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Gargiulo P, Basile C, Galasso G, Bellino M, D'Elia D, Patti G, Bosco M, Prinetti M, Andò G, Campanella F, Taverna G, Calabrò P, Cesaro A, Fimiani F, Catalano A, Varbella F, Corleto A, Barillà F, Muscoli S, Musumeci G, Delnevo F, Giallauria F, Napoli R, Porto I, Polimeni A, Quarta R, Maloberti A, Merlini PA, De Luca L, Casu G, Brunetti ND, Crisci M, Paloscia L, Bilato C, Indolfi C, Marzano F, Fontanarosa S, Buonocore D, Parlati ALM, Nardi E, Prastaro M, Soricelli A, Salvatore M, Paolillo S, Perrone-Filardi P. Strike early-strike strong lipid-lowering strategy with PCSK9i in ACS patients. Real-world evidence from AT-TARGET-IT registry. Eur J Prev Cardiol 2024:zwae170. [PMID: 38788773 DOI: 10.1093/eurjpc/zwae170] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 03/29/2024] [Accepted: 05/08/2024] [Indexed: 05/26/2024]
Abstract
AIMS No data are available on early initiation of proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) in patients with acute coronary syndrome (ACS) in real-world. This study investigates the effects of PCSK9i started at time of ACS hospitalization on lipid control and major CV events in real-world. METHODS The lipid control outcome was the percentage of patients reaching the LDL-C target of < 55 mg/dL at first lipid control. The clinical outcome was the incidence of composite major CV events (all cause death, non-fatal MI, non-fatal stroke, and ischemia-driven revascularization) during follow-up in relation to quartiles of LDL-C at first lipid control. RESULTS We included 771 patients with ACS from AT-TARGET-IT registry, receiving PCSK9i prescription during hospitalization or at discharge. Median LDL-C was 137 mg/dL and decreased to 43 mg/dL at first lipid control. 527 (68.3%) patients achieved LDL-C target at the first lipid control at a median time of 37 days from hospitalization; of them, 404 (76.8%) were discharged on statin plus ezetimibe background therapy. Event curves through a median follow-up of 11 months across quartiles of LDL-C showed a stepwise lower risk of 4P-MACE, 3P-MACE, all-cause mortality, and ischemia-driven revascularization in lower quartile of LDL-C values at first lipid control (<23 mg/dL) and in patients reaching LDL-C <55 mg/dL. CONCLUSIONS Intensive and early lipid-lowering therapy using PCSK9i in patients with ACS (strike early strike strong strategy) is safe and effective in clinical practice and associated with a reduction of residual CV risk.
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Affiliation(s)
- Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Christian Basile
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Gennaro Galasso
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Michele Bellino
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Debora D'Elia
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Giuseppe Patti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Manuel Bosco
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Matteo Prinetti
- Division of Cardiology, Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giuseppe Andò
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Francesca Campanella
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Giovanni Taverna
- Department of Clinical and Experimental Medicine, University of Messina, AOU Policlinico "G. Martino", Messina, Italy
| | - Paolo Calabrò
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Arturo Cesaro
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Fabio Fimiani
- Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli" and Divion of Cardiology, AORN "Sant' Anna e San Sebastiano", Caserta, Italy
| | - Angelo Catalano
- Cardiology Division Emergency Department, Eboli-Battipaglia-Roccadaspide, Maria SS Addolorata General Hospital, Eboli, Italy
| | - Ferdinando Varbella
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Antonella Corleto
- Division of Cardiology, Interventional Unit, Infermi Rivoli Hospital Rivoli, San Luigi Gonzaga University Hospital, Orbassano, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | | | - Francesco Giallauria
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Traslational Medical Sciences, Precision Medicine Unit, Federico II University, Naples, Italy
| | - Italo Porto
- Cardiovascular Disease Unit, Department of Internal Medicine (Di.M.I.), University of Genoa, Genoa, Italy and Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiology Network, Genoa, Italy
| | - Alberto Polimeni
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Rossella Quarta
- Division of Cardiology AOCS, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Cosenza, Italy
| | - Alessandro Maloberti
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Piera Angelica Merlini
- Cardiology 4, ASST GOM Niguarda, Milan, Italy and School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy
| | - Leonardo De Luca
- Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, S. Camillo-Forlanini, Rome, Italy
| | - Gavino Casu
- Department of Cardiology, Azienda Ospedaliera Universitaria di Sassari, Sassari, Italy and Clinical and Interventional Cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Mario Crisci
