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D’Onghia D, Colangelo D, Bellan M, Tonello S, Puricelli C, Virgilio E, Apostolo D, Minisini R, Ferreira LL, Sozzi L, Vincenzi F, Cantello R, Comi C, Pirisi M, Vecchio D, Sainaghi PP. Gas6/TAM system as potential biomarker for multiple sclerosis prognosis. Front Immunol 2024; 15:1362960. [PMID: 38745659 PMCID: PMC11091300 DOI: 10.3389/fimmu.2024.1362960] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/03/2024] [Indexed: 05/16/2024] Open
Abstract
Introduction The protein growth arrest-specific 6 (Gas6) and its tyrosine kinase receptors Tyro-3, Axl, and Mer (TAM) are ubiquitous proteins involved in regulating inflammation and apoptotic body clearance. Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system leading to progressive and irreversible disability if not diagnosed and treated promptly. Gas6 and TAM receptors have been associated with neuronal remyelination and stimulation of oligodendrocyte survival. However, few data are available regarding clinical correlation in MS patients. We aimed to evaluate soluble levels of these molecules in the cerebrospinal fluid (CSF) and serum at MS diagnosis and correlate them with short-term disease severity. Methods In a prospective cohort study, we enrolled 64 patients with a diagnosis of clinical isolated syndrome (CIS), radiological isolated syndrome (RIS) and relapsing-remitting (RR) MS according to the McDonald 2017 Criteria. Before any treatment initiation, we sampled the serum and CSF, and collected clinical data: disease course, presence of gadolinium-enhancing lesions, and expanded disability status score (EDSS). At the last clinical follow-up, we assessed EDSS and calculated MS severity score (MSSS) and age-related MS severity (ARMSS). Gas6 and TAM receptors were determined using an ELISA kit (R&D Systems) and compared to neurofilament (NFLs) levels evaluated with SimplePlex™ fluorescence-based immunoassay. Results At diagnosis, serum sAxl was higher in patients receiving none or low-efficacy disease-modifying treatments (DMTs) versus patients with high-efficacy DMTs (p = 0.04). Higher CSF Gas6 and serum sAXL were associated with an EDSS <3 at diagnosis (p = 0.04; p = 0.037). Serum Gas6 correlates to a lower MSSS (r2 = -0.32, p = 0.01). Serum and CSF NFLs were confirmed as disability biomarkers in our cohort according to EDSS (p = 0.005; p = 0.002) and MSSS (r2 = 0.27, p = 0.03; r2 = 0.39, p = 0.001). Results were corroborated using multivariate analysis. Conclusions Our data suggest a protective role of Gas6 and its receptors in patients with MS and suitable severity disease biomarkers.
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Affiliation(s)
- Davide D’Onghia
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences, Pharmacology, University of Piemonte Orientale (UPO), Novara, Italy
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
| | - Chiara Puricelli
- Department of Health Sciences, Clinical Biochemistry, University of Piemonte Orientale (UPO), Novara, Italy
| | - Eleonora Virgilio
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Daria Apostolo
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Luciana L. Ferreira
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Leonardo Sozzi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Federica Vincenzi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
| | - Roberto Cantello
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Cristoforo Comi
- Department of Translational Medicine, Neurology Unit, S. Andrea Hospital, University of Piemonte Orientale (UPO), Vercelli, Italy
| | - Mario Pirisi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
| | - Domizia Vecchio
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
- Department of Translational Medicine, Neurology Unit, Maggiore Della Carità Hospital, University of Piemonte Orientale, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale (UPO), Novara, Italy
- Center for Autoimmune and Allergic Diseases (CAAD), University of Piemonte Orientale (UPO), Novara, Italy
- Department of Health Sciences, Interdisciplinary Research Center of Autoimmune Diseases (IRCAD), University of Piemonte Orientale (UPO), Novara, Italy
- Internal Medicine and Rheumatology Unit, Azienda Ospedaliera Universitaria (AOU) “Maggiore della Carita”, Novara, Italy
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Nerviani A, Boutet MA, Ghirardi GM, Goldmann K, Sciacca E, Rivellese F, Pontarini E, Prediletto E, Abatecola F, Caliste M, Pagani S, Mauro D, Bellan M, Cubuk C, Lau R, Church SE, Hudson BM, Humby F, Bombardieri M, Lewis MJ, Pitzalis C. Axl and MerTK regulate synovial inflammation and are modulated by IL-6 inhibition in rheumatoid arthritis. Nat Commun 2024; 15:2398. [PMID: 38493215 PMCID: PMC10944458 DOI: 10.1038/s41467-024-46564-6] [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: 03/08/2023] [Accepted: 02/27/2024] [Indexed: 03/18/2024] Open
Abstract
The TAM tyrosine kinases, Axl and MerTK, play an important role in rheumatoid arthritis (RA). Here, using a unique synovial tissue bioresource of patients with RA matched for disease stage and treatment exposure, we assessed how Axl and MerTK relate to synovial histopathology and disease activity, and their topographical expression and longitudinal modulation by targeted treatments. We show that in treatment-naive patients, high AXL levels are associated with pauci-immune histology and low disease activity and inversely correlate with the expression levels of pro-inflammatory genes. We define the location of Axl/MerTK in rheumatoid synovium using immunohistochemistry/fluorescence and digital spatial profiling and show that Axl is preferentially expressed in the lining layer. Moreover, its ectodomain, released in the synovial fluid, is associated with synovial histopathology. We also show that Toll-like-receptor 4-stimulated synovial fibroblasts from patients with RA modulate MerTK shedding by macrophages. Lastly, Axl/MerTK synovial expression is influenced by disease stage and therapeutic intervention, notably by IL-6 inhibition. These findings suggest that Axl/MerTK are a dynamic axis modulated by synovial cellular features, disease stage and treatment.
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Affiliation(s)
- Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Marie-Astrid Boutet
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
- Nantes Université, Oniris, INSERM, Regenerative Medicine and Skeleton, RMeS, UMR 1229, F-44000, Nantes, France
| | - Giulia Maria Ghirardi
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Katriona Goldmann
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Elisabetta Sciacca
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Felice Rivellese
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Elena Pontarini
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Edoardo Prediletto
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Federico Abatecola
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Mattia Caliste
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Sara Pagani
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Daniele Mauro
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Mattia Bellan
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
- Department of Rheumatology, University of Eastern Piedmont and Maggiore della Carita Hospital, Novara, Italy
| | - Cankut Cubuk
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Rachel Lau
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | | | | | - Frances Humby
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Michele Bombardieri
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Myles J Lewis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London & NIHR BRC Barts Health NHS Trust, London, UK.
- Department of Biomedical Sciences, Humanitas University & IRCCS Humanitas Research Hospital, Milan, Italy.
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Ferreira LL, Rosatto N, Marzullo P, Bellan M. Circadian variations in the elderly: A scoping review. Chronobiol Int 2024; 41:311-328. [PMID: 38501270 DOI: 10.1080/07420528.2024.2327456] [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: 12/18/2023] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
The circadian clock plays important roles in several physiological processes. With aging, some of these circadian rhythms have been shown to be disrupted and suggested contributing to age-related diseases. The aim of this scoping review was to examine and map the existing evidence of circadian differences between young and older people in body fluid composition. Literature search was carried out on PubMed, Embase, Scopus and OpenGrey. The studies were screened based on inclusion and exclusion criteria by two independent reviewers and the results were summarized tabularly and narratively. The review process resulted in the identification of 1889 publications, of which 42 were eligible for inclusion. Forty-eight parameters or families of parameters were identified, including cortisol and melatonin, sex hormones, thyroid-related hormones, steroids and aldosterone. However, many were reported by only a single study. The results from the studies were heterogeneous. Even though the majority suggested the flattening of several circadian oscillations in the elderly population, this was not always observed for all the parameters analyzed, and some contradictory results were found. This review revealed a substantial number of publications that explored this research question, but further studies would be important to elucidate the clinical significance of these alterations.
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Affiliation(s)
- Luciana L Ferreira
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nadia Rosatto
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
- Center on Autoimmune and Allergic Diseases, Università del Piemonte Orientale, Novara, Italy
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4
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Sacchetti S, Vidali M, Esposito T, Zorzi S, Burgener A, Ciccarello L, Cammarota G, Zanotti V, Giacomini L, Bellan M, Pirisi M, Lopez RS, Dianzani U, Vaschetto R, Rolla R. The Role of New Morphological Parameters Provided by the BC 6800 Plus Analyzer in the Early Diagnosis of Sepsis. Diagnostics (Basel) 2024; 14:340. [PMID: 38337856 PMCID: PMC10855753 DOI: 10.3390/diagnostics14030340] [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: 12/29/2023] [Revised: 01/31/2024] [Accepted: 02/02/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Late diagnosis of sepsis is associated with adverse consequences and high mortality rate. The aim of this study was to evaluate the diagnostic value of hematologic research parameters, that reflect the cell morphology of blood cells, available on the BC 6800 plus automated analyzer (Mindray) for the early detection of sepsis. MATERIALS AND METHODS A complete blood count (CBC) was performed by Mindray BC 6800 Plus Analyzer in 327 patients (223 with a confirmed diagnosis of sepsis following sepsis-3 criteria, 104 without sepsis), admitted at the Intensive Care Unit of the Novara's Hospital (Italy) and in 56 patients with localized infection. RESULTS In univariate logistic regression, age, Hb, RDW, MO#, NMR, NeuX, NeuY, NeuZ, LymX, MonX, MonY, MonZ were associated with sepsis (p < 0.005). In multivariate analysis, only RDW, NeuX, NeuY, NeuZ, MonX and MonZ were found to be independent predictors of sepsis (p < 0.005). Morphological research parameters are confirmed to be predictors of sepsis even when analyzing the group with localized infection. CONCLUSIONS In addition to already established biomarkers and basic CBC parameters, new morphological cell parameters can be a valuable aid in the early diagnosis of sepsis at no additional cost.
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Affiliation(s)
- Sara Sacchetti
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Matteo Vidali
- Clinical Pathology Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Teresa Esposito
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Stefano Zorzi
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Alessia Burgener
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Lorenzo Ciccarello
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Gianmaria Cammarota
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Valentina Zanotti
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Luca Giacomini
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Mattia Bellan
- Department of Translational Medicine, Division of Internal Medicine, Università del Piemonte Orientale, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (M.B.); (M.P.)
| | - Mario Pirisi
- Department of Translational Medicine, Division of Internal Medicine, Università del Piemonte Orientale, “Maggiore della Carità” University Hospital, 28100 Novara, Italy; (M.B.); (M.P.)
| | - Ramon Simon Lopez
- Medical Xpert Systems SA, Brunnenmattstrasse 6, 6317 Oberwil bei Zug, Switzerland;
| | - Umberto Dianzani
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
| | - Rosanna Vaschetto
- Unit of Anaesthesia and Intensive Care, Department of Translational Medicine, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (T.E.); (S.Z.); (A.B.); (L.C.); (G.C.); (R.V.)
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Department of Health Sciences, Università del Piemonte Orientale, Maggiore della Carità University Hospital, 28100 Novara, Italy; (S.S.); (V.Z.); (L.G.); (U.D.); (R.R.)
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Sola D, Smirne C, Bruggi F, Bottino Sbaratta C, Tamen Njata AC, Valente G, Pavanelli MC, Vitetta R, Bellan M, De Paoli L, Pirisi M. Unveiling the Mystery of Adult-Onset Still's Disease: A Compelling Case Report. Life (Basel) 2024; 14:195. [PMID: 38398704 PMCID: PMC10890189 DOI: 10.3390/life14020195] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Adult-onset Still's disease (AOSD) is a rare systemic inflammatory disorder. Diagnosis can take a long time, especially in the presence of confounding factors, and it is, to some extent, a process of exclusion. AOSD has life-threating complications ranging from asymptomatic to severe, such as macrophage activation syndrome (MAS), which is also referred to as hemophagocytic lymphohistocytosis (HLH). This condition is correlated with cytokine storm production and monocyte/macrophage overactivation and typically occurs with rash, pyrexia, pancytopenia, hepatosplenomegaly and systemic involvement. Exitus occurs in approximately 10% of cases. For the treatment of MAS-HLH, the Histiocyte Society currently suggests high-dose corticosteroids, with the possible addition of cyclosporine A, anti-interleukin (IL)-1, or IL-6 biological drugs; the inclusion of etoposide is recommended for the most severe conditions. In all cases, a multidisciplinary collaboration involving the resources and expertise of several specialists (e.g., rheumatologist, infectiologist, critical care medicine specialist) is advised. Herein, we provide a detailed description of the clinical case of a previously healthy young woman in which MAS developed as a dramatic onset manifestation of AOSD and whose diagnosis posed a real clinical challenge; the condition was finally resolved by applying the HLH-94 protocol (i.e., etoposide in combination with dexamethasone).
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Affiliation(s)
- Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
| | - Carlo Smirne
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Francesco Bruggi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Chiara Bottino Sbaratta
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Aubin Cardin Tamen Njata
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Guido Valente
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Pathology Unit, Sant'Andrea Hospital, 13100 Vercelli, Italy
| | | | - Rosetta Vitetta
- Rheumatology Unit, Sant'Andrea Hospital, 13100 Vercelli, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
| | | | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
- Internal Medicine Unit, Maggiore della Carità Hospital, 28100 Novara, Italy
- CAAD (Center for Autoimmune and Allergic Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
- IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale, 28100 Novara, Italy
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6
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Screm G, Mondini L, Confalonieri P, Salton F, Trotta L, Barbieri M, Mari M, Reccardini N, Della Porta R, Kodric M, Bandini G, Hughes M, Bellan M, Lerda S, Confalonieri M, Ruaro B. Nailfold Capillaroscopy Analysis Can Add a New Perspective to Biomarker Research in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis. Diagnostics (Basel) 2024; 14:254. [PMID: 38337770 PMCID: PMC10854947 DOI: 10.3390/diagnostics14030254] [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: 12/12/2023] [Revised: 01/12/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) includes granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MPA), and eosinophilic granulomatosis with polyangiitis (EGPA), all of which are characterised by inflammation of small-medium-sized vessels. Progressive understanding of these diseases has allowed researchers and clinicians to start discussing nailfold video capillaroscopy (NVC) as a future tool for many applications in daily practice. Today, NVC plays a well-established and validated role in differentiating primary from secondary Raynaud's phenomenon correlated with scleroderma. Nevertheless, there has not been sufficient attention paid to its real potential in the ANCA-associated vasculitis. In fact, the role of NVC in vasculitis has never been defined and studied in a multicentre and multinational study. In this review, we carried out a literature analysis to identify and synthesise the possible role of capillaroscopy for patients with ANCA-associated vasculitis. METHODS Critical research was performed in the electronic archive (PUBMED, UpToDate, Google Scholar, ResearchGate), supplemented with manual research. We searched in these databases for articles published until November 2023. The following search words were searched in the databases in all possible combinations: capillaroscopy, video capillaroscopy, nailfold-video capillaroscopy, ANCA-associated vasculitis, vasculitis, granulomatosis with polyangiitis, EGPA, and microscopic polyangiitis. RESULTS The search identified 102 unique search results. After the evaluation, eight articles were selected for further study. The literature reported that capillaroscopy investigations documented non-specific abnormalities in 70-80% of AAV patients. Several patients showed neoangiogenesis, capillary loss, microhaemorrhages, and bushy and enlarged capillaries as the most frequent findings. Furthermore, the difference between active phase and non-active phase in AAV patients was clearly discernible. The non-active phase showed similar rates of capillaroscopy alterations compared to the healthy subjects, but the active phase had higher rates in almost all common abnormalities instead. CONCLUSIONS Microvascular nailfold changes, observed in patients affected by vasculitis, may correlate with the outcome of these patients. However, these non-specific abnormalities may help in the diagnosis of vasculitis. As such, new analysis analyses are necessary to confirm our results.
