/09/2023] Open
Abstract
In patients with suspected dementia with Lewy bodies, the detection of the disease-associated α-synuclein in easily accessible tissues amenable to be collected using minimally invasive procedures remains a major diagnostic challenge. This approach has the potential to take advantage of modern molecular assays for the diagnosis of α-synucleinopathy and, in turn, to optimize the recruitment and selection of patients in clinical trials, using drugs directed at counteracting α-synuclein aggregation. In this study, we explored the diagnostic accuracy of α-synuclein real-time quaking-induced conversion assay by testing olfactory mucosa and CSF in patients with a clinical diagnosis of probable (n = 32) or prodromal (n = 5) dementia with Lewy bodies or mixed degenerative dementia (dementia with Lewy bodies/Alzheimer's disease) (n = 6). Thirty-eight patients with non-α-synuclein-related neurodegenerative and non-neurodegenerative disorders, including Alzheimer's disease (n = 10), sporadic Creutzfeldt-Jakob disease (n = 10), progressive supranuclear palsy (n = 8), corticobasal syndrome (n = 1), fronto-temporal dementia (n = 3) and other neurological conditions (n = 6) were also included, as controls. All 81 patients underwent olfactory swabbing while CSF was obtained in 48 participants. At the initial blinded screening of olfactory mucosa samples, 38 out of 81 resulted positive while CSF was positive in 19 samples out of 48 analysed. After unblinding of the results, 27 positive olfactory mucosa were assigned to patients with probable dementia with Lewy bodies, five with prodromal dementia with Lewy bodies and three to patients with mixed dementia, as opposed to three out 38 controls. Corresponding results of CSF testing disclosed 10 out 10 positive samples in patients with probable dementia with Lewy bodies and six out of six with mixed dementia, in addition to three out of 32 for controls. The accuracy among results of real-time quaking-induced conversion assays and clinical diagnoses was 86.4% in the case of olfactory mucosa and 93.8% for CSF. For the first time, we showed that α-synuclein real-time quaking-induced conversion assay detects α-synuclein aggregates in olfactory mucosa of patients with dementia with Lewy bodies and with mixed dementia. Additionally, we provided preliminary evidence that the combined testing of olfactory mucosa and CSF raised the concordance with clinical diagnosis potentially to 100%. Our results suggest that nasal swabbing might be considered as a first-line screening procedure in patients with a diagnosis of suspected dementia with Lewy bodies followed by CSF analysis, as a confirmatory test, when the result in the olfactory mucosa is incongruent with the initial clinical diagnosis.
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Affiliation(s)
- Daniela Perra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Matilde Bongianni
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Giovanni Novi
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Francesco Janes
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Valentina Bessi
- Department of Neuroscience, Psychology, Drug Research and Child Health, 50134 University of Florence, Azienda Ospedaliera-Universitaria Careggi, Florence, Italy
| | - Stefano Capaldi
- Biocrystallography Laboratory, Department of Biotechnology, University of Verona, 37134 Verona, Italy
| | - Luca Sacchetto
- Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Guido Schenone
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
| | - Silvia Morbelli
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Health Science (DISSAL), University of Genova, 16132 Genova, Italy
| | - Michele Fiorini
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Tatiana Cattaruzza
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Giulia Mazzon
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Christina D Orrù
- Laboratory of Persistent Viral Diseases, Rocky Mountain Laboratories, National Institute for Allergy and Infectious Diseases, National Institutes of Health, Hamilton, 59840 Montana, USA
| | - Mauro Catalan
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Paola Polverino
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Andrea Bernardini
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Gaia Pellitteri
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Mariarosa Valente
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Claudio Bertolotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Benedetta Nacmias
- Department of Neuroscience, Psychology, Drug Research and Child Health, University of Florence, Azienda Ospedaliera- Universitaria Careggi, 50134 Florence, Italy
- IRCCS Fondazione Don Carlo Gnocchi, 50143 Florence, Italy
| | - Giandomenico Maggiore
- Department of Otorhinolaryngology, Careggi University Hospital, 50134 Florence, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Paolo Manganotti
- Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Cattinara University Hospital ASUGI, University of Trieste, 34128 Trieste, Italy
| | - Gianluigi Gigli
- Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, 33100 Udine, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
| | - Flavio Nobili
- IRCCS Ospedale Policlinico San Martino, 16132 Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child health (DINOGMI), University of Genova, 16132 Genova, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Policlinico G. B. Rossi, 37134 Verona, Italy
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Tagliapietra M, Crescenzo F, Castellotti B, Gellera C, Polo D, Cavallaro T, Zanette G, Fabrizi GM. Peripheral nerve enlargement on nerve ultrasound parallels neuropathological changes in adult-onset Krabbe disease. Muscle Nerve 2021; 63:E33-E35. [PMID: 33455011 DOI: 10.1002/mus.27175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/05/2022]