- Department of Cardiology, Division of Interventional Cardiology, Monaldi Hospital, Naples, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Vicenza, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, Catanzaro, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Sara Fontanarosa
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Davide Buonocore
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | | | - Ermanno Nardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Prastaro
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Andrea Soricelli
- IRCCS Synlab SDN, Naples, Italy; Department of Motor Sciences and Healthiness, University of Naples Parthenope, Naples, Italy
| | | | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
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Lauretani F, Giallauria F, Testa C, Zinni C, Lorenzi B, Zucchini I, Salvi M, Napoli R, Maggio MG. Dopamine Pharmacodynamics: New Insights. Int J Mol Sci 2024; 25:5293. [PMID: 38791331 DOI: 10.3390/ijms25105293] [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: 02/25/2024] [Revised: 05/04/2024] [Accepted: 05/07/2024] [Indexed: 05/26/2024] Open
Abstract
Dopamine is a key neurotransmitter involved in physiological processes such as motor control, motivation, reward, cognitive function, and maternal and reproductive behaviors. Therefore, dysfunctions of the dopaminergic system are related to a plethora of human diseases. Dopamine, via different circuitries implicated in compulsive behavior, reward, and habit formation, also represents a key player in substance use disorder and the formation and perpetuation of mechanisms leading to addiction. Here, we propose dopamine as a model not only of neurotransmission but also of neuromodulation capable of modifying neuronal architecture. Abuse of substances like methamphetamine, cocaine, and alcohol and their consumption over time can induce changes in neuronal activities. These modifications lead to synaptic plasticity and finally to morphological and functional changes, starting from maladaptive neuro-modulation and ending in neurodegeneration.
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Affiliation(s)
- Fulvio Lauretani
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University-Hospital of Parma, 43126 Parma, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, "Federico II" University of Naples, via S. Pansini 5, 80131 Naples, Italy
| | - Crescenzo Testa
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Claudia Zinni
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Beatrice Lorenzi
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Irene Zucchini
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Marco Salvi
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, "Federico II" University of Naples, via S. Pansini 5, 80131 Naples, Italy
| | - Marcello Giuseppe Maggio
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
- Cognitive and Motor Center, Medicine and Geriatric-Rehabilitation Department of Parma, University-Hospital of Parma, 43126 Parma, Italy
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Candido R, Nicolucci A, Larosa M, Rossi MC, Napoli R. Treatment intensification following glucagon-like peptide-1 receptor agonist in type 2 diabetes: Comparative effectiveness analyses between free vs. fixed combination of GLP-1 RA and basal insulin. RESTORE-G real-world study. Nutr Metab Cardiovasc Dis 2024:S0939-4753(24)00125-X. [PMID: 38693036 DOI: 10.1016/j.numecd.2024.03.023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND AND AIMS Add-on of basal insulin (BI) to intensify the ongoing therapy with glucagon-like peptide 1 receptor agonist (GLP-1 RA) is recommended, but it is unclear if free or fixed combination of BI and GLP-1 RA produce similar outcomes. A retrospective comparative effectiveness analysis of the add-on of glargine 300 U/mL (Gla-300) to ongoing GLP-1 RA vs. switch to fixed ratio combination of degludec and liraglutide (iDegLira) was performed. METHODS AND RESULTS Real-world data collected in electronic medical records by 32 Italian diabetes clinics. Propensity score (PS) adjustment was applied to assess changes in glycated hemoglobin (HbA1c), fasting blood glucose (FBG), body weight, and BI dose after 6 months from Gla-300 or iDegLira initiation. Compared to iDegLira group (N = 260), Gla-300+GLP-1 RA group (N = 255) had older age and higher levels of HbA1c (9.1 vs. 8.9%). After 6 months, statistically significant greater FBG improvement [estimated mean difference and 95% confidence intervals: -24.05 mg/dl (-37.04; -11.06; p = 0.0003) and BI dose increase [+0.03 U/kg (95%CI 0.00; 0.06); p = 0.009] were found in the free vs. fixed combination group, although low doses of BI (0.2 U/kg) were reached in both groups. Trends of larger HbA1c and body weight reductions with the free combination were also found, without reaching the statistical significance. CONCLUSION Although inertia in insulin initiation and titration was documented in both groups, higher benefit on FBG control was obtained with free vs. fixed combination, likely due to a better titration of BI and GLP-1 RA.