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Affiliation(s)
- Gianluca Screm
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Marco Mari
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Nicolò Reccardini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Rossana Della Porta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Giulia Bandini
- Department of Experimental and Clinical Medicine, Division of Internal Medicine, University of Florence, Azienda Ospedaliero–Universitaria Careggi (AOUC), 50134 Florence, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Azienda Ospedaliero–Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milan, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, University of Trieste, Hospital of Cattinara, 34149 Trieste, Italy; (G.S.)
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Apostolo D, Ferreira LL, Vincenzi F, Vercellino N, Minisini R, Latini F, Ferrari B, Burlone ME, Pirisi M, Bellan M. From MASH to HCC: the role of Gas6/TAM receptors. Front Immunol 2024; 15:1332818. [PMID: 38298195 PMCID: PMC10827955 DOI: 10.3389/fimmu.2024.1332818] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/02/2024] [Indexed: 02/02/2024] Open
Abstract
Metabolic dysfunction-associated steatohepatitis (MASH) is the replacement term for what used to be called nonalcoholic steatohepatitis (NASH). It is characterized by inflammation and injury of the liver in the presence of cardiometabolic risk factors and may eventually result in the development of hepatocellular carcinoma (HCC), the most common form of primary liver cancer. Several pathogenic mechanisms are involved in the transition from MASH to HCC, encompassing metabolic injury, inflammation, immune dysregulation and fibrosis. In this context, Gas6 (Growth Arrest-Specific 6) and TAM (Tyro3, Axl, and MerTK) receptors may play important roles. The Gas6/TAM family is involved in the modulation of inflammation, lipid metabolism, fibrosis, tumor progression and metastasis, processes which play an important role in the pathophysiology of acute and chronic liver diseases. In this review, we discuss MASH-associated HCC and the potential involvement of the Gas6/TAM system in disease development and progression. In addition, since therapeutic strategies for MASH and HCC are limited, we also speculate regarding possible future treatments involving the targeting of Gas6 or TAM receptors.
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Affiliation(s)
- Daria Apostolo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luciana L Ferreira
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federica Vincenzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Nicole Vercellino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Federico Latini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Barbara Ferrari
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Michela E Burlone
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
- Center on Autoimmune and Allergic Diseases, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine, Azienda Ospedaliero-Universitaria Maggiore Della Carità, Novara, Italy
- Center on Autoimmune and Allergic Diseases, Università del Piemonte Orientale, Novara, Italy
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Zeqaj I, Piffero R, Calzaducca E, Pirisi M, Bellan M. The Potential Role of Vitamin D Supplementation in Cognitive Impairment Prevention. CNS Neurol Disord Drug Targets 2024; 23:628-637. [PMID: 36998124 DOI: 10.2174/1871527322666230328130417] [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] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 02/12/2023] [Accepted: 02/14/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Vitamin D is implicated in many processes in the central nervous system (CNS), such as neurogenesis, neurotransmitter synthesis, synaptogenesis and protection against oxidative stress, thereby exerting a neuroprotective effect. OBJECTIVE In the present review, we aimed to evaluate the potential benefit(s) of vitamin D supplementation for CNS aging in different clinical contexts. METHODS We performed a literature search, looking for clinical trials and randomized clinical trials evaluating the effect of vitamin D supplementation on different endpoints related to cognitive outcomes. RESULTS Firstly, we identified 16 papers dealing with the impact of vitamin D supplementation on cognitive function in healthy subjects; the current literature suggests a real role for vitamin D supplementation in the prevention of cognitive decay in this clinical setting. Conversely, two papers suggest that vitamin D supplementation may be beneficial in patients with mild cognitive impairment (MCI). Finally, current data on vitamin D in Alzheimer's disease are contradictory. CONCLUSION Vitamin D supplementation may improve the cognitive outcomes of patients with MCI, whereas there is no evidence that it may prevent dementia or modulate the course of Alzheimer's disease.
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Affiliation(s)
- Iris Zeqaj
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale UPO, Novara, Italy
- Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Roberto Piffero
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale UPO, Novara, Italy
- Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Elisa Calzaducca
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale UPO, Novara, Italy
- Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale UPO, Novara, Italy
- Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Università del Piemonte Orientale UPO, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale UPO, Novara, Italy
- Division of Internal Medicine, "AOU Maggiore della Carità", Novara, Italy
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Università del Piemonte Orientale UPO, Novara, Italy
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9
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Patrucco F, Albera C, Bellan M, Zava M, Gavelli F, Balbo PE, Solidoro P. Measure of lung dielectric proprieties in patients with Idiopathic Pulmonary Fibrosis: correlation with clinical, radiological and pulmonary functional parameters. Respir Med 2023; 217:107370. [PMID: 37516274 DOI: 10.1016/j.rmed.2023.107370] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/15/2023] [Accepted: 07/24/2023] [Indexed: 07/31/2023]
Abstract
BACKGROUND Dielectric properties of biological tissues are biophysical parameters; in lung they change with amount of air, blood and parenchyma. Remote Dielectric Sensing (ReDS™) technology measures dielectric properties of lung tissues quantifying the content of fluids inside the scan volume. We aimed to evaluate the reliability of ReDS™ measure in Idiopathic Pulmonary Fibrosis (IPF) patients and in healthy volunteers, and to investigate the correlation of ReDS™ score with clinical, radiological and functional parameters. METHODS We conducted a prospective observational study, including 52 patients with diagnosis of IPF and 17 healthy volunteers; for each patient we recorded: complete functional evaluation, dyspnoea score (mMRC scale), Usual Interstitial Pneumonia (UIP) Computed Tomography (CT) pattern (UIP definite or probable) and ReDS™ measure (expressed in %). RESULTS ReDS™ measure was reported as correct both in patients and controls, the firsts with higher scores (33.8% vs 29.1%, p = 0.003). In IPF patients we observed a significant inverse correlation with ReDS™ score and Forced Vital Capacity (FVC), Vital Capacity (VC) and Total Lung Capacity (TLC) measures and, when we considered only patients with UIP definite CT pattern, the correlation was inverse with FVC, VC, TLC, DLCO. In IPF patients the higher was mMRC dyspnoea index, the higher was ReDS™ score. No significant correlations were observed between ReDS™ score and functional parameters in healthy controls. DISCUSSION We demonstrated a correlation of ReDS™ scores with some functional (mainly indicative or diagnostic for restriction) and clinical parameters in IPF patients; the score was correlated with density of tissues possibly quantifying tissue fibrosis in IPF patients.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità di Novara, Novara, Italy; Translational Medicine Department, University of Eastern Piedmont, Novara, Italy.
| | - Carlo Albera
- Medical Sciences Department, University of Turin, Turin, Italy; Respiratory Diseases Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | - Mattia Bellan
- Translational Medicine Department, University of Eastern Piedmont, Novara, Italy; Division of Internal Medicine, Medical Department, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Martina Zava
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità di Novara, Novara, Italy
| | - Francesco Gavelli
- Translational Medicine Department, University of Eastern Piedmont, Novara, Italy
| | - Piero Emilio Balbo
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità di Novara, Novara, Italy; Translational Medicine Department, University of Eastern Piedmont, Novara, Italy
| | - Paolo Solidoro
- Medical Sciences Department, University of Turin, Turin, Italy; Respiratory Diseases Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, Turin, Italy
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Di Maggio G, Confalonieri P, Salton F, Trotta L, Ruggero L, Kodric M, Geri P, Hughes M, Bellan M, Gilio M, Lerda S, Baratella E, Confalonieri M, Mondini L, Ruaro B. Biomarkers in Systemic Sclerosis: An Overview. Curr Issues Mol Biol 2023; 45:7775-7802. [PMID: 37886934 PMCID: PMC10604992 DOI: 10.3390/cimb45100490] [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: 09/02/2023] [Revised: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Systemic sclerosis (SSc) is a complex autoimmune disease characterized by significant fibrosis of the skin and internal organs, with the main involvement of the lungs, kidneys, heart, esophagus, and intestines. SSc is also characterized by macro- and microvascular damage with reduced peripheral blood perfusion. Several studies have reported more than 240 pathways and numerous dysregulation proteins, giving insight into how the field of biomarkers in SSc is still extremely complex and evolving. Antinuclear antibodies (ANA) are present in more than 90% of SSc patients, and anti-centromere and anti-topoisomerase I antibodies are considered classic biomarkers with precise clinical features. Recent studies have reported that trans-forming growth factor β (TGF-β) plays a central role in the fibrotic process. In addition, interferon regulatory factor 5 (IRF5), interleukin receptor-associated kinase-1 (IRAK-1), connective tissue growth factor (CTGF), transducer and activator of transcription signal 4 (STAT4), pyrin-containing domain 1 (NLRP1), as well as genetic factors, including DRB1 alleles, are implicated in SSc damage. Several interleukins (e.g., IL-1, IL-6, IL-10, IL-17, IL-22, and IL-35) and chemokines (e.g., CCL 2, 5, 23, and CXC 9, 10, 16) are elevated in SSc. While adiponectin and maresin 1 are reduced in patients with SSc, biomarkers are important in research but will be increasingly so in the diagnosis and therapeutic approach to SSc. This review aims to present and highlight the various biomarker molecules, pathways, and receptors involved in the pathology of SSc.
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Affiliation(s)
- Giuseppe Di Maggio
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Pietro Geri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK;
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Medicine, Azienda Ospedaliero–Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Michele Gilio
- Infectious Disease Unit, San Carlo Hospital, 85100 Potenza, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Elisa Baratella
- Department of Radiology, Cattinara Hospital, University of Trieste, 34149 Trieste, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy; (G.D.M.); (M.K.); (P.G.); (L.M.)
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Cifaldi R, Salton F, Confalonieri P, Trotta L, Barbieri M, Ruggero L, Valeri G, Pozzan R, Della Porta R, Kodric M, Baratella E, Bellan M, Lerda S, Hughes M, Confalonieri M, Cova MA, Gandin I, Mondini L, Ruaro B. Pulmonary Sarcoidosis and Immune Dysregulation: A Pilot Study on Possible Correlation. Diagnostics (Basel) 2023; 13:2899. [PMID: 37761266 PMCID: PMC10530165 DOI: 10.3390/diagnostics13182899] [Citation(s) in RCA: 1] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/01/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Sarcoidosis is a systemic inflammatory disease characterized by an altered inflammatory response. OBJECTIVE The aim of this study was to evaluate whether immune system alterations detected by lymphocyte typing in peripheral blood correlate with the severity of sarcoidosis, calculated according to two separate severity scores proposed by Wasfi in 2006 and Hamzeh in 2010. MATERIALS AND METHODS Eighty-one patients were recruited, and clinical data and laboratory tests at the time of diagnosis were obtained in order to assess the severity index score and investigate any statistically significant correlation with the cytofluorimetry data. RESULTS Our data demonstrated that none of the two scores show an association with the level of total lymphocytes or lymphocyte subclasses. LIMITATIONS First of all, the sample taken into consideration is small. The assessment was performed only at disease onset and not during the disease. Furthermore, the severity scores do not take into account disease activity (measured by PET/CT or gallium scintigraphy). CONCLUSIONS Lymphocyte subpopulation values at the time of diagnosis do not appear to correlate with disease severity at onset.
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Affiliation(s)
- Rossella Cifaldi
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianmaria Valeri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Rossana Della Porta
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Metka Kodric
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Elisa Baratella
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine, University Hospital, Maggiore della Carità, 28100 Novara, Italy
| | - Selene Lerda
- Management Specialization School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Maria Assunta Cova
- Department of Radiology, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Ilaria Gandin
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34149 Trieste, Italy
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Healt Sciencies, Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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Apostolo D, Ferreira LL, Di Tizio A, Ruaro B, Patrucco F, Bellan M. A Review: The Potential Involvement of Growth Arrest-Specific 6 and Its Receptors in the Pathogenesis of Lung Damage and in Coronavirus Disease 2019. Microorganisms 2023; 11:2038. [PMID: 37630598 PMCID: PMC10459962 DOI: 10.3390/microorganisms11082038] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/31/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
The tyrosine kinase receptors of the TAM family-Tyro3, Axl and Mer-and their main ligand Gas6 (growth arrest-specific 6) have been implicated in several human diseases, having a particularly important role in the regulation of innate immunity and inflammatory response. The Gas6/TAM system is involved in the recognition of apoptotic debris by immune cells and this mechanism has been exploited by viruses for cell entry and infection. Coronavirus disease 2019 (COVID-19) is a multi-systemic disease, but the lungs are particularly affected during the acute phase and some patients may suffer persistent lung damage. Among the manifestations of the disease, fibrotic abnormalities have been observed among the survivors of COVID-19. The mechanisms of COVID-related fibrosis remain elusive, even though some parallels may be drawn with other fibrotic diseases, such as idiopathic pulmonary fibrosis. Due to the still limited number of scientific studies addressing this question, in this review we aimed to integrate the current knowledge of the Gas6/TAM axis with the pathophysiological mechanisms underlying COVID-19, with emphasis on the development of a fibrotic phenotype.
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Affiliation(s)
- Daria Apostolo
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy; (D.A.); (L.L.F.); (A.D.T.); (M.B.)
| | - Luciana L. Ferreira
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy; (D.A.); (L.L.F.); (A.D.T.); (M.B.)
| | - Alice Di Tizio
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy; (D.A.); (L.L.F.); (A.D.T.); (M.B.)
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Barbara Ruaro
- Pulmonology Department, University of Trieste, 34128 Trieste, Italy;
| | - Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale (UPO), 28100 Novara, Italy; (D.A.); (L.L.F.); (A.D.T.); (M.B.)
- Division of Internal Medicine, Medical Department, AOU Maggiore della Carità Hospital, 28100 Novara, Italy
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13
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Rizzi M, Tonello S, Brinno C, Zecca E, Matino E, Cittone M, Rizzi E, Casciaro GF, D’Onghia D, Colangelo D, Minisini R, Bellan M, Castello LM, Chiocchetti A, Pirisi M, Rigamonti C, Lilleri D, Zavaglio F, Bergami F, Sola D, Sainaghi PP. SARS-CoV-2 infection risk is higher in vaccinated patients with inflammatory autoimmune diseases or liver transplantation treated with mycophenolate due to an impaired antiviral immune response: results of the extended follow up of the RIVALSA prospective cohort. Front Immunol 2023; 14:1185278. [PMID: 37545528 PMCID: PMC10398576 DOI: 10.3389/fimmu.2023.1185278] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 07/07/2023] [Indexed: 08/08/2023] Open
Abstract
Background A relevant proportion of immunocompromised patients did not reach a detectable seroconversion after a full primary vaccination cycle against SARS-CoV-2. The effect of different immunosuppressants and the potential risks for SARS-CoV-2 infection in these subjects is largely unknown. Methods Patients from the Rivalsa prospective, observational cohort study with planned anti SARS-CoV-2 third dose mRNA vaccination between October and December 2021 were asked to participate to this follow-up study. Patients were asked about eventual confirmed positivity to SARS-CoV-2 infection within 6 months from the third dose and to undergo a blood draw to evaluate seroconversion status after the additional vaccine shot. Results 19 out of 114 patients taking part in the survey developed a confirmed SARS-CoV-2 infection; we identified mycophenolate treatment as an independent predictor of an increased risk of infection even after the third vaccine dose (OR: 5.20, 95% CI: 1.70-20.00, p=0.0053). This result is in agreement with the in vitro evidence that MMF impairs both B and T lymphocytes driven immune responses (reduction both in memory B cells producing anti-spike antibodies and in proliferating CD4+ and CD8+ T cells). Conclusions Immunocompromised patients need an additional vaccine administration to reach a detectable seroconversion, thus fostering a more personalized approach to their clinical management. Moreover, patients undergoing mycophenolate treatment show a specific increased infection risk, with respect to other immunosuppressants thus supporting a closer monitoring of their health status.