Affiliation(s)
- Matteo Tagliapietra
- Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Verona, Italy
| | - Francesco Crescenzo
- Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Verona, Italy
| | - Barbara Castellotti
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cinzia Gellera
- Unit of Medical Genetics and Neurogenetics, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Diana Polo
- Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Verona, Italy
| | - Tiziana Cavallaro
- Neurology Division, Department of Neuroscience, AOUI Verona, Verona, Italy
| | | | - Gian Maria Fabrizi
- Department of Neuroscience, Biomedicine and Motor Sciences, University of Verona, Verona, Italy
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23
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Danese A, Federico A, Martini A, Mantovani E, Zucchella C, Tagliapietra M, Tamburin S, Cavallaro T, Marafioti V, Monaco S, Turri G. QTc Prolongation in Patients with Dementia and Mild Cognitive Impairment: Neuropsychological and Brain Imaging Correlations. J Alzheimers Dis 2020; 72:1241-1249. [PMID: 31683480 DOI: 10.3233/jad-190632] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The QTc interval is the electrocardiographic manifestation of ventricular depolarization and repolarization. This marker is often prolonged in acute and chronic neurological conditions. The cause of the cerebrogenic QT prolongation remains unclear. The aim of the study was to analyze the relation between QTc interval and the degree of cognitive impairment and structural brain imaging changes in patients with dementia and mild cognitive impairment (MCI). To this aim, 269 patients were screened, of whom 61 met one or more exclusion criteria. The remaining 208 patients (56 control subjects, 44 patients with MCI, and 108 with dementia) were recruited. Eighty-five patients using drugs causing prolongation of QT interval were further excluded. The QT interval was measured manually in all 12 leads by a single blinded observer, assuming the longest QT value adjusted for heart rate by using the Bazett's formula. All patients underwent a structural brain imaging and the following measures were obtained: the bicaudate ratio and the periventricular hyperintensity and deep white matter hyperintensity using the modified Fazekas scale. Prolonged QTc interval was prevalent in 1) patients with dementia, especially in those with moderate-severe degree; 2) subjects with impairment of praxis and attention, low functional status, and behavioral symptoms; 3) patients with global and temporal atrophy and with higher scores on the Fazekas or leukoaraiosis scales. Degenerative and vascular processes might play a main role in QTc interval prolongation because of the damage to brain areas involved in the control of the autonomic cardiac nervous system.
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Affiliation(s)
- Alessandra Danese
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Angela Federico
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Alice Martini
- School of Psychology, Keele University, Newcastle-under-Lyme, United Kingdom
| | - Elisa Mantovani
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Chiara Zucchella
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Stefano Tamburin
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Tiziana Cavallaro
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Vincenzo Marafioti
- Cardiovascular and Thoracic Department, University Hospital of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Turri
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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24
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Tagliapietra M, Zanusso G, Ferrari S, Orlandi R, Bertolasi L, Cavallaro T, Monaco S. Myelin uncompaction and axo-glial detachment in chronic ataxic neuropathy with monospecific IgM antibody to ganglioside GD1b. J Peripher Nerv Syst 2019; 25:54-59. [PMID: 31837178 DOI: 10.1111/jns.12359] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 12/01/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022]
Abstract
To describe clinical features, disease course, treatment response, and sural nerve biopsy findings in a patient with chronic sensory ataxic neuropathy, Binet stage A chronic lymphocytic leukemia, and monoclonal IgMλ paraprotein against ganglioside GD1b. During 9 months of hospitalization at two neurologic centers, the patient underwent serial neurologic examinations, neurophysiologic studies, imaging investigations, extensive laboratory work-up, bone marrow, and sural nerve biopsies. The patient had a severe progressive sensory neuropathy accompanied by motor involvement, dysautonomia, and marked bulbar weakness with preserved ocular movements. Conduction studies were characterized by prolonged F-wave minimal latencies, prolonged distal latencies, reduction of compound motor action potentials, and absence of sensory nerve action potentials. Sural nerve biopsy showed endoneurial edema, axonal degeneration, and regeneration, in the absence of cellular inflammation, macrophagic activation, and B-lymphocyte infiltration; no IgM or complement deposition was detected. Myelinated fibers showed redundant/abnormally thickened myelin, myelin vacuolation, and frank intramyelinic edema with condensed axoplasm. Ultrastructural features included axo-glial detachment, disruption of membrane integrity, and myelin uncompaction. This study shows that monospecific anti-GD1b IgM paraprotein is associated with non-inflammatory nerve damage. We suggest that the loss of myelin and axonal integrity reflects antibody-induced disruption of membrane lipid rafts.