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Affiliation(s)
- Riccardo Candido
- Diabetes Centre District 3, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Antonio Nicolucci
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine and Diabetes, Federico II University School of Medicine and Institute of Experimental Endocrinology and Oncology, National Research Council, Napoli, Italy; AOU Federico II, Napoli, Italy
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Candido R, Nicolucci A, Larosa M, Rossi MC, Napoli R. Treatment intensification following glucagon-like peptide-1 receptor agonist treatment in type 2 diabetes: The RESTORE-G real-world study. Nutr Metab Cardiovasc Dis 2023; 33:2294-2305. [PMID: 37679243 DOI: 10.1016/j.numecd.2023.07.025] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 07/10/2023] [Accepted: 07/14/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND AND AIMS To assess intensification approaches with basal insulin (BI) following glucagon-like peptide-1 receptor agonist (GLP-1 RA) treatment in type 2 diabetes (T2D). METHODS AND RESULTS Real-world data were collected in electronic medical records by 32 Italian diabetes clinics between 2011 and 2021. Primary endpoint was the proportion of insulin-naïve T2D patients treated with GLP-1 RA who initiated (add-on or switch) BI. Secondary endpoints were: treatment approaches, mean time to BI start, effectiveness and safety. Among 7,962 eligible patients, BI was prescribed to 3,164 (39.7%; 95%CI 38.7; 40.8): 67.6% switched to BI (22.1% also starting 1-3 injections of short-acting insulin), 22.7% added BI while maintaining GLP-1 RA, and 9.7% switched to a fixed-ratio combination of GLP-1 RA and BI (FRC). Median time since the first GLP-1 RA to BI/FRC prescription was 27.4 (IQ range 11.8-53.5) months. In this study 60.3% of patients did not start BI/FRC, among whom 15.2% intensified GLP-1 RA therapy with other oral agents. Effectiveness and safety were documented in all intensification approaches with BI/FRC, but HbA1c level at intensification time of ≥9.0% and suboptimal BI titration suggested clinical inertia. Use of second generation BI and add-on to GLP-1 RA schemes increased over time and effectiveness improved. CONCLUSION Clinical inertia should be overcome using innovative insulin options. Timely combination therapy of BI and GLP-1 RA is a valuable choice.
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Affiliation(s)
- Riccardo Candido
- Diabetes Centre District 4, Azienda Sanitaria Universitaria Integrata, Trieste, Italy
| | - Antonio Nicolucci
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy.