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Affiliation(s)
- Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), Novara, Italy
| | - Cristiana Brinno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Micol Cittone
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Eleonora Rizzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Giuseppe Francesco Casciaro
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Davide D’Onghia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Division of Internal Medicine, Azienda Ospedaliera “SS. Antonio e Biagio e Cesare Arrigo”, Alessandria, Italy
| | - Annalisa Chiocchetti
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Daniele Lilleri
- Unit of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Zavaglio
- Unit of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Bergami
- Unit of Microbiology and Virology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniele Sola
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, and IRCAD (Interdisciplinary Research Center of Autoimmune Diseases), Università del Piemonte Orientale (UPO), Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, AOU “Maggiore della Carità”, Novara, Italy
- Division of Emergency Medicine and COVID-19 sub-intensive unit, AOU “Maggiore della Carità”, Novara, Italy
- Internal Medicine and Rheumatology Unit, AOU “Maggiore della Carità”, Novara, Italy
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14
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Salton F, Confalonieri P, Meduri GU, Mondini L, Trotta L, Barbieri M, Bozzi C, Torregiani C, Lerda S, Bellan M, Confalonieri M, Ruaro B, Tavano S, Pozzan R. Theory and Practice of Glucocorticoids in COVID-19: Getting to the Heart of the Matter-A Critical Review and Viewpoints. Pharmaceuticals (Basel) 2023; 16:924. [PMID: 37513836 PMCID: PMC10385094 DOI: 10.3390/ph16070924] [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: 05/03/2023] [Revised: 06/18/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
Prolonged, low-dose glucocorticoids (GCs) have shown the highest efficacy among pharmacological and non-pharmacological treatments for COVID-19. Despite the World Health Organization's recommendation against their use at the beginning of the pandemic, GCs at a dose equivalent to dexamethasone 6 mg/day for 10 days are now indicated in all COVID-19 cases who require respiratory support. However, the efficacy of the intervention depends on the timing of initiation, the dose, and other individual factors. Indeed, patients treated with similar GC protocols often experience different outcomes, which do not always correlate with the presence of comorbidities or with the severity of respiratory involvement at baseline. This prompted us to critically review the literature on the rationale, pharmacological principles, and clinical evidence that should guide GC treatment. Based on these data, the best treatment protocol probably involves an initial bolus dose to saturate the glucocorticoid receptors, followed by a continuous infusion to maintain constant plasma levels, and eventually a slow tapering to interruption. Methylprednisolone has shown the highest efficacy among different GC molecules, most likely thanks to its higher ability to penetrate the lung. Decreased tissue sensitivity to glucocorticoids is thought to be the main mechanism accounting for the lower response to the treatment in some individuals. We do not have a readily available test to identify GC resistance; therefore, to address inter-individual variability, future research should aim at investigating clinical, physiological, and laboratory markers to guide a personalized GC treatment approach.
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Affiliation(s)
- Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Gianfranco Umberto Meduri
- Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Mariangela Barbieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Bozzi
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Chiara Torregiani
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Business School, University of Milano, 20149 Milano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- A.O.U. Maggiore della Carità, 28100 Novara, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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15
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Mondini L, Confalonieri P, Pozzan R, Ruggero L, Trotta L, Lerda S, Hughes M, Bellan M, Confalonieri M, Ruaro B, Salton F, Tavano S. Microvascular Alteration in COVID-19 Documented by Nailfold Capillaroscopy. Diagnostics (Basel) 2023; 13:diagnostics13111905. [PMID: 37296759 DOI: 10.3390/diagnostics13111905] [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: 04/23/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
COVID-19 is a multisystemic disease that mainly affects and causes dysregulation of the endothelium, causing systemic manifestations. A nailfold video capillaroscopy is a safe, easy, and noninvasive method to evaluate microcirculation alteration. In this review, we analyzed the literature available to date regarding the object of nailfold video capillaroscopy (NVC) use in patients with a SARS-CoV-2 infection, both in the acute phase and after discharge. The scientific evidence pointed out the main alterations in capillary circulation shown by NVC, so reviewing the findings of each article allowed us to define and analyze the future prospects and needs for possibly including NVC within the management of patients with COVID-19, both during and after the acute phase.
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Affiliation(s)
- Lucrezia Mondini
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Paola Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Riccardo Pozzan
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Luca Ruggero
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Liliana Trotta
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Selene Lerda
- Graduate School, University of Milan, 20149 Milano, Italy
| | - Michael Hughes
- Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Salford Royal NHS Foundation Trust, Manchester M6 8HD, UK
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Center for Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Azienda Ospedaliero-Universitaria, Maggiore della Carità, 28100 Novara, Italy
| | - Marco Confalonieri
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Barbara Ruaro
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Francesco Salton
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
| | - Stefano Tavano
- Pulmonology Unit, Department of Medical Surgical and Health Sciences, University Hospital of Cattinara, University of Trieste, 34149 Trieste, Italy
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16
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Rizzi M, D'Onghia D, Tonello S, Minisini R, Colangelo D, Bellan M, Castello LM, Gavelli F, Avanzi GC, Pirisi M, Sainaghi PP. COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters. Int J Mol Sci 2023; 24:ijms24087099. [PMID: 37108262 PMCID: PMC10138390 DOI: 10.3390/ijms24087099] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Clinical knowledge about SARS-CoV-2 infection mechanisms and COVID-19 pathophysiology have enormously increased during the pandemic. Nevertheless, because of the great heterogeneity of disease manifestations, a precise patient stratification at admission is still difficult, thus rendering a rational allocation of limited medical resources as well as a tailored therapeutic approach challenging. To date, many hematologic biomarkers have been validated to support the early triage of SARS-CoV-2-positive patients and to monitor their disease progression. Among them, some indices have proven to be not only predictive parameters, but also direct or indirect pharmacological targets, thus allowing for a more tailored approach to single-patient symptoms, especially in those with severe progressive disease. While many blood test-derived parameters quickly entered routine clinical practice, other circulating biomarkers have been proposed by several researchers who have investigated their reliability in specific patient cohorts. Despite their usefulness in specific contexts as well as their potential interest as therapeutic targets, such experimental markers have not been implemented in routine clinical practice, mainly due to their higher costs and low availability in general hospital settings. This narrative review will present an overview of the most commonly adopted biomarkers in clinical practice and of the most promising ones emerging from specific population studies. Considering that each of the validated markers reflects a specific aspect of COVID-19 evolution, embedding new highly informative markers into routine clinical testing could help not only in early patient stratification, but also in guiding a timely and tailored method of therapeutic intervention.
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Affiliation(s)
- Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Davide D'Onghia
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, 28100 Novara, Italy
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17
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Patrucco F, Solidoro P, Gavelli F, Apostolo D, Bellan M. Idiopathic Pulmonary Fibrosis and Post-COVID-19 Lung Fibrosis: Links and Risks. Microorganisms 2023; 11:microorganisms11040895. [PMID: 37110318 PMCID: PMC10146995 DOI: 10.3390/microorganisms11040895] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is considered the paradigmatic example of chronic progressive fibrosing disease; IPF does not result from a primary immunopathogenic mechanism, but immune cells play a complex role in orchestrating the fibrosing response. These cells are activated by pathogen-associated or danger-associated molecular patterns generating pro-fibrotic pathways or downregulating anti-fibrotic agents. Post-COVID pulmonary fibrosis (PCPF) is an emerging clinical entity, following SARS-CoV-2 infection; it shares many clinical, pathological, and immune features with IPF. Similarities between IPF and PCPF can be found in intra- and extracellular physiopathological pro-fibrotic processes, genetic signatures, as well as in the response to antifibrotic treatments. Moreover, SARS-CoV-2 infection can be a cause of acute exacerbation of IPF (AE-IPF), which can negatively impact on IPF patients’ prognosis. In this narrative review, we explore the pathophysiological aspects of IPF, with particular attention given to the intracellular signaling involved in the generation of fibrosis in IPF and during the SARS-CoV-2 infection, and the similarities between IPF and PCPF. Finally, we focus on COVID-19 and IPF in clinical practice.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità Hospital, 28100 Novara, Italy
- Correspondence:
| | - Paolo Solidoro
- Medical Sciences Department, University of Turin, 10126 Turin, Italy
- Respiratory Diseases Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Francesco Gavelli
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
- Emergency Medicine Department, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Daria Apostolo
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
| | - Mattia Bellan
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
- Division of Internal Medicine, Medical Department, AOU Maggiore della Carità di Novara, 28100 Novara, Italy
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18
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Apostolo D, D’Onghia D, Tonello S, Minisini R, Baricich A, Gramaglia C, Patrucco F, Zeppegno P, Acquaviva A, Balbo PE, Castello LM, Cappellano G, Chiocchetti A, Gerevini C, Giordano M, Laaguid F, Manfredi M, Raineri D, Rigamonti C, Rolla R, Romano V, Confalonieri M, Savoia P, Zavattaro E, Pirisi M, Ruaro B, Sainaghi PP, Bellan M. Decreased Gas6 and sAxl Plasma Levels Are Associated with Hair Loss in COVID-19 Survivors. Int J Mol Sci 2023; 24:ijms24076257. [PMID: 37047229 PMCID: PMC10094682 DOI: 10.3390/ijms24076257] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 03/29/2023] Open
Abstract
Post-acute conditions after coronavirus disease 2019 (COVID-19) are quite common, although the underlying pathogenetic mechanisms leading to these conditions are not yet completely understood. In this prospective observational study, we aimed to test the hypothesis that Growth Arrest-Specific 6 (Gas6) and its soluble receptors, Axl (sAxl) and MerTK (sMer), might be implicated. A total of 263 subjects underwent a structured clinical evaluation one year after their hospital discharge for COVID-19, and they consented to donate a blood sample to measure their circulating Gas6, sAxl, and sMer levels. A total of 98 (37.3%) post-COVID-19 subjects complained of at least one residual physical symptom one year after their hospital discharge. Univariate analysis revealed that sAxl was marginally associated with residual symptoms, but at the level of logistic regression analysis, only the diffusing capacity of the lungs for carbon monoxide (DLCO) (OR 0.98, CI 95%: 0.96–0.99; p = 0.007) and the female sex (OR 2.49, CI 95%: 1.45–4.28; p = 0.001) were independently associated with long-lasting symptoms. A total of 69 (26.2%) subjects had hair loss. At the level of univariate analysis, Gas6, sAxl, DLCO, and the female gender were associated with its development. In a logistic regression analysis model, Gas6 (OR 0.96, CI 95%: 0.92–0.99; p = 0.015) and sAxl (OR 0.98, CI 95%; 0.97–1.0; p = 0.014), along with the female sex (OR 6.58, CI 95%: 3.39–12.78; p = 0.0001), were independent predictors of hair loss. Decreased levels of Gas6 and sAxl were associated with a history of hair loss following COVID-19. This was resolved spontaneously in most patients, although 23.7% complained of persistent hair loss one year after hospital discharge.
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19
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Matino E, Tavella E, Rizzi M, Avanzi GC, Azzolina D, Battaglia A, Becco P, Bellan M, Bertinieri G, Bertoletti M, Casciaro GF, Castello LM, Colageo U, Colangelo D, Comolli D, Costanzo M, Croce A, D’Onghia D, Della Corte F, De Mitri L, Dodaro V, Givone F, Gravina A, Grillenzoni L, Gusmaroli G, Landi R, Lingua A, Manzoni R, Marinoni V, Masturzo B, Minisini R, Morello M, Nelva A, Ortone E, Paolella R, Patti G, Pedrinelli A, Pirisi M, Ravizzi L, Rizzi E, Sola D, Sola M, Tonello N, Tonello S, Topazzo G, Tua A, Valenti P, Vaschetto R, Vassia V, Zecca E, Zublena N, Manzoni P, Sainaghi PP. Effect of Lactoferrin on Clinical Outcomes of Hospitalized Patients with COVID-19: The LAC Randomized Clinical Trial. Nutrients 2023; 15:nu15051285. [PMID: 36904283 PMCID: PMC10005739 DOI: 10.3390/nu15051285] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
As lactoferrin is a nutritional supplement with proven antiviral and immunomodulatory abilities, it may be used to improve the clinical course of COVID-19. The clinical efficacy and safety of bovine lactoferrin were evaluated in the LAC randomized double-blind placebo-controlled trial. A total of 218 hospitalized adult patients with moderate-to-severe COVID-19 were randomized to receive 800 mg/die oral bovine lactoferrin (n = 113) or placebo (n = 105), both given in combination with standard COVID-19 therapy. No differences in lactoferrin vs. placebo were observed in the primary outcomes: the proportion of death or intensive care unit admission (risk ratio of 1.06 (95% CI 0.63-1.79)) or proportion of discharge or National Early Warning Score 2 (NEWS2) ≤ 2 within 14 days from enrollment (RR of 0.85 (95% CI 0.70-1.04)). Lactoferrin showed an excellent safety and tolerability profile. Even though bovine lactoferrin is safe and tolerable, our results do not support its use in hospitalized patients with moderate-to-severe COVID-19.
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Affiliation(s)
- Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Elena Tavella
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Manuela Rizzi
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Antonio Battaglia
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Becco
- Division of Oncology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Giovanni Bertinieri
- Division of Internal Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Giuseppe Francesco Casciaro
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Division of Internal Medicine, Azienda Ospedaliera “SS. Antonio e Biagio e Cesare Arrigo”, 15121 Alessandria, Italy
| | - Umberto Colageo
- Intensive Care Unit, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Donato Colangelo
- Department of Health Sciences, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Davide Comolli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Martina Costanzo
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Davide D’Onghia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Francesco Della Corte
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Luigi De Mitri
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Valentina Dodaro
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Filippo Givone
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Alessia Gravina
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Luca Grillenzoni
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | | | - Raffaella Landi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Anna Lingua
- Division of Infectious Disease, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Roberto Manzoni
- Division of Dermatology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Vito Marinoni
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Bianca Masturzo
- Division of Obstetrics and Gynecology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Marina Morello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Anna Nelva
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Elena Ortone
- Division of Geriatric Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Rita Paolella
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Medical Department, Division of Cardiology, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Anita Pedrinelli
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Lidia Ravizzi
- Division of Pneumology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Eleonora Rizzi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Daniele Sola
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Mariolina Sola
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Nadir Tonello
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Gigliola Topazzo
- Division of Diabetology and Endocrinology, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Aldo Tua
- Division of Emergency Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Piera Valenti
- Department of Public Health and Infectious Diseases, University of Rome, La Sapienza, 00185 Rome, Italy
| | - Rosanna Vaschetto
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Anesthesia and Intensive Care Medicine, AOU “Maggiore della Carità”, 28100 Novara, Italy
| | - Veronica Vassia
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
| | - Nicoletta Zublena
- Division of Palliative Care, Ospedale degli Infermi, 13875 Ponderano, Italy
| | - Paolo Manzoni
- Department of Maternal-Infant Medicine, Ospedale degli Infermi, 13875 Ponderano, Italy
- Internal Medicine, Department of Medical Sciences, Azienda Ospedaliero-Universitaria (AOU) Città della Salute e della Scienza, University of Turin School of Medicine, 10126 Turin, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Department of Internal Medicine and COVID-19 Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- Division of Emergency Medicine and COVID-19 Sub-Intensive Unit, Azienda Ospedaliero-Universitaria (AOU) “Maggiore della Carità”, 28100 Novara, Italy
- CAAD, Center for Autoimmune and Allergic Diseases, Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence:
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Bellan M, Apostolo D, Albè A, Crevola M, Errica N, Ratano G, Tonello S, Minisini R, D’Onghia D, Baricich A, Patrucco F, Zeppegno P, Gramaglia C, Balbo PE, Cappellano G, Casella S, Chiocchetti A, Clivati E, Giordano M, Manfredi M, Patti G, Pinato DJ, Puricelli C, Raineri D, Rolla R, Sainaghi PP, Pirisi M. Determinants of long COVID among adults hospitalized for SARS-CoV-2 infection: A prospective cohort study. Front Immunol 2022; 13:1038227. [PMID: 36601115 PMCID: PMC9807078 DOI: 10.3389/fimmu.2022.1038227] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 09/06/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022] Open
Abstract
Rationale Factors associated with long-term sequelae emerging after the acute phase of COVID-19 (so called "long COVID") are unclear. Here, we aimed to identify risk factors for the development of COVID-19 sequelae in a prospective cohort of subjects hospitalized for SARS-CoV-2 infection and followed up one year after discharge. Methods A total of 324 subjects underwent a comprehensive and multidisciplinary evaluation one year after hospital discharge for COVID-19. A subgroup of 247/324 who consented to donate a blood sample were tested for a panel of circulating cytokines. Results In 122 patients (37.8%) there was evidence of at least one persisting physical symptom. After correcting for comorbidities and COVID-19 severity, the risk of developing long COVID was lower in the 109 subjects admitted to the hospital in the third wave of the pandemic than in the 215 admitted during the first wave, (OR 0.69, 95%CI 0.51-0.93, p=0.01). Univariable analysis revealed female sex, diffusing capacity of the lungs for carbon monoxide (DLCO) value, body mass index, anxiety and depressive symptoms to be positively associated with COVID-19 sequelae at 1 year. Following logistic regression analysis, DLCO was the only independent predictor of residual symptoms (OR 0.98 CI 95% (0.96-0.99), p=0.01). In the subgroup of subjects with normal DLCO (> 80%), for whom residual lung damage was an unlikely explanation for long COVID, the presence of anxiety and depressive symptoms was significantly associated to persistent symptoms, together with increased levels of a set of pro-inflammatory cytokines: interferon-gamma, tumor necrosis factor-alpha, interleukin (IL)-2, IL-12, IL-1β, IL-17. In logistic regression analysis, depressive symptoms (p=0.02, OR 4.57 [1.21-17.21]) and IL-12 levels (p=0.03, OR 1.06 [1.00-1.11]) 1-year after hospital discharge were independently associated with persistence of symptoms. Conclusions Long COVID appears mainly related to respiratory sequelae, prevalently observed during the first pandemic wave. Among patients with little or no residual lung damage, a cytokine pattern consistent with systemic inflammation is in place.