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Affiliation(s)
- Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.,Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.,Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Sergio Ferrari
- Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Riccardo Orlandi
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.,Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | | | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Italy.,Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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25
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Marangi A, Tagliapietra M, Vicenzi V, Pasquin I, Salviati A. Teaching NeuroImages: Brain MRI and DaT-SPECT imaging in adult GM1 gangliosidosis. Neurology 2019; 91:e187-e188. [PMID: 29987186 DOI: 10.1212/wnl.0000000000005775] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Antonio Marangi
- From the Department of Neurosciences, Biomedicine and Movement Sciences (A.M., M.T., V.V., A.S.), and Interdisciplinary Group for Hereditary Metabolic Diseases (GIMME) (A.S.), University of Verona; and Department of Nuclear Medicine (I.P.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
| | - Matteo Tagliapietra
- From the Department of Neurosciences, Biomedicine and Movement Sciences (A.M., M.T., V.V., A.S.), and Interdisciplinary Group for Hereditary Metabolic Diseases (GIMME) (A.S.), University of Verona; and Department of Nuclear Medicine (I.P.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Virginia Vicenzi
- From the Department of Neurosciences, Biomedicine and Movement Sciences (A.M., M.T., V.V., A.S.), and Interdisciplinary Group for Hereditary Metabolic Diseases (GIMME) (A.S.), University of Verona; and Department of Nuclear Medicine (I.P.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Isabella Pasquin
- From the Department of Neurosciences, Biomedicine and Movement Sciences (A.M., M.T., V.V., A.S.), and Interdisciplinary Group for Hereditary Metabolic Diseases (GIMME) (A.S.), University of Verona; and Department of Nuclear Medicine (I.P.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Alessandro Salviati
- From the Department of Neurosciences, Biomedicine and Movement Sciences (A.M., M.T., V.V., A.S.), and Interdisciplinary Group for Hereditary Metabolic Diseases (GIMME) (A.S.), University of Verona; and Department of Nuclear Medicine (I.P.), Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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26
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Cagnin A, Mariotto S, Fiorini M, Gaule M, Bonetto N, Tagliapietra M, Buratti E, Zanusso G, Ferrari S, Monaco S. Microglial and Neuronal TDP-43 Pathology in Anti-IgLON5-Related Tauopathy. J Alzheimers Dis 2018; 59:13-20. [PMID: 28550263 DOI: 10.3233/jad-170189] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A novel neuronal tauopathy, mainly confined to hypothalamus and brainstem tegmentum, has recently been reported in patients with autoantibodies to the neuronal cell-adhesion molecule IgLON5. We describe a patient with anti-IgLON5 syndrome, who presented with dysautonomia and sleep disorder, followed by subacute dementia. Postmortem brain examination disclosed neuronal tau pathology prevailing in the hippocampus, amygdala, and locus coeruleus, in addition to microglial/neuronal TDP-43 pathology, with overexpression of aberrantly phosphorylated forms and neurotoxic truncated fragments, in basal ganglia, nucleus basalis, thalamus, and midbrain. These findings suggest that neurodegeneration in anti-IgLON5 syndrome might also occur via a microglia-triggered non-cell autonomous pathway.