| | | | - Maria Chiara Rossi
- CORESEARCH, Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine and Diabetes, Federico II University School of Medicine and Institute of Experimental Endocrinology and Oncology, National Research Council, Napoli, Italy
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de Bartolomeis A, De Simone G, De Prisco M, Barone A, Napoli R, Beguinot F, Billeci M, Fornaro M. Insulin effects on core neurotransmitter pathways involved in schizophrenia neurobiology: a meta-analysis of preclinical studies. Implications for the treatment. Mol Psychiatry 2023; 28:2811-2825. [PMID: 37085712 PMCID: PMC10615753 DOI: 10.1038/s41380-023-02065-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
Impairment of insulin action and metabolic dysregulation have traditionally been associated with schizophrenia, although the molecular basis of such association remains still elusive. The present meta-analysis aims to assess the impact of insulin action manipulations (i.e., hyperinsulinemia, hypoinsulinemia, systemic or brain insulin resistance) on glutamatergic, dopaminergic, γ-aminobutyric acid (GABA)ergic, and serotonergic pathways in the central nervous system. More than one hundred outcomes, including transcript or protein levels, kinetic parameters, and other components of the neurotransmitter pathways, were collected from cultured cells, animals, or humans, and meta-analyzed by applying a random-effects model and adopting Hedges'g to compare means. Two hundred fifteen studies met the inclusion criteria, of which 180 entered the quantitative synthesis. Significant impairments in key regulators of synaptic plasticity processes were detected as the result of insulin handlings. Specifically, protein levels of N-methyl-D-aspartate receptor (NMDAR) subunits including type 2A (NR2A) (Hedges' g = -0.95, 95%C.I. = -1.50, -0.39; p = 0.001; I2 = 47.46%) and 2B (NR2B) (Hedges'g = -0.69, 95%C.I. = -1.35, -0.02; p = 0.043; I2 = 62.09%), and Postsynaptic density protein 95 (PSD-95) (Hedges'g = -0.91, 95%C.I. = -1.51, -0.32; p = 0.003; I2 = 77.81%) were found reduced in insulin-resistant animal models. Moreover, insulin-resistant animals showed significantly impaired dopamine transporter activity, whereas the dopamine D2 receptor mRNA expression (Hedges'g = 3.259; 95%C.I. = 0.497, 6.020; p = 0.021; I2 = 90.61%) increased under insulin deficiency conditions. Insulin action modulated glutamate and GABA release, as well as several enzymes involved in GABA and serotonin synthesis. These results suggest that brain neurotransmitter systems are susceptible to insulin signaling abnormalities, resembling the discrete psychotic disorders' neurobiology and possibly contributing to the development of neurobiological hallmarks of treatment-resistant schizophrenia.
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Affiliation(s)
- Andrea de Bartolomeis
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy.
| | - Giuseppe De Simone
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Michele De Prisco
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036, Barcelona, Catalonia, Spain
| | - Annarita Barone
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
- URT Genomic of Diabetes, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy
| | - Francesco Beguinot
- Department of Translational Medical Sciences, University of Naples "Federico II", Via S. Pansini 5, 80131, Naples, Italy
- URT Genomic of Diabetes, Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy
| | - Martina Billeci
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Michele Fornaro
- Section of Psychiatry, Laboratory of Molecular and Translational Psychiatry, Unit of Treatment-Resistant Psychiatric Disorders, Department of Neuroscience, Reproductive Sciences and Odontostomatology University of Naples "Federico II", School of Medicine, Via Pansini 5, 80131, Naples, Italy
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Napoli R, Fortina M, Plebani G, Giannotti S, Pannone A, Rossi A, Visonà E, Tegner Y, Brindisino F, Vascellari A. Cross Cultural Adaptation and Multi Centric Validation of The Italian Version of The Tegner Activity Scale. Muscles Ligaments Tendons J 2023. [DOI: 10.32098/mltj.01.2023.18] [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: 03/17/2023]
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Napoli R, Berra C, Catarig AM, Di Loreto C, Donatiello E, Berentzen TL, Pitocco D, Giorgino F. Once-weekly semaglutide use in patients with type 2 diabetes: Real-world data from the SURE Italy observational study. Diabetes Obes Metab 2023; 25:1658-1667. [PMID: 36789682 DOI: 10.1111/dom.15020] [Citation(s) in RCA: 8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/02/2023] [Accepted: 02/12/2023] [Indexed: 02/16/2023]
Abstract