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Affiliation(s)
- Mattia Bellan
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy,*Correspondence: Mattia Bellan,
| | | | - Alice Albè
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Martina Crevola
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Nicolò Errica
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Giacomo Ratano
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | | | | | | | - Alessio Baricich
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Filippo Patrucco
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Patrizia Zeppegno
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Carla Gramaglia
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | | | | | - Sara Casella
- Università del Piemonte Orientale (UPO), Novara, Italy
| | | | | | - Mara Giordano
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | | | - Giuseppe Patti
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - David James Pinato
- Università del Piemonte Orientale (UPO), Novara, Italy,Department of Surgery and Cancer, Imperial College London, Hammersmith Hospital, London, United Kingdom
| | - Chiara Puricelli
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | | | - Roberta Rolla
- Università del Piemonte Orientale (UPO), Novara, Italy
| | - Pier Paolo Sainaghi
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale (UPO), Novara, Italy,”AOU Maggiore della Carità”, Novara, Italy
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Patrucco F, Bellan M, Solidoro P. COVID‑19: different waves and different outcomes. Pol Arch Intern Med 2022; 132. [DOI: 10.20452/pamw.16352] [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: 11/05/2022]
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22
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Perazzi M, Gallina E, Manfredi GF, Patrucco F, Acquaviva A, Colangelo D, Pirisi M, Bellan M. Vitamin D in Systemic Sclerosis: A Review. Nutrients 2022; 14:nu14193908. [PMID: 36235561 PMCID: PMC9573213 DOI: 10.3390/nu14193908] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/10/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: In the present paper we aimed to review the evidence about the potential implication of vitamin D in the pathogenesis and management of systemic sclerosis (SSc); (2) Methods: we performed a review of the literature looking for studies evaluating the potential role of vitamin D and its analogs in SSc. We searched the PubMed, Medline, Embase, and Cochrane libraries using the following strings: (vitamin D OR cholecalciferol) AND (systemic sclerosis OR scleroderma). We included cohort studies, case-control studies, randomized controlled trials, and observational studies. (3) Results: we identified nine pre-clinical and 21 clinical studies. Pre-clinical data suggest that vitamin D and its analogs may suppress fibrogenesis. Clinical data are concordant in reporting a high prevalence of hypovitaminosis D and osteoporosis in SSc patients; data about the association with clinical manifestations and phenotypes of SSc are, conversely, far less consistent; (4) Conclusions: in vitro data suggest that vitamin D may play an antifibrotic role in SSc, but clinical data confirming this finding are currently lacking. Hypovitaminosis D is common among SSc patients and should be treated to reduce the risk of osteoporosis.
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Affiliation(s)
- Mattia Perazzi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
| | - Enrico Gallina
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
| | - Giulia Francesca Manfredi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
| | - Antonio Acquaviva
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
| | - Donato Colangelo
- Department of Health Sciences (DSS), Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine (DIMET), Università del Piemonte Orientale UPO, Via Solaroli 17, 28100 Novara, Italy
- Department of Internal Medicine, Rheumatology Unit, “AOU Maggiore della Carità”, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale UPO, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3737512
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Gramaglia C, Gattoni E, Gambaro E, Bellan M, Balbo PE, Baricich A, Sainaghi PP, Pirisi M, Binda V, Feggi A, Jona A, Marangon D, Prosperini P, Zeppegno P. Anxiety, Stress and Depression in COVID-19 Survivors From an Italian Cohort of Hospitalized Patients: Results From a 1-Year Follow-Up. Front Psychiatry 2022; 13:862651. [PMID: 35782424 PMCID: PMC9247238 DOI: 10.3389/fpsyt.2022.862651] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022] Open
Abstract
Background Mental health-related symptoms can persist over time beyond the most common respiratory clinical features of COVID-19. A recent meta-analysis underlined that mental health sequalae may be relevant for COVID-19 survivors and reported the following prevalence rates: 20% for post-traumatic stress disorder, 22% for anxiety, 36% for psychological distress, and 21% for depression. In the context of a multi-disciplinary follow-up project, we already investigated the mid-term (4 months) psychiatric outcomes in a sample of COVID-19 survivors. Patients were re-assessed after 1-year since hospital discharge. Methods Follow-up conducted after 1 year involved 196 individuals recovered from COVID-19. Patients were assessed with a multi-disciplinary approach; including both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview (MINI) to assess the presence of anxiety, stress, and depressive symptoms and the following self-administered questionnaires: Beck Anxiety Inventory, Beck Depression Inventory-II, Resilience Scale for Adults, Impact of Event Scale, and COVID-19 Peritraumatic Distress Index (CPDI). Results Anxiety (p < 0.0001) and depressive (p < 0.0003) symptoms registered at the clinical interview showed a significant improvement from the 4 to 12-months follow-up. Logistic regression model showed that female gender (p = 0.006), arterial hypertension (p = 0.01), obesity (0.04), anxiety (p < 0.0001), and depressive (p = 0.02) symptoms at 4-months follow-up were associated with persistence of anxiety symptoms at 12 months. At logistic regression analysis female gender (p = 0.02) and depressive symptoms at 4-months follow-up (p = 0.01) were associated with depressive symptoms after 12 months. Conclusion Severity of the disease in the acute phase, in this study, was not a determining factor in identifying subjects at risk of developing clinically relevant anxiety and depression as a consequence of COVID-19 disease. Findings from the logistic regressions suggest that the factors most affecting depression and anxiety in COVID survivors after 12 months were female gender, the presence of anxiety and depression after 4 months and some physical symptoms, not necessarily COVID-related. Impact of infection and consequent hospitalization for COVID-19 did no longer represent a relevant issue for depressive symptoms, compared to other general factors.
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Affiliation(s)
- Carla Gramaglia
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mattia Bellan
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Alessio Baricich
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Valeria Binda
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Feggi
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Amalia Jona
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Debora Marangon
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Patrizia Zeppegno
- Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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Bellan M, Scotti L, Ferrante D, Calzaducca E, Manfredi GF, Sainaghi PP, Barone-Adesi F. Risk of Severe Infection among Rheumatoid Arthritis Patients on Biological DMARDs: A Population-Based Cohort Study. J Clin Med 2022; 11:jcm11112955. [PMID: 35683344 PMCID: PMC9181346 DOI: 10.3390/jcm11112955] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/14/2022] [Accepted: 05/22/2022] [Indexed: 12/15/2022] Open
Abstract
Biological disease-modifying anti-rheumatic drugs (bDMARDs) are widely used for the management of rheumatoid arthritis, although their benefits are counterweight by an increased risk of infections. In the present study, we used administrative data to compare the risk of severe infections among different classes of bDMARDs. A retrospective cohort study was conducted using Administrative Health Databases of the Piedmont Region, Italy. Relevant data were obtained from: (1) the inhabitants registry, (2) hospital discharge records, and (3) the co-payment exemption registry and (4) drug claims registry. Fine and Gray competing risk models were fitted to evaluate the association between the use of different types of bDMARDs and occurrence of severe infection accounting for treatment interruption as competing risk. A total of 1780 new users of bDMARDs were identified. Among them, 50 hospitalizations for infection occurred during the study period. The use of Tocilizumab was associated with an increased risk of infection, compared to tumor necrosis factor (TNF) inhibitor drugs (sub-distribution hazard ratios-sHR: 2.510; 95% CI: 1.279–4.926), whereas no difference in the risk of severe infection was found for abatacept (sHR: 0.584; 95% CI: 0.234–1.457). bDMARDs treatment is generally safe in clinical practice with slight but important differences among classes. The increased risk of infection associated with tocilizumab use should be taken into account when balancing the risk and benefits of starting a treatment with this drug.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Lorenza Scotti
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
| | - Daniela Ferrante
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
| | - Elisa Calzaducca
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
| | - Giulia Francesca Manfredi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
- Department of Internal Medicine and Rheumatology Unit, Azienda Ospedaliero-Universitaria Maggiore Della Carità, 28100 Novara, Italy
- Center for Translational Research on Autoimmune and Allergic Diseases (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3737512
| | - Francesco Barone-Adesi
- Department of Translational Medicine (DiMet), Università del Piemonte Orientale (UPO), Via Solaroli 17, 28100 Novara, Italy; (M.B.); (L.S.); (D.F.); (E.C.); (G.F.M.); (F.B.-A.)
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Morosini U, Marengo M, Prenna S, Colombatto A, Fornara L, Quaglia M, Merlotti G, Paolo Sainaghi P, Bellan M, Cantaluppi V. MO329: Acute Kidney Injury (AKI) is Associated With Increased in-Hospital Mortality and With Impairment of Renal, Lung, Motor and Immune Function 1 Year After Discharge For COVID-19. Nephrol Dial Transplant 2022. [PMCID: PMC9383918 DOI: 10.1093/ndt/gfac068.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND AIMS AKI is the most frequent complication after respiratory failure in COVID-19. AKI increases mortality risk, length of hospital stay and healthcare costs, with possible progression towards CKD. Study aims: (1) evaluation of AKI incidence in 1020 COVID-19 hospitalized patients; (2) comparison of AKI incidence in COVID-19 versus pre-pandemic period; (3) establishment of out-patient follow-up for monitoring kidney, lung, motor and immune function; (4) creation of a biobank for biomarker discovery studies. METHOD AKI incidence was calculated matching laboratory and administrative data of 26 214 hospitalized patients in 2018–2019 and in 1020 COVID-19 patients in 2020–2021: KDIGO algorithms were applied for AKI grading. After 12 months from discharge, 232 COVID AKI patients and relative controls matched for age and gender were evaluated for kidney (eGFR, biomarkers of tubular damage NGAL, CCl-14, DKK-3), lung (DLCO, CT scan) and neuro-motor (SPPB, 2-min walking test, post-traumatic stress test-IES) function. RESULTS Before the pandemic, in-hospital AKI incidence was 18% (10% KDIGO 1, 5% KDIGO 2, 3% KDIGO 3): median age of AKI patients was 69. In-hospital mortality was 3.5% in non-AKI group versus 15% in AKI group in accordance with KDIGO stages. In COVID patients, AKI incidence increased to 37% (20% KDIGO 1.11% KDIGO 2, 6% KDIGO 3): median age of patients was 54. In-hospital mortality was 31% in the AKI group; AKI is an independent risk factor for death. After 12 months from hospital discharge, COVID AKI patients showed a persistent reduction of respiratory function (severe DLCO impairment < 60%) related to the extent of CT scan abnormalities. AKI patients also presented the motor function impairment and a worse post-traumatic stress response. GFR reduction was 1.8 mL/min in non-AKI patients versus 9.7 mL/min in AKI COVID patients not related to age. Urinary DKK-3 and CCL-14 were also higher in the AKI group. Last, IgG response after SARS-CoV-2 vaccination was significantly lower in the AKI group. CONCLUSION AKI incidence was significantly increased during COVID-19 in respect to the pre-pandemic period, with an association with higher mortality in class 2–3 KDIGO. In the post-COVID follow-up, AKI was associated with lung and neuro-motor function impairment, a defective antibody response and a sudden GFR decline concomitant to the persistence of tubular injury biomarkers. These results suggest the importance of nephrological and multidisciplinary follow-up of frail patients who developed AKI during hospitalization for COVID-19.
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Affiliation(s)
- Umberto Morosini
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | | | - Stefania Prenna
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | - Andrea Colombatto
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | - Laura Fornara
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | - Marco Quaglia
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | - Guido Merlotti
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
| | | | - Mattia Bellan
- Translational Medicine, University of Eastern Piedmont, Vercelli, Italy
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Barini M, Percivale I, Danna P, Longo V, Costantini P, Paladini A, Airoldi C, Bellan M, Saba L, Carriero A. 18 months computed tomography follow-up after Covid-19 interstitial pneumonia. J Public Health Res 2022; 11. [PMID: 35315262 PMCID: PMC8973211 DOI: 10.4081/jphr.2022.2782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 01/10/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Our aim is to evaluate the possible persistence of lung parenchyma alterations, in patients who have recovered from Covid-19. Design and methods: We enrolled a cohort of 115 patients affected by Covid-19, who performed a chest CT scan in the Emergency Department and a chest CT 18 months after hospital discharge. We performed a comparison between chest CT scan 18 months after discharge and spirometric data of patients enrolled. We obtained quantitative scores related to well-aerated parenchyma, interstitial lung disease and parenchymal consolidation. A radiologist recorded the characteristics indicated by the Fleischner Society and “fibrotic like” changes, expressed through a CT severity score ranging from 0 (no involvement) to 25 (maximum involvement). Results: 115 patients (78 men, 37 women; mean age 60.15 years old ±12.52). On quantitative analysis, after 18 months, the volume of normal ventilated parenchyma was significantly increased (16.34 points on average ±14.54, p<0.0001). Groundglass opacities and consolidation values tend to decrease (-9.80 and -6.67 points, p<0.0001). On semiquantitative analysis, pneumonia extension, reactive lymph nodes and crazy paving reached statistical significance (p<0.0001). The severity score decreased by 2.77 points on average (SD 4.96; p<0.0001). There were not statistically significant changes on “fibrotic-like” changes correlated with level of treatment and there was not a statistically significant correlation between CT lung score and spirometric results obtained 18 months after discharge. Conclusions: Patients recovered from Covid-19 seem to have an improvement of ventilated parenchyma and “fibrotic-like” alterations. The level of treatment does not appear to influence fibrotic changes. Significance for public health After more than a year from first SARS-CoV-2 infection cases in Europe, alongside the always current problems of diagnosis and clinical management, a new criticism is emerging: the possible long-term outcomes that Covid-19 patients may have. To try to answer at least in part this question, in agreement with the pulmonologists of our center, we decided to select a group of patients who have overcome Covid-19, with heterogeneous levels of intensity of care, and to perform a radiological and clinical 18 months follow-up. In this paper we made a comparison between the chest CT performed at the onset of the disease and the CT performed after 18 months, evaluating the evolution of the parenchymal alterations. We hope that the results obtained in this study can provide useful information in the future follow-up of patients affected by Covid-19, a central issue of public health in the coming years in many areas of the world.
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Affiliation(s)
- Michela Barini
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Ilaria Percivale
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Pietro Danna
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Vittorio Longo
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Pietro Costantini
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Andrea Paladini
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara.
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale, Novara.
| | - Luca Saba
- Department of Medical Science, University of Cagliari.
| | - Alessandro Carriero
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara.