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Affiliation(s)
| | - Sara Mariotto
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Michele Fiorini
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Marina Gaule
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Nicola Bonetto
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Matteo Tagliapietra
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Emanuele Buratti
- Molecular Pathology Group, International Centre for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Gianluigi Zanusso
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Sergio Ferrari
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Salvatore Monaco
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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27
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Cagnin A, Simioni M, Tagliapietra M, Citton V, Pompanin S, Della Puppa A, Ermani M, Manara R. A Simplified Callosal Angle Measure Best Differentiates Idiopathic-Normal Pressure Hydrocephalus from Neurodegenerative Dementia. J Alzheimers Dis 2015; 46:1033-8. [DOI: 10.3233/jad-150107] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Annachiara Cagnin
- Department of Neurosciences, University of Padova, Padova, Italy
- IRCCS San Camillo Hospital Foundation, Venice, Italy
| | | | | | | | - Sara Pompanin
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Mario Ermani
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Renzo Manara
- Neuroradiology, Section of Neurosciences, University of Salerno, Salerno, Italy
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28
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Tagliapietra M, Zanusso G, Fiorini M, Bonetto N, Zarantonello G, Zambon A, Ermani M, Monaco S, Manara R, Cagnin A. Accuracy of diagnostic criteria for sporadic creutzfeldt-jakob disease among rapidly progressive dementia. J Alzheimers Dis 2013. [PMID: 23207489 DOI: 10.3233/jad-121873] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rapidly progressive dementia (RPD) is a rare presentation of different neurological disorders characterized by cognitive impairment leading to loss of functional independence within 24 months or less. The increasing recognition of treatable non-prion causes of RPD has made the differential diagnosis with sporadic Creutzfeldt-Jakob disease (sCJD) of crucial importance. We therefore assessed the frequency of different etiologies of RPD and evaluated the accuracy of newly proposed diagnostic criteria for sCJD. Clinical records of patients with RPD referred to Memory Clinic between 2007 and 2012 were retrospectively analyzed. The accuracy of diagnostic criteria for sCJD was evaluated by: a) MRI images in DWI and FLAIR sequences; and (b) CSF 14-3-3 protein. In addition, CSF total tau protein level was also assessed. Final diagnosis was obtained after a 1-year follow-up or after autopsy. Among 37 patients with RPD, the most frequent causes were non-prion diseases, either untreatable (38%) or potentially treatable (32%), thus leaving sCJD as a less frequent cause (30%). DWI images had a sensitivity of 73% and specificity of 96%, while FLAIR yielded a very low sensitivity (40%). CSF 14-3-3 protein had a sensitivity of 100%, but a very low specificity (43%). The strongest independent predictor of sCJD diagnosis was the CSF tau level (p = 0.002) (91% sensitivity, 83% specificity). Treatable causes of RPD are as frequent as sCJD and a rapid differential diagnosis is mandatory. We suggest that DWI images and CSF analysis combining 14-3-3 and total tau protein determination hold the best informative diagnostic values.
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Affiliation(s)
- Matteo Tagliapietra
- Department of Neurosciences, SNPSRR, University of Padova, Via Giustiniani 5, Padua, Italy
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29
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Attanasio A, Bedin M, Stocco S, Negrin V, Biancon A, Cecchetto G, Tagliapietra M. Clinical outcomes and complications of enteral nutrition among older adults. Minerva Med 2009; 100:159-166. [PMID: 19390502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
AIM Several reviews or clinical trials published in the last years have not demonstrated that tube feeding can improve outcomes, including inhalation pneumonia, survival, pressure sores. Further, high rate of risks are recognized. Therefore, this practice should be discouraged for severely demented patients. The aim of this study was to assess the validity of these findings in a sanitary district in the Venetian Region, Italy, characterized by a fully integrated program of territorial-hospital care and where enteral nutrition (EN) is supervised by a specialized nutritional team (NT). METHODS A distinctive aspect of this study concerns the fact that all patients with tube feeding were followed at home, in hospital, in nursing home by the same NT. The team controls the selection of patients and supports the follow-up, according to the guidelines of the Italian Society of Parenteral and Enteral nutrition. The study provides a prospective evaluation including 108 patients, mean age 78.2 years, followed for 12 months. Each patient underwent multidimensional tests, including activities of daily living, instrumental activities of daily living, Norton, Pfeiffer and Karnofsky scales, and anthropometric and biochemical indicators of nutritional status. RESULTS The main diagnoses were dementia (72 patients), stroke (23 patients), malignancy (5 patients), amyotrophic lateral sclerosis (3 patients) and miscellaneous disease (5 patients). EN was delivered by PEG (62 patient), NGT (45 patient), jejunostomy in one patient. The main complications of nasogastric tube versus PEG have been inhalation 15.5% and 7.9%, respectively, tube displacement 62.2%, and 4.7%, tube clogging 11.1% and 7.9 %. The first month mortality rate was 7.4% and 23.1% at one year. The mean survival was 674 days. CONCLUSIONS Almost all complications have been mild and could be managed throughout adequately. Their prevalence is low, with reference to the long period of follow-up, for a whole of 39420 days. Tube displacement is frequent with NGT but not with PEG and may be a cause of physical restraint, compromising in this way patient's quality of life. In this study, survival was nearly three times higher than reported in literature. These positive outcomes may be the result of two factors. First, the selection and follow-up program was supervised by the same nutritional team. Second, the network of integrated services of continuing care, including nursing homes, hospital and home care.
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Affiliation(s)
- A Attanasio
- Division of Long Hospitalization Ward, Department of Rehabilitation, S. Giacomo Hospital, Castelfranco Veneto, Treviso, Italy.
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