AIMS SURE Italy, a multicentre, prospective, open-label, observational, real-world study, investigated once-weekly semaglutide in patients with type 2 diabetes (T2D) in routine clinical practice. MATERIALS AND METHODS Adults with T2D and ≥1 documented glycated haemoglobin (HbA1c) level within 12 weeks of semaglutide initiation were enrolled. The primary endpoint was change in HbA1c from baseline to end of study (EOS; ~30 weeks). Other endpoints included changes in body weight, waist circumference and patient-reported outcomes, and the proportion of patients achieving HbA1c <7.0% or <6.5%, weight loss ≥5% and a post-hoc composite endpoint (HbA1c reduction of ≥1%-point and weight loss ≥5%). These endpoints were reported for patients on semaglutide at EOS [effectiveness analysis set (EAS)]. Safety data were reported in the full analysis set. RESULTS Of 579 patients who initiated semaglutide (full analysis set), 491 completed the study on treatment (EAS). Mean baseline HbA1c was 8.0%, and 20.7% (120 of 579) of patients had HbA1c <7.0%. Mean semaglutide dose at EOS was 0.66 ± 0.28 mg. In the EAS, mean HbA1c and body weight decreased by 1.1%-point (95% confidence interval 1.20, 1.05; P < .0001) and 4.2 kg (95% confidence interval 4.63, 3.67; P < .0001), respectively. At EOS, 61.7% and 40.8% of patients achieved HbA1c <7.0% and <6.5%, respectively, 40.5% achieved weight loss ≥5% and 25.3% achieved the post-hoc composite endpoint. Patient-reported outcomes improved from baseline to EOS. No new safety concerns were identified. CONCLUSIONS In routine clinical practice in Italy, patients with T2D treated with once-weekly semaglutide for 30 weeks achieved clinically significant improvements in HbA1c, body weight and other outcomes.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences Federico, II University School of Medicine, Naples, Italy
| | | | | | - Chiara Di Loreto
- Diabetic Clinic, USL Umbria1, Perugia Territorial Health Structure, Perugia, Italy
| | | | | | - Dario Pitocco
- Diabetes Care Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Francesco Giorgino
- Department of Precision and Regenerative Medicine and Ionian Area, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Bari, Italy
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Tecce N, Guardasole V, Rotondo MC, Matarazzo M, Miele C, Napoli R. Vascular smooth muscle cell dysfunction in patients with hemochromatosis. Intern Emerg Med 2023; 18:311-313. [PMID: 36241935 DOI: 10.1007/s11739-022-03127-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 02/01/2023]
Affiliation(s)
- Nicola Tecce
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Vincenzo Guardasole
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Maria Cristina Rotondo
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Margherita Matarazzo
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy
| | - Claudia Miele
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy
- Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Pansini 5, 80131, Naples, Italy.
- Institute of Experimental Endocrinology and Oncology, National Research Council, Naples, Italy.
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Prevenzano I, Leone A, Longo M, Nicolò A, Cabaro S, Collina F, Panarese I, Botti G, Formisano P, Napoli R, Beguinot F, Miele C, Nigro C. Glyoxalase 1 knockdown induces age-related β-cell dysfunction and glucose intolerance in mice. EMBO Rep 2022; 23:e52990. [PMID: 35620868 PMCID: PMC9253754 DOI: 10.15252/embr.202152990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 04/20/2022] [Accepted: 05/02/2022] [Indexed: 09/09/2023] Open
Abstract
Tight control of glycemia is a major treatment goal for type 2 diabetes mellitus (T2DM). Clinical studies indicated that factors other than poor glycemic control may be important in fostering T2DM progression. Increased levels of methylglyoxal (MGO) associate with complications development, but its role in the early steps of T2DM pathogenesis has not been defined. Here, we show that MGO accumulation induces an age-dependent impairment of glucose tolerance and glucose-stimulated insulin secretion in mice knockdown for glyoxalase 1 (Glo1KD). This metabolic alteration associates with the presence of insular inflammatory infiltration (F4/80-positive staining), the islet expression of senescence markers, and higher levels of cytokines (MCP-1 and TNF-α), part of the senescence-activated secretory profile, in the pancreas from 10-month-old Glo1KD mice, compared with their WT littermates. In vitro exposure of INS832/13 β-cells to MGO confirms its casual role on β-cell dysfunction, which can be reverted by senolytic treatment. These data indicate that MGO is capable to induce early phenotypes typical of T2D progression, paving the way for novel prevention approaches to T2DM.