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Bellan M, Murano F, Ceruti F, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Maglione V, Manfredi GF, Acquaviva A, Piffero R, Patti G, Pirisi M, Sainaghi PP. Increased Levels of ICOS and ICOSL Are Associated to Pulmonary Arterial Hypertension in Patients Affected by Connective Tissue Diseases. Diagnostics (Basel) 2022; 12:diagnostics12030704. [PMID: 35328257 PMCID: PMC8947069 DOI: 10.3390/diagnostics12030704] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 12/07/2022] Open
Abstract
Background: Pulmonary hypertension (PH) is a life-threatening complication of connective tissue diseases (CTD); in this study, we aimed at investigating the potential role of inducible co-stimulator (ICOS) and its ligand (ICOS-L) as biomarkers of PH in CTD. Materials and Methods: We recruited 109 patients: 84 CTD patients, 13 patients with CTD complicated by pulmonary arterial hypertension (PAH), and 12 subjects with PAH alone. All recruited patients underwent a complete clinical and instrumental assessment along with quantitative measurement of serum ICOS and ICOS-L. Results: Independently of the underlying cause, patients with PAH were older and had a lower glomerular filtration rate. Interestingly, patients with both CTD-related and CTD-unrelated PAH had higher ICOS and ICOS-L serum concentrations than CTD patients (0.0001 for both). When compared to CTD patients, those affected by CTD-PAH showed higher ICOS (440 (240–600) vs. 170 (105–275) pg/mL, p = 0.0001) and ICOS-L serum concentrations (6000 (4300–7000) vs. 2450 (1500–4100) pg/mL; p = 0.0001). In a logistic regression, ICOS and ICOS-L were associated with a diagnosis of PAH, independently from age, gender, and renal function. The corresponding receiver operating characteristic (ROC) curves demonstrated a good diagnostic performance for both ICOS and ICOS-L. Conclusions: ICOS and ICOS-L are increased in patients with PAH, irrespectively from the underlying cause, and represent promising candidate biomarkers for the diagnostic screening for PAH among CTDs patients.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3737512
| | - Francesco Murano
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Federico Ceruti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | | | - Stelvio Tonello
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Rosalba Minisini
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Ailia Giubertoni
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Daniele Sola
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Veronica Maglione
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Giulia Francesca Manfredi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Antonio Acquaviva
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Roberto Piffero
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
| | - Giuseppe Patti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardiology, AOU Maggiore della Carità, 28100 Novara, Italy;
| | - Mario Pirisi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale (UPO), 28100 Novara, Italy; (F.M.); (F.C.); (S.T.); (R.M.); (A.G.); (V.M.); (G.F.M.); (A.A.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Rheumatology Unit, Department of Internal Medicine, AOU Maggiore della Carità, 28100 Novara, Italy; (D.S.); (R.P.)
- Center for Translational Research on Autoimmune and Allergic Disease (CAAD), Università del Piemonte Orientale (UPO), 28100 Novara, Italy
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Cumitini L, Giubertoni A, Rossi L, Solli M, Bellan M, Patti G. AN INTRIGUING CASE OF MYOCARDIAL INFARCTION IN HORTON DISEASE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04449-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Burlone ME, Bellan M, Barbaglia MN, Mocchetti G, Mallela VR, Minisini R, Rigamonti C, Pirisi M. HSD17B13 and other liver fat-modulating genes predict development of hepatocellular carcinoma among HCV-positive cirrhotics with and without viral clearance after DAA treatment. Clin J Gastroenterol 2022; 15:301-309. [PMID: 35098490 DOI: 10.1007/s12328-021-01578-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022]
Abstract
BACKGROUND Genetic predisposition to accumulate liver fat (expressed by a polygenic risk score, GRS, based on the number of at-risk alleles of PNPLA3, TM6SF2, MBOAT7 and GCKR) may influence the probability of developing hepatocellular carcinoma (HCC) after hepatitis C treatment. Whether this holds true taking into account carriage of the HSD17B13:TA splice variant, also affecting lipogenesis, and achievement of viral clearance (SVR), is unknown. METHODS PNPLA3, TM6SF2, MBOAT7, GCKR and HSD17B13 variants were determined in a cohort of 328 cirrhotic patients free of HCC before starting treatment with direct acting antivirals (DAA). RESULTS SVR in the study cohort was 96%. At the end of follow-up, N = 21 patients had been diagnosed an HCC; none of the genes included in the GRS was individually associated with HCC development. However, in a Cox proportional hazards model, a GRS > 0.457 predicted HCC independently of sex, diabetes, albumin, INR and FIB4. The fit of the model improved adding treatment outcome and carriage of the HSD17B13:TA splice variant, with sex, GRS > 0.457, HSD17B13:TA splice variant and failure to achieve an SVR (hazard ratio = 6.75, 4.24, 0.24 and 7.7, respectively) being independent predictors of HCC. CONCLUSION Our findings confirm that genes modulating liver fat and lipogenesis are important risk factors for HCC development among cirrhotics C treated with DAA.
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Affiliation(s)
- Michela E Burlone
- Internal Medicine, Azienda Ospedaliero-Universitaria "Maggiore Della Carità", Novara, Italy
| | - Mattia Bellan
- Internal Medicine, Azienda Ospedaliero-Universitaria "Maggiore Della Carità", Novara, Italy
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Matteo N Barbaglia
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Ginevra Mocchetti
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Venkata R Mallela
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Rosalba Minisini
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Cristina Rigamonti
- Internal Medicine, Azienda Ospedaliero-Universitaria "Maggiore Della Carità", Novara, Italy
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy
| | - Mario Pirisi
- Internal Medicine, Azienda Ospedaliero-Universitaria "Maggiore Della Carità", Novara, Italy.
- Department of Translational Medicine (DiMeT), Università del Piemonte Orientale, Novara, Italy.
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Renda G, Ricci F, Spinoni EG, Grisafi L, D’Ardes D, Mennuni M, Tana C, Rognoni A, Bellan M, Sainaghi PP, Pirisi M, De Vecchi S, Gallina S, Pierdomenico SD, Cipollone F, Patti G. Predictors of Mortality and Cardiovascular Outcome at 6 Months after Hospitalization for COVID-19. J Clin Med 2022; 11:jcm11030729. [PMID: 35160182 PMCID: PMC8836381 DOI: 10.3390/jcm11030729] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023] Open
Abstract
Clinical outcome data of patients discharged after Coronavirus disease 2019 (COVID-19) are limited and no study has evaluated predictors of cardiovascular prognosis in this setting. Our aim was to assess short-term mortality and cardiovascular outcome after hospitalization for COVID-19. A prospective cohort of 296 consecutive patients discharged after COVID-19 from two Italian institutions during the first wave of the pandemic and followed up to 6 months was included. The primary endpoint was all-cause mortality. The co-primary endpoint was the incidence of the composite outcome of major adverse cardiac and cerebrovascular events (MACCE: cardiovascular death, myocardial infarction, stroke, pulmonary embolism, acute heart failure, or hospitalization for cardiovascular causes). The mean follow-up duration was 6 ± 2 months. The incidence of all-cause death was 4.7%. At multivariate analysis, age was the only independent predictor of mortality (aHR 1.08, 95% CI 1.01–1.16). MACCE occurred in 7.2% of patients. After adjustment, female sex (aHR 2.6, 95% CI 1.05–6.52), in-hospital acute heart failure during index hospitalization (aHR 3.45, 95% CI 1.19–10), and prevalent atrial fibrillation (aHR 3.05, 95% CI 1.13–8.24) significantly predicted the incident risk of MACCE. These findings may help to identify patients for whom a closer and more accurate surveillance after discharge for COVID-19 should be considered.
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Affiliation(s)
- Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (F.R.); (S.G.)
- SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (D.D.); (C.T.); (S.D.P.); (F.C.)
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (F.R.); (S.G.)
- Department of Clinical Sciences, Lund University, 203 13 Malmö, Sweden
| | - Enrico Guido Spinoni
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Leonardo Grisafi
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Damiano D’Ardes
- SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (D.D.); (C.T.); (S.D.P.); (F.C.)
- Department of Medicine and Science of Aging, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Mennuni
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
| | - Claudio Tana
- SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (D.D.); (C.T.); (S.D.P.); (F.C.)
| | - Andrea Rognoni
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
| | - Mattia Bellan
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Mario Pirisi
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
| | - Simona De Vecchi
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy; (G.R.); (F.R.); (S.G.)
| | - Sante Donato Pierdomenico
- SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (D.D.); (C.T.); (S.D.P.); (F.C.)
- Department of Innovative Technologies in Medicine & Dentistry, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Francesco Cipollone
- SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy; (D.D.); (C.T.); (S.D.P.); (F.C.)
- Department of Medicine and Science of Aging, G. D’Annunzio University of Chieti-Pescara, 66100 Chieti, Italy
| | - Giuseppe Patti
- Maggiore della Carità Hospital, 28100 Novara, Italy; (E.G.S.); (L.G.); (M.M.); (A.R.); (M.B.); (P.P.S.); (M.P.); (S.D.V.)
- Department of Translational Medicine, University of Eastern Piedmont, 28100 Novara, Italy
- Correspondence: ; Tel.: +39-0321-3733597
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Cumitini L, Giubertoni A, Rossi L, Solli M, Bellan M, Patti G. 159 Acute coronary syndrome in patient with giant cell arteritis: a fascinating case. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab148.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The diagnosis of acute coronary syndrome with persistent ST segment elevation, although apparently simple to detect by electrocardiographic abnormalities, can sometimes be insidious due to a difficult differential diagnosis with aortic dissection. Performing a coronary angiography in case of aortic dissection can be potentially life-threatening so, when suspected, this diagnosis needs to be rule out. Furthermore, coronary vasculitis is a rare but devastating complication of giant cell arteritis.
Methods and results
We describe a case of 62-year-old man hospitalized for acute coronary syndrome with persistent ST segment elevation involving the inferior wall. Ha was a heavy smoker with familiar history of cardiovascular disease and recent suspicion of Horton arteritis with aortic involvement under investigation, no previous cardiological events. Presenting symptoms are chest pain, sweating, bradycardia, and hypotension. In the emergency department, due to the history of suspected arteritis, chest CT scan was performed in order to rule out the hypothesis of aortic dissection before proceeding to coronarography. No signs of aortic rupture but the presence of thickening of the aorta from the arch to the carrefour was found. The coronary angiography showed critical stenosis in the medial tract of the circumflex artery and thrombotic subocclusion in the middle segment of the right coronary (culprit lesion—Figure 1) that was treated with PCI using drug-eluting stent. The echocardiogram showed mild left ventricular disfunction (EF 53%) due to posterolateral hypokinesia, no other pathological findings. Blood tests revealed anaemia, elevated platelets, and an increase of inflammation markers. Peak Hs-troponin was 18 000 ng/L (n.v. < 0.02 ng/ml). After 2 days we performed elective revascularization of the circumflex artery using a drug-eluting stent. Considering the medical history, we performed temporal artery biopsy and a total body PET scan that showed accumulation of radioactive tracer from the aortic arch to the sub-renal abdominal aorta, with a thickened wall. After that empirical corticosteroid therapy was started and some days later the result of the temporal artery biopsy confirmed the diagnosis of Horton arteritis. The patient was discharged to a rehabilitation structure in good general condition with cardioactive and corticosteroid therapy after 9 days of hospitalization.
Conclusions
Horton arteritis usually involves the external carotid artery and its branches, but sometimes inflammation of the aorta occurs in a subgroup of patients and rarely can involve the coronary arteries. An acute coronary syndrome in patients with Horton arteritis can be very insidious because aortic dissection can be the hidden cause, so chest CT scan must be performed before coronary angiography to avoid acute complication associated with an elevated mortality. Furthermore, being the vasculitic inflammation the trigger of the coronary involvement immunosuppressive therapy could be helpful to prevent subsequent acute coronary events.
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Affiliation(s)
- Luca Cumitini
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
| | - Ailia Giubertoni
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
| | - Lidia Rossi
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
| | - Martina Solli
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
| | - Mattia Bellan
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
| | - Giuseppe Patti
- Cardiology Department—A.O.U. Maggiore della Carità, Novara, Italy
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Patrucco F, Zeppegno P, Baricich A, Gramaglia CM, Balbo PE, Falaschi Z, Carriero A, Cuneo D, Pirisi M, Bellan M. Long-lasting consequences of Coronavirus disease 19 pneumonia: a systematic review. Minerva Med 2021; 113:158-171. [PMID: 34856780 DOI: 10.23736/s0026-4806.21.07594-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Coronavirus Disease 19 (Covid-19) is an infectious disease caused by the newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have plenty of data about the clinical features of the disease's acute phase, while little is known about the long-term consequences on survivors. EVIDENCE ACQUISITION We aimed to review systematically emerging evidence about clinical and functional consequences of Covid-19 pneumonia months after hospital discharge. EVIDENCE SYNTHESIS Current evidence supports the idea that a high proportion of Covid-19 survivors complain of symptoms months after the acute illness phase, being fatigue and reduced tolerance to physical effort the most frequently reported symptom. The strongest association for these symptoms is with the female gender, while disease severity seems less relevant. Respiratory symptoms are associated with a decline in respiratory function and, conversely, seem to be more frequent in those who experienced a more severe acute pneumonia. Current evidence highlighted a persistent motor impairment which is, again, more prevalent among those survivors who experienced a more severe acute phase of the disease. Additionally, the persistence of symptoms is a primary determinant of mental health outcome, with anxiety, depression, sleep disturbances, and post-traumatic stress symptoms being commonly reported in Covid-19 survivors. CONCLUSIONS Current literature highlights the importance of a multidisciplinary approach to Coronavirus Disease 19 since the sequelae appear to involve different organs and systems. Given the pandemic outbreak's size, this is a critical public health issue: a better insight on this topic should inform clinical decisions about the modalities of follow-up for Covid-19 survivors.
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Affiliation(s)
- Filippo Patrucco
- Pneumology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Alessio Baricich
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy - .,Physical and Rehabilitation Medicine, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Carla M Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Psychiatry Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Piero E Balbo
- Pneumology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Zeno Falaschi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Radiology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Alessandro Carriero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Radiology Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Daria Cuneo
- Department of Health Sciences, Università del Piemonte Orientale, Novara, Italy.,Physical and Rehabilitation Medicine, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Internal Medicine Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy.,Internal Medicine Department, Ospedale Maggiore della Carità University Hospital, Novara, Italy
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Bellan M, Sainaghi PP. Commenting on Paraneoplastic Arthritides: Insights to Pathogenesis, Diagnostic Approach, and Treatment. J Clin Rheumatol 2021; 27:S879. [PMID: 33961356 DOI: 10.1097/rhu.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Moia R, Cittone MG, Boggione P, Manfredi GF, Favini C, Awikeh B, Pedrinelli AR, Mahmoud AM, Nicolosi M, Bellan M, Sainaghi PP, Pirisi M, Gaidano G, Patriarca A, Rigamonti C. Stiffer Spleen Predicts Higher Bone Marrow Fibrosis and Higher JAK2 Allele Burden in Patients With Myeloproliferative Neoplasms. Front Oncol 2021; 11:777730. [PMID: 34765563 PMCID: PMC8576346 DOI: 10.3389/fonc.2021.777730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 10/08/2021] [Indexed: 12/29/2022] Open
Abstract
A total of 63 myeloproliferative neoplasms [MPN; 9 polycythemia vera (PV), 32 essential thrombocythemia (ET), and 22 myelofibrosis (MF)] underwent spleen stiffness (SS) measurement by vibration-controlled transient elastography equipped with a novel spleen-dedicated module. Higher SS values significantly correlated with grade 2-3 bone marrow (BM) fibrosis (p=0.035), with hemoglobin level <10 g/dl (p=0.014) and with white blood cells ≥10,000/μl (p=0.008). Median SS was significantly higher in MF patients compared to ET and PV (p=0.015). SS also correlated with higher JAK2 variant allele frequency (p=0.02). This study identifies SS as a potential noninvasive tool that reflects BM fibrosis and the mutational burden in MPN.
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Affiliation(s)
- Riccardo Moia
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Micol Giulia Cittone
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Paola Boggione
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Francesca Manfredi
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Chiara Favini
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Bassel Awikeh
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Anita Rebecca Pedrinelli
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Abdurraouf Mokhtar Mahmoud
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Maura Nicolosi
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Mattia Bellan
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Gianluca Gaidano
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Andrea Patriarca
- Division of Hematology, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Cristina Rigamonti
- Division of Internal Medicine, Department of Translational Medicine, Università del Piemonte Orientale and Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
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Patrucco F, Airoldi C, Falaschi Z, Bellan M, Castello LM, Filippone F, Matranga S, Masellis S, Smeriglia A, Solidoro P, Balbo PE, Gavelli F. Mycotic infection prevalence among patients undergoing bronchoalveolar lavage with search of SARS-CoV-2 after two negative nasopharyngeal swabs. J Breath Res 2021; 15. [PMID: 34464944 DOI: 10.1088/1752-7163/ac2290] [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: 04/09/2021] [Accepted: 08/31/2021] [Indexed: 11/11/2022]
Abstract
The evidence that severe coronavirus disease 2019 (COVID-19) is a risk factor for development of mycotic respiratory infection with an increased mortality is rising. Immunosuppressed are among the most susceptible patients andAspergillusspecies is the most feared superinfection. In this study we evaluated mycotic isolation prevalence on bronchoalveolar lavage (BAL) of patients who underwent bronchoscopy in search of severe acute respiratory coronavirus 2 (SARS-CoV-2) RNA. Moreover, we described the clinical characteristics and main outcomes of these patients. We included 118 patients, 35.9% of them were immunosuppressed for different reasons: in 23.7% we isolated SARS-CoV-2 RNA, in 33.1% we identified at least one mycotic agent and both in 15.4%. On BAL we observed in three casesAspergillusspp, in six casesPneumocystisand in 32Candidaspp. The prevalence of significant mold infection was 29.3% and 70.7% of cases were false positive or clinically irrelevant infections. In-hospital mortality of patients with fungal infection was 15.3%. The most frequent computed tomography (CT) pattern, evaluated with the Radiological Society of North America consensus statement, among patients with a mycotic pulmonary infection was the atypical one (p< 0.0001). Mycotic isolation on BAL may be interpreted as an innocent bystander, but its identification could influence the prognosis of patients, especially in those who need invasive investigations during the COVID-19 pandemic; BAL plays a fundamental role in resolving clinical complex cases, especially in immunosuppressed patients independently from radiological features, without limiting its role in ruling out SARS-CoV-2 infection.
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Affiliation(s)
- Filippo Patrucco
- Medical Department, Division of Respiratory Diseases, Maggiore della Carità Hospital, Novara, Italy.,Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Chiara Airoldi
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - Zeno Falaschi
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Maggiore della Carità Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Medical Department, Internal Medicine Unit, Maggiore della Carità Hospital, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Filippone
- Department of Diagnosis and Treatment Services, Radiodiagnostics, Maggiore della Carità Hospital, Novara, Italy
| | - Simone Matranga
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Serena Masellis
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Aurora Smeriglia
- Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Paolo Solidoro
- Cardiovascular and Thoracic Department, Pneumology Unit U, AOU Città della Salute e della Scienza di Torino, Torino, Italy
| | - Piero Emilio Balbo
- Medical Department, Division of Respiratory Diseases, Maggiore della Carità Hospital, Novara, Italy
| | - Francesco Gavelli
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.,Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
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Chighizola CB, Crisafulli F, Hoxha A, Carubbi F, Bellan M, Monti S, Costa L, Baldi C, Radin M, Praino E, Coletto LA, Pregnolato F, Sciascia S, Sainaghi PP, Bellis E, Ramoni V, Quartuccio L, Alunno A, Gerosa M, Andreoli L. Psychosocial burden in young patients with primary anti-phospholipid syndrome: an Italian nationwide survey (The AQUEOUS study). Clin Exp Rheumatol 2021; 39:938-946. [PMID: 32940209 DOI: 10.55563/clinexprheumatol/2b73dn] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/27/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The AQUEOUS (Anti-phospholipid syndrome: a QUEstionnaire for yOUng patientS) study aimed to assess how the diagnosis of primary anti-phospholipid syndrome (PAPS) affects the psychosocial status of young patients. METHODS Subjects with PAPS aged 18-45 years were invited to compile an ad hoc designed questionnaire and the Short Form-12 to assess quality of life (QoL). RESULTS Ninety-two patients (83.7% females) were recruited in 10 Italian centres. Vascular and obstetric manifestations were equally represented. Nearly half of the patients perceived the need for psychological support, 89.2% when considering women after pregnancy complications. Social activities and working efficiency were reduced in APS patients, also intimacy was threatened. In all cases, fatigue appeared to be the main determinant. PAPS affected family planning, due to fears of treatment side-effects, disease hereditariness, inability to care for the newborn child. Fertility appeared to be conserved: the median time to pregnancy was 2 months; assisted reproduction techniques were pursued by 5 women. Our survey documented significantly lower rates of hospitalisation and learning disabilities in 51 children born after APS diagnosis as compared to 48 children born before. PAPS patients displayed lower QoL in physical and, to a greater extent, mental scores compared to the general Italian population. Both components were significantly lower in women and in patients with fatigue. CONCLUSIONS The AQUEOUS study assessed for the first time the unmet needs of young PAPS patients, enabling the development of a future "youth-focused" strategy to reduce disease burden.
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Affiliation(s)
- Cecilia Beatrice Chighizola
- Experimental Laboratory of Immunological and Rheumatologic Researches, Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy.
| | - Francesca Crisafulli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Ariela Hoxha
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, and Rheumatology Unit, Department of Medicine-DIMED, University of Padova, Italy
| | - Francesco Carubbi
- Rheumatology Unit, Department of Biotechnological and Applied Clinical Science, School of Medicine, University of L'Aquila; Department of Medicine, ASL1 Avezzano-Sulmona-L'Aquila, L'Aquila, Italy
| | - Mattia Bellan
- Center for Translational Research on Autoimmune and Allergic Disease-CAAD, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Luisa Costa
- Rheumatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy
| | - Caterina Baldi
- Rheumatology Unit, Department of Medicine, Surgery and Neurosciences, Siena University Hospital, Italy
| | - Massimo Radin
- Centre of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Emanuela Praino
- Rheumatology Unit, D.S.S.4 Barletta, ASL BT, Barletta, Italy
| | - Lavinia Agra Coletto
- Division of Clinical Rheumatology, Research Center for Adult and Paediatric Rheumatic Diseases, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Francesca Pregnolato
- Experimental Laboratory of Immunological and Rheumatologic Researches, Immunology and Rheumatology Unit, San Luca Hospital, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Savino Sciascia
- Centre of Research of Immunopathology and Rare Diseases - Coordinating Center of Piemonte and Valle d'Aosta Network for Rare Diseases, and SCDU Nephrology and Dialysis, University of Turin and S. Giovanni Bosco Hospital, Turin, Italy
| | - Pier Paolo Sainaghi
- Center for Translational Research on Autoimmune and Allergic Disease-CAAD, Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Elisa Bellis
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Veronique Ramoni
- Department of Rheumatology, IRCCS Policlinico S. Matteo Foundation, University of Pavia, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, ASUFC, Santa Maria della Misericordia Hospital, Department of Medicine, University of Udine, Italy
| | - Alessia Alunno
- Rheumatology Unit, Department of Medicine, University of Perugia, Italy
| | - Maria Gerosa
- Division of Clinical Rheumatology, Research Center for Adult and Paediatric Rheumatic Diseases, ASST G. Pini & CTO, Department of Clinical Sciences and Community Health, University of Milan, Italy
| | - Laura Andreoli
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili, Department of Clinical and Experimental Sciences, University of Brescia, Italy
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Soddu D, Sola D, Bellan M, Boin E, Cittone MG, Zecca E, Matino E, Pedrazzoli R, Rizzi E, Pedrinelli AR, Tonello S, Vassia V, Landi R, Pirisi M, Sainaghi PP. Red cell distribution width is a potential predictor of early relapse in polymyalgia rheumatica. Reumatismo 2021; 73:117-121. [PMID: 34342213 DOI: 10.4081/reumatismo.2021.1395] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/15/2021] [Indexed: 11/23/2022] Open
Abstract
Red blood cell distribution width (RDW) has been studied as a prognostic biomarker for different chronic inflammatory diseases. In this paper we aim to evaluate its potential role in the prediction of early relapse in patients affected by polymyalgia rheumatica (PMR). We revised retrospectively clinical records of patients who received a diagnosis of PMR, according to 2012 ACR/EULAR classification criteria, for whom baseline clinical and laboratory data were available. The baseline RDW variation coefficient was correlated to the risk of relapse, in the first 6 months of the disease. We identified 44 patients [females 15 (34.0%)/males 29 (66.0%); median age 80 (72-83)], 9 of whom had an early relapse. These patients showed a larger median RDW than patients who did not relapse [13.7 (13.5-14.9)% vs 13.5 (12.7-14.2)%; p=0.04). The two groups were comparable for all the other clinical and laboratory parameters considered. Interestingly, patients in the higher half of the RDW distribution showed a shorter relapse-free survival (p<0.03). In a stepwise logistic regression, RDW (p=0.01) predicted the risk of relapse at 6 months, while age, gender, CRP, ESR, Hb, MCV and prednisone dose did not fit the model. Our results show that RDW is an independent biomarker of early relapse, making this parameter a potentially promising predictive marker in PMR.
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Affiliation(s)
- D Soddu
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - D Sola
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - M Bellan
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - E Boin
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - M G Cittone
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Zecca
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - E Matino
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Pedrazzoli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - E Rizzi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - A R Pedrinelli
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - S Tonello
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara.
| | - V Vassia
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - R Landi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara.
| | - M Pirisi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
| | - P P Sainaghi
- Department of Translational Medicine, University of Piemonte Orientale UPO, Novara; Division of Internal Medicine, Immunorheumatology Unit, "Maggiore della Carità" Hospital, Novara; CAAD, Centre for Autoimmune and Allergic Diseases, Novara.
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Smirne C, D'Avolio A, Bellan M, Gualerzi A, Crobu MG, Pirisi M. Sofosbuvir-based therapies in genotype 2 hepatitis C virus cirrhosis: A real-life experience with focus on ribavirin dose. Pharmacol Res Perspect 2021; 9:e00811. [PMID: 34152088 PMCID: PMC8214994 DOI: 10.1002/prp2.811] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/14/2021] [Indexed: 12/05/2022] Open
Abstract
This study aimed to investigate the efficacy and safety of sofosbuvir-based therapies for the treatment of cirrhosis from hepatitis C virus (HCV) genotype 2 infection. Data of all consecutive HCV genotype 2 cirrhotic patients who started sofosbuvir-based treatments between January 2015 and March 2017 in eight Italian tertiary hospitals were collected retrospectively. Overall, 273 patients (Child A: 94.5%) were enrolled. In the 194 subjects treated with sofosbuvir/ribavirin, median initial ribavirin dosage was 13.9 mg/kg/day, and therapy duration was 16 weeks. Sustained virological response (SVR) rates were 93.8% in intention-to-treat (ITT) and 95.3% in per-protocol (PP) analyses for the 129 treatment-naïve patients, and 96.9% (ITT) and 98.4% (PP) for the 65 treatment-experienced subjects. Adverse events were reported in 142 patients (73.2%), but only 1.5% discontinued treatment. Eighty-eight subjects with treatment-induced anemia (mild: 34.5%, moderate: 7.7%, severe: 3.1%) had to reduce ribavirin dosage, but SVR rates were comparable to the weight-based dose group, both in ITT (95.4% and 94.3%) and PP (97.7% and 95.2%) analyses, respectively. Moreover, ITT and PP SVR rates were similar between shorter (<20 weeks) (94.1% and 96.0%, respectively) and prolonged (≥20 weeks) regimens (95.7% and 96.7%, respectively). SVR rates in the 79 subjects treated with sofosbuvir/daclatasvir (without ribavirin) were similar (ITT: 96.2%; PP: 97.4%, respectively), without de novo/worsening anemia. In conclusion, in a real-life study centered on genotype 2 patients with well-compensated cirrhosis, sofosbuvir-based regimens were associated with good SVR and tolerability rates, regardless of previous antiviral treatments, without a significant impact of on treatment ribavirin dose reductions.
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Affiliation(s)
- Carlo Smirne
- Internal Medicine DivisionDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | - Antonio D'Avolio
- Infectious Diseases UnitDepartment of Medical SciencesUniversity of TorinoTurinItaly
| | - Mattia Bellan
- Internal Medicine DivisionDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
| | | | - Maria G. Crobu
- Laboratory of Molecular VirologyMaggiore della Carità HospitalNovaraItaly
| | - Mario Pirisi
- Internal Medicine DivisionDepartment of Translational MedicineUniversità del Piemonte OrientaleNovaraItaly
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Grossini E, Garhwal DP, Calamita G, Romito R, Rigamonti C, Minisini R, Smirne C, Surico D, Bellan M, Pirisi M. Exposure to Plasma From Non-alcoholic Fatty Liver Disease Patients Affects Hepatocyte Viability, Generates Mitochondrial Dysfunction, and Modulates Pathways Involved in Fat Accumulation and Inflammation. Front Med (Lausanne) 2021; 8:693997. [PMID: 34277668 PMCID: PMC8282995 DOI: 10.3389/fmed.2021.693997] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 06/07/2021] [Indexed: 12/11/2022] Open
Abstract
Changes of lipidic storage, oxidative stress and mitochondrial dysfunction may be involved in the pathogenesis of non-alcoholic fatty liver disease (NAFLD). Although the knowledge of intracellular pathways has vastly expanded in recent years, the role and mechanisms of circulating triggering factor(s) are debated. Thus, we tested the hypothesis that factors circulating in the blood of NAFLD patients may influence processes underlying the disease. Huh7.5 cells/primary human hepatocytes were exposed to plasma from 12 NAFLD patients and 12 healthy subjects and specific assays were performed to examine viability, H2O2 and mitochondrial reactive oxygen species (ROS) release, mitochondrial membrane potential and triglycerides content. The involvement of NLRP3 inflammasome and of signaling related to peroxisome-proliferator-activating-ligand-receptor-γ (PPARγ), sterol-regulatory-element-binding-protein-1c (SREBP-1c), nuclear-factor-kappa-light-chain-enhancer of activated B cells (NF-kB), and NADPH oxidase 2 (NOX2) was evaluated by repeating the experiments in the presence of NLRP3 inflammasome blocker, MCC950, and through Western blot. The results obtained shown that plasma of NAFLD patients was able to reduce cell viability and mitochondrial membrane potential by about 48 and 24% (p < 0.05), and to increase H2O2, mitochondrial ROS, and triglycerides content by about 42, 19, and 16% (p < 0.05), respectively. An increased expression of SREBP-1c, PPARγ, NF-kB and NOX2 of about 51, 121, 63, and 46%, respectively, was observed (p < 0.05), as well. Those effects were reduced by the use of MCC950. Thus, in hepatocytes, exposure to plasma from NAFLD patients induces a NAFLD-like phenotype by interference with NLRP3-inflammasome pathways and the activation of intracellular signaling related to SREBP-1c, PPARγ, NF-kB and NOX2.