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Affiliation(s)
- Immacolata Prevenzano
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Alessia Leone
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Michele Longo
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Antonella Nicolò
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Serena Cabaro
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Francesca Collina
- Pathology UnitIstituto Nazionale Tumori‐IRCCS‐Fondazione G.PascaleNaplesItaly
| | - Iacopo Panarese
- Unità di Anatomia PatologicaDipartimento di Salute Mentale e Fisica e Medicina PreventivaUniversità degli Studi della Campania "L. Vanvitelli"NaplesItaly
| | - Gerardo Botti
- Scientific DirectionIstituto Nazionale Tumori‐IRCCS‐Fondazione G.PascaleNaplesItaly
| | - Pietro Formisano
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Raffaele Napoli
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Francesco Beguinot
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Claudia Miele
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
| | - Cecilia Nigro
- URT Genomics of Diabetes‐IEOSCNR & Department of Translational Medicine – Federico IIUniversity of NaplesNaplesItaly
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10
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Salzano A, D'Assante R, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Sciacqua A, Filardi PP, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Arcopinto M, Gargiulo P, Perticone M, Colao A, Milano S, Garavaglia A, Napoli R, Suzuki T, Bossone E, Marra AM, Cittadini A. Progressive right ventricular dysfunction and exercise impairment in patients with heart failure and diabetes mellitus: insights from the T.O.S.CA. Registry. Cardiovasc Diabetol 2022; 21:108. [PMID: 35710369 PMCID: PMC9204878 DOI: 10.1186/s12933-022-01543-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 05/16/2022] [Indexed: 01/01/2023] Open
Abstract
Background Findings from the T.O.S.CA. Registry recently reported that patients with concomitant chronic heart failure (CHF) and impairment of insulin axis (either insulin resistance—IR or diabetes mellitus—T2D) display increased morbidity and mortality. However, little information is available on the relative impact of IR and T2D on cardiac structure and function, cardiopulmonary performance, and their longitudinal changes in CHF. Methods Patients enrolled in the T.O.S.CA. Registry performed echocardiography and cardiopulmonary exercise test at baseline and at a patient-average follow-up of 36 months. Patients were divided into three groups based on the degree of insulin impairment: euglycemic without IR (EU), euglycemic with IR (IR), and T2D. Results Compared with EU and IR, T2D was associated with increased filling pressures (E/e′ratio: 15.9 ± 8.9, 12.0 ± 6.5, and 14.5 ± 8.1 respectively, p < 0.01) and worse right ventricular(RV)-arterial uncoupling (RVAUC) (TAPSE/PASP ratio 0.52 ± 0.2, 0.6 ± 0.3, and 0.6 ± 0.3 in T2D, EU and IR, respectively, p < 0.05). Likewise, impairment in peak oxygen consumption (peak VO2) in TD2 vs EU and IR patients was recorded (respectively, 15.8 ± 3.8 ml/Kg/min, 18.4 ± 4.3 ml/Kg/min and 16.5 ± 4.3 ml/Kg/min, p < 0.003). Longitudinal data demonstrated higher deterioration of RVAUC, RV dimension, and peak VO2 in the T2D group (+ 13% increase in RV dimension, − 21% decline in TAPSE/PAPS ratio and − 20% decrease in peak VO2). Conclusion The higher risk of death and CV hospitalizations exhibited by HF-T2D patients in the T.O.S.CA. Registry is associated with progressive RV ventricular dysfunction and exercise impairment when compared to euglycemic CHF patients, supporting the pivotal importance of hyperglycaemia and right chambers in HF prognosis. Trial registration ClinicalTrials.gov identifier: NCT023358017
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Affiliation(s)
- Andrea Salzano
- IRCCS SYNLAB SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122, Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine-Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB) - IRCCS - Scientific Institute of Telese Terme, Telese Terme, BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera Dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera Dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Unit of Endocrinology and Metabolic Diseases, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento Di Medicina Sperimentale E Clinica, Università Degli Studi Di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, AOUP P. Giaccone, Palermo, Italy
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy. .,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy. .,Department of Translational Medical Sciences, Division of Internal Medicine and Metabolism and Rehabilitation, Federico II University of Naples, Via S. Pansini 5, Bld.18, 1stfloor, 80131, Naples, Italy.
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11
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Costabile G, Vitale M, Della Pepa G, Cipriano P, Vetrani C, Testa R, Mena P, Bresciani L, Tassotti M, Calani L, Del Rio D, Brighenti F, Napoli R, Rivellese AA, Riccardi G, Giacco R. A wheat aleurone-rich diet improves oxidative stress but does not influence glucose metabolism in overweight/obese individuals: Results from a randomized controlled trial. Nutr Metab Cardiovasc Dis 2022; 32:715-726. [PMID: 35123855 DOI: 10.1016/j.numecd.2021.12.016] [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: 09/15/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Aleurone is the innermost layer of wheat bran, rich in fiber, minerals, vitamins, phenolic compounds, and betaine. The metabolic effects of aleurone rich foods are still unknown. Our aim was to investigate the effects of consuming a Wheat Aleurone rich diet vs. a Refined Wheat diet for 8 weeks on fasting and postprandial glycemic and lipid metabolism, inflammation, and oxidative stress in overweight/obese individuals. METHODS AND RESULTS According to a randomized cross-over study design, 23 overweight/obese individuals, age 56 ± 9 years (M±SD), were assigned to two isoenergetic diet - Wheat Aleurone and Refined Wheat diets - for 8 weeks. The diets were similar for macronutrient composition but different for the aleurone content (40-50 g/day in the Wheat Aleurone diet). After each diet, fasting and postprandial plasma metabolic profile, ferulic acid metabolites and 8-isoprostane concentrations in 24-h urine samples were evaluated. Compared with the Refined Wheat Diet, the Wheat Aleurone Diet increased fasting plasma concentrations of betaine by 15% (p = 0.042) and decreased the excretion of 8-isoprostane by 33% (p = 0.035). Conversely, it did not affect the fasting and postprandial glucose, insulin and triglyceride responses, homocysteine, and C-Reactive Protein concentrations, nor excretion of phenolic metabolites. CONCLUSION An 8-week Wheat Aleurone Diet improves the oxidative stress and increases plasma betaine levels in overweight/obese individuals with an increased cardiometabolic risk. However, further studies with longer duration and larger sample size are needed to evaluate the benefits of aleurone-rich foods on glucose and lipid metabolism in individuals with more severe metabolic abnormalities. CLINICAL TRIAL REGISTRY NUMBER NCT02150356, (https://clinicaltrials.gov).