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Affiliation(s)
- Elena Grossini
- Laboratory of Physiology, Department of Translational Medicine, University East Piedmont, Novara, Italy.,AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Divya Praveen Garhwal
- Laboratory of Physiology, Department of Translational Medicine, University East Piedmont, Novara, Italy.,AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Giuseppe Calamita
- Laboratory of Cellular and Molecular Physiology and Pathophysiology, Department of Biosciences, Biotechnologies and Biopharmaceutics, University of Bari "Aldo Moro", Bari, Italy
| | - Raffaele Romito
- General Surgery Unit, Azienda Ospedaliera Maggiore della Carità University Hospital, Novara, Italy
| | - Cristina Rigamonti
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Internal Medicine Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Rosalba Minisini
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Internal Medicine Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Carlo Smirne
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Internal Medicine Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Daniela Surico
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Obstetrics and Gynecology Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Mattia Bellan
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Internal Medicine Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
| | - Mario Pirisi
- AGING Project, Department of Translational Medicine, University East Piedmont, Novara, Italy.,Internal Medicine Unit, Department of Translational Medicine, University East Piedmont, Novara, Italy
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Gramaglia C, Gambaro E, Bellan M, Balbo PE, Baricich A, Sainaghi PP, Pirisi M, Baldon G, Battistini S, Binda V, Feggi A, Gai M, Gattoni E, Jona A, Lorenzini L, Marangon D, Martelli M, Prosperini P, Zeppegno P. Mid-term Psychiatric Outcomes of Patients Recovered From COVID-19 From an Italian Cohort of Hospitalized Patients. Front Psychiatry 2021; 12:667385. [PMID: 34177656 PMCID: PMC8222628 DOI: 10.3389/fpsyt.2021.667385] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/05/2021] [Indexed: 12/11/2022] Open
Abstract
Background: Although the usual primary clinical manifestation of Coronavirus disease (COVID-19) is respiratory, several non-respiratory symptoms have been described, including neuropsychiatric ones. The aim of this study was to investigate the mid-term mental health outcomes in patients recovered from COVID-19, 3-4 months after discharge from the University Hospital Maggiore della Carità, Novara, Italy. Furthermore, we investigated the possible association of the mid-term mental health consequences of the COVID-19 infection with patients' clinical current status, persistent physical impairment and severity of acute phase of the disease. Methods: Prospective study involving 238 individuals recovered from COVID-19. In the context of a multi-disciplinary approach, patients' assessment included both a clinical interview performed by an experienced psychiatrist, trained in the use of the Mini-International Neuropsychiatric Interview to assess the presence of anxiety and depressive symptoms and self-administered questionnaires: Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), Resilience Scale for Adults (RSA), Impact of Event Scale (IES). Results: At the psychiatric assessment 32.9 and 29.5% of participants showed anxiety and depressive symptoms, respectively. Changes in appetite and sleep patterns emerged for 15.6 and 31.2% of patients. According to the self-administered questionnaires, 7.1% of participants had moderate-severe anxiety levels (BAI), while 10.5% had mild to severe depression (BDI-II). Twenty-six (11%) participants were referred to further psychiatric consultation. Psychiatric symptoms showed no correlation with acute COVID-19 severity; in our sample patients with depressive symptoms at the clinical interview, as well as those with mild to severe levels of depression according to BDI-II scores, had lower forced expiratory volume in the 1st second (FEV1) values than those without and greater odds for persistent, poor tolerance for physical efforts. Conclusions: As could be expected, an approach including both a psychiatric interview and the use of self-administered questionnaires is likely to capture the psychiatric outcome of patients recovered from COVID-19 better than questionnaires alone. Anxiety and depressive symptoms at follow-up had no correlation with the severity of COVID acute manifestations, but rather with ongoing and persistent physical symptoms. Further studies and longer follow-up duration will allow a better understanding of the complex relationship between residual physical symptoms, quality of life and psychological health.
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Affiliation(s)
- Carla Gramaglia
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mattia Bellan
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | | | - Alessio Baricich
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Baldon
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
| | - Sofia Battistini
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
| | - Valeria Binda
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Feggi
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Martina Gai
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
| | - Eleonora Gattoni
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Amalia Jona
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Luca Lorenzini
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
| | - Debora Marangon
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Maria Martelli
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
| | | | - Patrizia Zeppegno
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale UPO, Novara, Italy
- Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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Bellan M, Piccinino C, Tonello S, Minisini R, Giubertoni A, Sola D, Pedrazzoli R, Gagliardi I, Zecca E, Calzaducca E, Mazzoleni F, Piffero R, Patti G, Pirisi M, Sainaghi PP. Role of Osteopontin as a Potential Biomarker of Pulmonary Arterial Hypertension in Patients with Systemic Sclerosis and Other Connective Tissue Diseases (CTDs). Pharmaceuticals (Basel) 2021; 14:ph14050394. [PMID: 33919476 PMCID: PMC8143460 DOI: 10.3390/ph14050394] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 12/11/2022] Open
Abstract
Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue diseases (CTD). Its early diagnosis is essential to start effective treatment. In the present paper, we aimed to evaluate the role of plasma osteopontin (OPN) as a candidate biomarker of PAH in a cohort of CTD patients. OPN is a pleiotropic protein involved in inflammation and fibrogenesis and, therefore, potentially promising in this specific clinical context. We performed a cross-sectional observational study on a cohort of 113 CTD patients (females N = 101, 89.4%) affected by systemic sclerosis N = 88 (77.9%), mixed connective tissue disease N = 10 (8.8%), overlap syndrome N = 10 (8.8%) or undifferentiated connective tissue disease N = 5 (4.4%). CTD-PAH patients showed significantly higher OPN plasma values than patients with CTD alone (241.0 (188.8–387.2) vs. 200.7 (133.5–281.6) ng/mL; p = 0.03). Although OPN levels were directly correlated with age and inversely with glomerular filtration rate, they remained associated with PAH at multivariate analysis. In conclusion, OPN was significantly associated with PAH among patients with CTD, suggesting it may have a role as a non-invasive disease biomarker of PAH.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
- Correspondence:
| | - Cristina Piccinino
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Stelvio Tonello
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Rosalba Minisini
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Ailia Giubertoni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Daniele Sola
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Ileana Gagliardi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Elisa Calzaducca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Federica Mazzoleni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Roberto Piffero
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (S.T.); (R.M.); (A.G.); (I.G.); (E.Z.); (E.C.); (F.M.); (R.P.); (G.P.); (M.P.); (P.P.S.)
- Division of Cardoilogy, “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD (Center for Translational Research on Autoimmune and Allergic Disease), Maggiore della Carità Hospital, 28100 Novara, Italy
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Bellan M, Giubertoni A, Piccinino C, Buffa M, Cromi D, Sola D, Pedrazzoli R, Gagliardi I, Calzaducca E, Zecca E, Patrucco F, Patti G, Sainaghi PP, Pirisi M. Cardiopulmonary Exercise Testing Is an Accurate Tool for the Diagnosis of Pulmonary Arterial Hypertension in Scleroderma Related Diseases. Pharmaceuticals (Basel) 2021; 14:ph14040342. [PMID: 33917930 PMCID: PMC8068386 DOI: 10.3390/ph14040342] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 11/16/2022] Open
Abstract
The early diagnosis of pulmonary arterial hypertension (PAH) is a major determinant of prognosis in patients affected by connective tissue diseases (CTDs) complicated by PAH. In the present paper we investigated the diagnostic accuracy of cardiopulmonary exercise testing (CPET) in this specific setting. We recorded clinical and laboratory data of 131 patients who underwent a CPET at a pulmonary hypertension clinic. Out of them, 112 (85.5%) had a diagnosis of CTDs; 8 (6.1%) received a diagnosis of CTDs-PAH and 11 (8.4%) were affected PH of different etiology. Among CPET parameters the following parameters showed the best diagnostic performance for PAH: peak volume of oxygen uptake (VO2; AUC: 0.845, CI95% 0.767-0.904), ratio between ventilation and volume of exhaled carbon dioxide (VE/VCO2 slope; AUC: 0.888, CI95%: 0.817-0.938) and end-tidal partial pressures (PetCO2; AUC: 0.792, CI95%: 0.709-0.861). These parameters were comparable among CTDs-PAH and PH of different etiology. The diagnostic performance was even improved by creating a composite score which included all the three parameters identified. In conclusion, CPET is a very promising tool for the stratification of risk of PAH among CTDs patients; the use of composite measures may improve diagnostic performance.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
- Correspondence:
| | - Ailia Giubertoni
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Cristina Piccinino
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Mariachiara Buffa
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Debora Cromi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Daniele Sola
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Roberta Pedrazzoli
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Ileana Gagliardi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Elisa Calzaducca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
| | - Filippo Patrucco
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale UPO, 28100 Novara, Italy; (A.G.); (M.B.); (D.C.); (I.G.); (E.C.); (E.Z.); (F.P.); (G.P.); (P.P.S.); (M.P.)
- “AOU Maggiore della Carità” Hospital, 28100 Novara, Italy; (C.P.); (D.S.); (R.P.)
- CAAD, (Center for Translational Research on Autoimmune and Allergic Disease) Maggiore della Carità Hospital and Università del Piemonte Orientale UPO, 28100 Novara, Italy
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Salmi L, Gavelli F, Patrucco F, Bellan M, Sainaghi PP, Avanzi GC, Castello LM. Growth Arrest-Specific Gene 6 Administration Ameliorates Sepsis-Induced Organ Damage in Mice and Reduces ROS Formation In Vitro. Cells 2021; 10:cells10030602. [PMID: 33803290 PMCID: PMC7998241 DOI: 10.3390/cells10030602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/01/2021] [Accepted: 03/04/2021] [Indexed: 12/15/2022] Open
Abstract
Sepsis is a widespread life-threatening disease, with a high mortality rate due to inflammation-induced multiorgan failure (MOF). Thus, new effective modulators of the immune response are urgently needed to ameliorate the outcome of septic patients. As growth arrest-specific gene 6 (Gas6)/Tyro3, Axl, MerTK (TAM) receptors signaling has shown immunomodulatory activity in sepsis, here we sought to determine whether Gas6 protein injection could mitigate MOF in a cecal slurry mouse model of sepsis. Mice, divided into different groups according to treatment-i.e., placebo (B), ampicillin (BA), Gas6 alone (BG), and ampicillin plus Gas6 (BAG)-were assessed for vitality, histopathology and cytokine expression profile as well as inducible nitric oxide synthase (iNOS), ALT and LDH levels. BAG-treated mice displayed milder kidney and lung damage and reduced levels of cytokine expression and iNOS in the lungs compared to BA-treated mice. Notably, BAG-treated mice showed lower LDH levels compared to controls. Lastly, BAG-treated cells of dendritic, endothelial or monocytic origin displayed reduced ROS formation and increased cell viability, with a marked upregulation of mitochondrial activity. Altogether, our findings indicate that combined treatment with Gas6 and antibiotics ameliorates sepsis-induced organ damage and reduces systemic LDH levels in mice, suggesting that Gas6 intravenous injection may be a viable therapeutic option in sepsis.
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Mennuni MG, Renda G, Grisafi L, Rognoni A, Colombo C, Lio V, Foglietta M, Petrilli I, Pirisi M, Spinoni E, Azzolina D, Hayden E, Aimaretti G, Avanzi GC, Bellan M, Cantaluppi V, Capponi A, Castello LM, D'Ardes D, Corte FD, Gallina S, Krengli M, Malerba M, Pierdomenico SD, Savoia P, Zeppegno P, Sainaghi PP, Cipollone F, Patti G. Clinical outcome with different doses of low-molecular-weight heparin in patients hospitalized for COVID-19. J Thromb Thrombolysis 2021; 52:782-790. [PMID: 33649979 PMCID: PMC7919624 DOI: 10.1007/s11239-021-02401-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/11/2021] [Indexed: 12/19/2022]
Abstract
A pro-thrombotic milieu and a higher risk of thrombotic events were observed in patients with CoronaVirus disease-19 (COVID-19). Accordingly, recent data suggested a beneficial role of low molecular weight heparin (LMWH), but the optimal dosage of this treatment is unknown. We evaluated the association between prophylactic vs. intermediate-to-fully anticoagulant doses of enoxaparin and in-hospital adverse events in patients with COVID-19. We retrospectively included 436 consecutive patients admitted in three Italian hospitals. Outcome according to the use of prophylactic (4000 IU) vs. higher (> 4000 IU) daily dosage of enoxaparin was evaluated. The primary end-point was in-hospital death. Secondary outcome measures were in-hospital cardiovascular death, venous thromboembolism, new-onset acute respiratory distress syndrome (ARDS) and mechanical ventilation. A total of 287 patients (65.8%) were treated with the prophylactic enoxaparin regimen and 149 (34.2%) with a higher dosing regimen. The use of prophylactic enoxaparin dose was associated with a similar incidence of all-cause mortality (25.4% vs. 26.9% with the higher dose; OR at multivariable analysis, including the propensity score: 0.847, 95% CI 0.400–0.1.792; p = 0.664). In the prophylactic dose group, a significantly lower incidence of cardiovascular death (OR 0.165), venous thromboembolism (OR 0.067), new-onset ARDS (OR 0.454) and mechanical intubation (OR 0.150) was observed. In patients hospitalized for COVID-19, the use of a prophylactic dosage of enoxaparin appears to be associated with similar in-hospital overall mortality compared to higher doses. These findings require confirmation in a randomized, controlled study.
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Affiliation(s)
- Marco G Mennuni
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Renda
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Leonardo Grisafi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Andrea Rognoni
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Crizia Colombo
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Veronica Lio
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Melissa Foglietta
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Ivan Petrilli
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Mario Pirisi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Enrico Spinoni
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Danila Azzolina
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Eyal Hayden
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Gianluca Aimaretti
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Gian Carlo Avanzi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Mattia Bellan
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Vincenzo Cantaluppi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Andrea Capponi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy
| | - Luigi M Castello
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Damiano D'Ardes
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Francesco Della Corte
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Sabina Gallina
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Marco Krengli
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Mario Malerba
- Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy.,Sant'Andrea Hospital, Vercelli, Italy
| | - Sante D Pierdomenico
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Paola Savoia
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Patrizia Zeppegno
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Pier P Sainaghi
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy.,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy
| | - Francesco Cipollone
- G. d'Annunzio University, Chieti-Pescara, Italy.,Ospedale Santissima Annunziata of Chieti, Chieti, Italy
| | - Giuseppe Patti
- Azienda Ospedaliero-Universitaria Maggiore della Carità, Novara, Italy. .,Dipartimento di Medicina Traslazionale, Università del Piemonte Orientale, UPO, Azienda Ospedaliero-Universitaria Maggiore della Carità, Via Solaroli 17, 28100, Novara, Italy.
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Patrucco F, Carriero A, Falaschi Z, Paschè A, Gavelli F, Airoldi C, Bellan M, Sainaghi PP, Solidoro P, Balbo PE. COVID-19 Diagnosis in Case of Two Negative Nasopharyngeal Swabs: Association between Chest CT and Bronchoalveolar Lavage Results. Radiology 2021; 298:E152-E155. [PMID: 33399508 PMCID: PMC7903987 DOI: 10.1148/radiol.2020203776] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/07/2020] [Accepted: 11/18/2020] [Indexed: 01/31/2023]
Abstract
See also the editorial by Little in this issue.
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Affiliation(s)
- Filippo Patrucco
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Alessandro Carriero
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Zeno Falaschi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Alessio Paschè
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Francesco Gavelli
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Chiara Airoldi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Mattia Bellan
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
| | - Pier Paolo Sainaghi
- From the Medical Department, Respiratory Diseases Unit (F.P., P.E.B.), Department of Diagnosis and Treatment Services, Radiodiagnostics (A.C., Z.F., A.P.), Emergency Medicine Department (F.G.), and Medical Department, Internal Medicine Unit (M.B., P.P.S.), Azienda Ospedaliero Universitaria Maggiore della Carità di Novara, C.so Mazzini 18, 28100 Novara, Italy; Translational Medicine Department, University of Piemonte Orientale Amedeo Avogadro, Novara, Italy (F.P., F.G., C.A., M.B.); and Medical Sciences Department, University of Torino, Turin, Italy (P.S.)
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De Vincentis A, Vespasiani-Gentilucci U, Costanzo L, Novella A, Cortesi L, Nobili A, Mannucci PM, Incalzi RA, Mannucci PM, Nobili A, Pietrangelo A, Perticone F, Licata G, Violi F, Corazza GR, Corrao S, Marengoni A, Salerno F, Cesari M, Tettamanti M, Pasina L, Franchi C, Franchi C, Cortesi L, Tettamanti M, Miglio G, Tettamanti M, Cortesi L, Ardoino I, Novella A, Prisco D, Silvestri E, Emmi G, Bettiol A, Mattioli I, Biolo G, Zanetti M, Bartelloni G, Vanoli M, Grignani G, Pulixi EA, Lupattelli G, Bianconi V, Alcidi R, Girelli D, Busti F, Marchi G, Barbagallo M, Dominguez L, Beneduce V, Cacioppo F, Corrao S, Natoli G, Mularo S, Raspanti M, Zoli M, Matacena ML, Orio G, Magnolfi E, Serafini G, Simili A, Palasciano G, Modeo ME, Gennaro CD, Cappellini MD, Fabio G, De Amicis MM, De Luca G, Scaramellini N, Cesari M, Rossi PD, Damanti S, Clerici M, Leoni S, Di Mauro AD, Di Sabatino A, Miceli E, Lenti MV, Pisati M, Dominioni CC, Pontremoli R, Beccati V, Nobili G, Leoncini G, Anastasio L, Carbone M, Cipollone F, Guagnano MT, Rossi I, Mancuso G, Calipari D, Bartone M, Delitala G, Berria M, Delitala A, Muscaritoli M, Molfino A, Petrillo E, Giorgi A, Gracin C, Zuccalà G, D'Aurizio G, Romanelli G, Marengoni A, Volpini A, Lucente D, Picardi A, Gentilucci UV, Bellelli G, Corsi M, Antonucci C, Sidoli C, Principato G, Arturi F, Succurro E, Tassone B, Giofrè F, Serra MG, Bleve MA, Brucato A, De Falco T, Fabris F, Bertozzi I, Bogoni G, Rabuini MV, Prandini T, Manfredini R, Fabbian F, Boari B, De Giorgi A, Tiseo R, Paolisso G, Rizzo MR, Catalano C, Borghi C, Strocchi E, Ianniello E, Soldati M, Schiavone S, Bragagni A, Sabbà C, Vella FS, Suppressa P, De Vincenzo GM, Comitangelo A, Amoruso E, Custodero C, Fenoglio L, Falcetta A, Fracanzani AL, Tiraboschi S, Cespiati A, Oberti G, Sigon G, Peyvandi F, Rossio R, Colombo G, Agosti P, Monzani V, Savojardo V, Ceriani G, Salerno F, Pallini G, Montecucco F, Ottonello L, Caserza L, Vischi G, Liberato NL, Tognin T, Purrello F, Di Pino A, Piro S, Rozzini R, Falanga L, Pisciotta MS, Bellucci FB, Buffelli S, Montrucchio G, Peasso P, Favale E, Poletto C, Margaria C, Sanino M, Violi F, Perri L, Guasti L, Castiglioni L, Maresca A, Squizzato A, Campiotti L, Grossi A, Diprizio RD, Bertolotti M, Mussi C, Lancellotti G, Libbra MV, Galassi M, Grassi Y, Greco A, Sciacqua A, Perticone M, Battaglia R, Maio R, Stanghellini V, Ruggeri E, del Vecchio S, Salvi A, Leonardi R, Damiani G, Capeci W, Mattioli M, Martino GP, Biondi L, Pettinari P, Ghio R, Col AD, Minisola S, Colangelo L, Cilli M, Labbadia G, Afeltra A, Pipita ME, Castellino P, Zanoli L, Gennaro A, Gaudio A, Saracco V, Fogliati M, Bussolino C, Mete F, Gino M, Vigorito C, Cittadini A, Moreo G, Prolo S, Pina G, Ballestrero A, Ferrando F, Gonella R, Cerminara D, Berra S, Dassi S, Nava MC, Graziella B, Baldassarre S, Fragapani S, Gruden G, Galanti G, Mascherini G, Petri C, Stefani L, Girino M, Piccinelli V, Nasso F, Gioffrè V, Pasquale M, Sechi L, Catena C, Colussi G, Cavarape A, Da Porto A, Passariello N, Rinaldi L, Berti F, Famularo G, Tarsitani P, Castello R, Pasino M, Ceda GP, Maggio MG, Morganti S, Artoni A, Grossi M, Del Giacco S, Firinu D, Costanzo G, Argiolas G, Montalto G, Licata A, Montalto FA, Corica F, Basile G, Catalano A, Bellone F, Principato C, Malatino L, Stancanelli B, Terranova V, Di Marca S, Di Quattro R, Malfa LL, Caruso R, Mecocci P, Ruggiero C, Boccardi V, Meschi T, Ticinesi A, Nouvenne A, Minuz P, Fondrieschi L, Imperiale GN, Pirisi M, Fra GP, Sola D, Bellan M, Porta M, Riva P, Quadri R, Larovere E, Novelli M, Scanzi G, Mengoli C, Provini S, Ricevuti L, Simeone E, Scurti R, Tolloso F, Tarquini R, Valoriani A, Dolenti S, Vannini G, Volpi R, Bocchi P, Vignali A, Harari S, Lonati C, Napoli F, Aiello I, Landolfi R, Montalto M, Mirijello A, Purrello F, Di Pino A, del Primario NEC, Ghidoni S, Salvatore T, Monaco L, Ricozzi C, Pilotto A, Indiano I, Gandolfo F. The multifaceted spectrum of liver cirrhosis in older hospitalised patients: analysis of the REPOSI registry. Age Ageing 2021; 50:498-504. [PMID: 32926127 DOI: 10.1093/ageing/afaa150] [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: 04/20/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Knowledge on the main clinical and prognostic characteristics of older multimorbid subjects with liver cirrhosis (LC) admitted to acute medical wards is scarce. OBJECTIVES To estimate the prevalence of LC among older patients admitted to acute medical wards and to assess the main clinical characteristics of LC along with its association with major clinical outcomes and to explore the possibility that well-distinguished phenotypic profiles of LC have classificatory and prognostic properties. METHODS A cohort of 6,193 older subjects hospitalised between 2010 and 2018 and included in the REPOSI registry was analysed. RESULTS LC was diagnosed in 315 patients (5%). LC was associated with rehospitalisation (age-sex adjusted hazard ratio, [aHR] 1.44; 95% CI, 1.10-1.88) and with mortality after discharge, independently of all confounders (multiple aHR, 2.1; 95% CI, 1.37-3.22), but not with in-hospital mortality and incident disability. Three main clinical phenotypes of LC patients were recognised: relatively fit subjects (FIT, N = 150), subjects characterised by poor social support (PSS, N = 89) and, finally, subjects with disability and multimorbidity (D&M, N = 76). PSS subjects had an increased incident disability (35% vs 13%, P < 0.05) compared to FIT. D&M patients had a higher mortality (in-hospital: 12% vs 3%/1%, P < 0.01; post-discharge: 41% vs 12%/15%, P < 0.01) and less rehospitalisation (10% vs 32%/34%, P < 0.01) compared to PSS and FIT. CONCLUSIONS LC has a relatively low prevalence in older hospitalised subjects but, when present, accounts for worse post-discharge outcomes. Phenotypic analysis unravelled the heterogeneity of LC older population and the association of selected phenotypes with different clinical and prognostic features.
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Affiliation(s)
| | | | - Luisa Costanzo
- Unit of Geriatrics, University Campus Bio-Medico, Rome, Italy
| | - Alessio Novella
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Laura Cortesi
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - Alessandro Nobili
- Laboratorio di Valutazione della Qualità delle Cure e dei Servizi per l'Anziano, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
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Spinoni EG, Mennuni M, Rognoni A, Grisafi L, Colombo C, Lio V, Renda G, Foglietta M, Petrilli I, D'Ardes D, Sainaghi PP, Aimaretti G, Bellan M, Castello L, Avanzi GC, Corte FD, Krengli M, Pirisi M, Malerba M, Capponi A, Gallina S, Pierdomenico SD, Cipollone F, Patti G. Contribution of Atrial Fibrillation to In-Hospital Mortality in Patients With COVID-19. Circ Arrhythm Electrophysiol 2021; 14:e009375. [PMID: 33591815 PMCID: PMC7892203 DOI: 10.1161/circep.120.009375] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Enrico Guido Spinoni
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Marco Mennuni
- Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Andrea Rognoni
- Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Leonardo Grisafi
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Crizia Colombo
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Veronica Lio
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Giulia Renda
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Melissa Foglietta
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Ivan Petrilli
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Damiano D'Ardes
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Pier Paolo Sainaghi
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Gianluca Aimaretti
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Mattia Bellan
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Luigi Castello
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Gian Carlo Avanzi
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Francesco Della Corte
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Marco Krengli
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Mario Pirisi
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Mario Malerba
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Sant'Andrea Hospital, Vercelli, Italy (M. Malerba)
| | - Andrea Capponi
- Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
| | - Sabina Gallina
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Sante Donato Pierdomenico
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Francesco Cipollone
- G. d'Annunzio University, Chieti-Pescara. Ospedale Santissima Annunziata of Chieti (G.R., M.F., I.P., D.D., S.G., S.D.P., F.C.)
| | - Giuseppe Patti
- Università del Piemonte Orientale, Novara (E.G.S., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., M. Malerba, G.P.).,Maggiore della Carità Hospital, Novara (E.G.S., M. Mennuni, A.R., L.G., C.C., V.L., P.P.S., G.A., M.B., L.C., G.C.A., F.D.C., M.K., M.P., A.C., G.P.)
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48
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Baricich A, Borg MB, Cuneo D, Cadario E, Azzolina D, Balbo PE, Bellan M, Zeppegno P, Pirisi M, Cisari C. Midterm functional sequelae and implications in rehabilitation after COVID-19: a cross-sectional study. Eur J Phys Rehabil Med 2021; 57:199-207. [PMID: 33565741 DOI: 10.23736/s1973-9087.21.06699-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND COVID-19 has been mainly investigated concerning the acute and subacute phase implications and management. Meanwhile, few studies focused on the midterm sequelae, which still remain largely unknown. AIM To assess the physical performance of COVID-19 survivors at 3 to 6 months from Hospital discharge. DESIGN A cross-sectional study focused on mid-term functional outcomes evaluation in COVID-19 survivors. SETTING Outpatients who had been previously hospitalized due to COVID-19 from March to May 2020 at the University Hospital of Novara, Italy. POPULATION We enrolled 204 patients, of which 60% were men, with the mean age of 57.9 years. METHODS Patients firstly underwent the short physical performance battery test (SPPB), which is composed of a series of physical tests assessing the lower limb function and the functional status of the subjects. Subsequently, based on SPPB results, patients' cardiorespiratory fitness performance was further investigated. Patients with normal SPPB score (SPPB>10) underwent the 2-minute walking test (2MWT) whereas, in order to safely test the cardiorespiratory function, in patients with abnormal SPPB score (SPPB≤10) the 1-minute sit-to-stand test (1MSTST) was performed. It should be noted that the 1MSTST can be safely performed even by subjects with compromised walking ability. RESULTS Overall, 66 patients (32% of our sample) showed an impaired physical performance at 3 to 6 months after hospital discharge. In particular, 29 patients presented an SPPB score ≤10, and the 1MSTST confirmed this status in the whole group (100%) compared to the reference values for age and sex. Besides, among patients with a normal SPPB score, 37 showed a lower sex- and age-matched 2MWT score. Finally, a significant association between Intensive Care Unit hospitalization or mechanical ventilation and physical impairment was observed together with a significant association between the walking ability (measured with SPPB and 2MWT) and the number of comorbidities. CONCLUSIONS A residual physical and functional impairment was observed in COVID-19 survivors at mid-term evaluation after hospitalization. CLINICAL REHABILITATION IMPACT Considering the current COVID-19 epidemiology, we might expect a tremendous burden of disability in the next future. Thus, an appropriate clinical rehabilitation pathway must be implemented.
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Affiliation(s)
- Alessio Baricich
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy - .,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy -
| | - Margherita B Borg
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
| | - Daria Cuneo
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
| | - Emanuela Cadario
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Danila Azzolina
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Piero E Balbo
- Department of Pneumology, Maggiore della Carità University Hospital, Novara, Italy
| | - Mattia Bellan
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Internal Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Psychiatry, Maggiore della Carità University Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy.,Department of Internal Medicine, Maggiore della Carità University Hospital, Novara, Italy
| | - Carlo Cisari
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Department of Physical Medicine and Rehabilitation, Maggiore della Carità University Hospital, Novara, Italy
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49
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Bellan M, Quaglia M, Nerviani A, Mauro D, Lewis M, Goegan F, Gibbin A, Pagani S, Salmi L, Molinari L, Castello LM, Avanzi GC, Cantaluppi V, Pirisi M, Sainaghi PP, Pitzalis C. Increased plasma levels of Gas6 and its soluble tyrosine kinase receptors Mer and Axl are associated with immunological activity and severity of lupus nephritis. Clin Exp Rheumatol 2021; 39:132-138. [DOI: 10.55563/clinexprheumatol/xyylza] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/17/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; Internal Medicine Division, Maggiore della Carità Hospital, Novara; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy.
| | - Marco Quaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara; and Division of Nephrology and Renal Transplantation, Maggiore della Carità Hospital, Novara, Italy
| | - Alessandra Nerviani
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, UK
| | - Daniele Mauro
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, UK
| | - Myles Lewis
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, UK
| | - Federica Goegan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Antonello Gibbin
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; and Internal Medicine Division, Maggiore della Carità Hospital, Novara, Italy
| | - Sara Pagani
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Livia Salmi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luca Molinari
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; and Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; and Emergency Medicine Department, Maggiore della Carità Hospital, Novara, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara; and Division of Nephrology and Renal Transplantation, Maggiore della Carità Hospital, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; and Internal Medicine Division, Maggiore della Carità Hospital, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara; Internal Medicine Division, Maggiore della Carità Hospital, Novara; IRCAD, Interdisciplinary Research Center of Autoimmune Diseases, Novara, Italy
| | - Costantino Pitzalis
- Centre for Experimental Medicine and Rheumatology, Barts and The London School of Medicine and Dentistry, William Harvey Research Institute, Queen Mary University of London, UK
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50
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Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, Baldon G, Bartolomei G, Battaglia M, Battistini S, Binda V, Borg M, Cantaluppi V, Castello LM, Clivati E, Cisari C, Costanzo M, Croce A, Cuneo D, De Benedittis C, De Vecchi S, Feggi A, Gai M, Gambaro E, Gattoni E, Gramaglia C, Grisafi L, Guerriero C, Hayden E, Jona A, Invernizzi M, Lorenzini L, Loreti L, Martelli M, Marzullo P, Matino E, Panero A, Parachini E, Patrucco F, Patti G, Pirovano A, Prosperini P, Quaglino R, Rigamonti C, Sainaghi PP, Vecchi C, Zecca E, Pirisi M. Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge. JAMA Netw Open 2021; 4:e2036142. [PMID: 33502487 PMCID: PMC7841464 DOI: 10.1001/jamanetworkopen.2020.36142] [Citation(s) in RCA: 258] [Impact Index Per Article: 86.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown. OBJECTIVE To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results. EXPOSURE Severe COVID-19 requiring hospitalization. MAIN OUTCOMES AND MEASURES The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae. RESULTS Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). CONCLUSIONS AND RELEVANCE These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.
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Affiliation(s)
- Mattia Bellan
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Daniele Soddu
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | | | - Alessio Baricich
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Patrizia Zeppegno
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Gian Carlo Avanzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giulia Baldon
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giuseppe Bartolomei
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Battaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Sofia Battistini
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Valeria Binda
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Margherita Borg
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Vincenzo Cantaluppi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Luigi Mario Castello
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Elisa Clivati
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carlo Cisari
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Martina Costanzo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Croce
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Daria Cuneo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carla De Benedittis
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Simona De Vecchi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alessandro Feggi
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Martina Gai
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gattoni
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Carla Gramaglia
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Leonardo Grisafi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Chiara Guerriero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Eyal Hayden
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Amalia Jona
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Marco Invernizzi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Luca Lorenzini
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Lucia Loreti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Maria Martelli
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Paolo Marzullo
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Erica Matino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Antonio Panero
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Elena Parachini
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Filippo Patrucco
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Giuseppe Patti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Alice Pirovano
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | | | - Riccardo Quaglino
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | - Cristina Rigamonti
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Pier Paolo Sainaghi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Camilla Vecchi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Erika Zecca
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
| | - Mario Pirisi
- Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
- Azienda Ospedaliero–Universitaria Maggiore della Carità, Novara, Italy
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