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Affiliation(s)
- Giuseppina Costabile
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Marilena Vitale
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Giuseppe Della Pepa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Roberta Testa
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Pedro Mena
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Letizia Bresciani
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Michele Tassotti
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Luca Calani
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Daniele Del Rio
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Furio Brighenti
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Via Volturno, 39, 43125, Parma, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Gabriele Riccardi
- Department of Clinical Medicine and Surgery, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Rosalba Giacco
- Institute of Food Sciences, National Research Council, Via Roma 64, 8 Avellino, Italy
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12
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Spinelli R, Florese P, Parrillo L, Zatterale F, Longo M, D’Esposito V, Desiderio A, Nerstedt A, Gustafson B, Formisano P, Miele C, Raciti GA, Napoli R, Smith U, Beguinot F. ZMAT3 hypomethylation contributes to early senescence of preadipocytes from healthy first-degree relatives of type 2 diabetics. Aging Cell 2022; 21:e13557. [PMID: 35146866 PMCID: PMC8920444 DOI: 10.1111/acel.13557] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/16/2021] [Accepted: 01/09/2022] [Indexed: 12/18/2022] Open
Abstract
Senescence of adipose precursor cells (APC) impairs adipogenesis, contributes to the age-related subcutaneous adipose tissue (SAT) dysfunction, and increases risk of type 2 diabetes (T2D). First-degree relatives of T2D individuals (FDR) feature restricted adipogenesis, reflecting the detrimental effects of APC senescence earlier in life and rendering FDR more vulnerable to T2D. Epigenetics may contribute to these abnormalities but the underlying mechanisms remain unclear. In previous methylome comparison in APC from FDR and individuals with no diabetes familiarity (CTRL), ZMAT3 emerged as one of the top-ranked senescence-related genes featuring hypomethylation in FDR and associated with T2D risk. Here, we investigated whether and how DNA methylation changes at ZMAT3 promote early APC senescence. APC from FDR individuals revealed increases in multiple senescence markers compared to CTRL. Senescence in these cells was accompanied by ZMAT3 hypomethylation, which caused ZMAT3 upregulation. Demethylation at this gene in CTRL APC led to increased ZMAT3 expression and premature senescence, which were reverted by ZMAT3 siRNA. Furthermore, ZMAT3 overexpression in APC determined senescence and activation of the p53/p21 pathway, as observed in FDR APC. Adipogenesis was also inhibited in ZMAT3-overexpressing APC. In FDR APC, rescue of ZMAT3 methylation through senolytic exposure simultaneously downregulated ZMAT3 expression and improved adipogenesis. Interestingly, in human SAT, aging and T2D were associated with significantly increased expression of both ZMAT3 and the P53 senescence marker. Thus, DNA hypomethylation causes ZMAT3 upregulation in FDR APC accompanied by acquisition of the senescence phenotype and impaired adipogenesis, which may contribute to FDR predisposition for T2D.
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Affiliation(s)
- Rosa Spinelli
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Pasqualina Florese
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Luca Parrillo
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Federica Zatterale
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Michele Longo
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Vittoria D’Esposito
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Antonella Desiderio
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Annika Nerstedt
- Lundberg Laboratory for Diabetes Research Department of Molecular and Clinical Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Birgit Gustafson
- Lundberg Laboratory for Diabetes Research Department of Molecular and Clinical Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Pietro Formisano
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Claudia Miele
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Gregory Alexander Raciti
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
| | - Ulf Smith
- Lundberg Laboratory for Diabetes Research Department of Molecular and Clinical Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Francesco Beguinot
- Department of Translational Medical Sciences Federico II University of Naples Naples Italy
- URT Genomics of Diabetes Institute of Experimental Endocrinology and Oncology National Research Council Naples Italy
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13
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Napoli R, Avogaro A, Formoso G, Piro S, Purrello F, Targher G, Consoli A. Beneficial effects of glucagon-like peptide 1 receptor agonists on glucose control, cardiovascular risk profile, and non-alcoholic fatty liver disease. An expert opinion of the Italian diabetes society. Nutr Metab Cardiovasc Dis 2021; 31:3257-3270. [PMID: 34627692 DOI: 10.1016/j.numecd.2021.08.039] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023]
Abstract
Patients with type 2 diabetes mellitus (T2DM) show an increased risk of cardiovascular diseases (CVD) and mortality. Many factors are implicated in the pathogenesis of CVD in patients with T2DM. Among the factors involved, chronic hyperglycemia and the cluster of CVD risk factors, such as dyslipidemia, hypertension, and obesity, play a major role. For many years, the control of hyperglycemia has been complicated by the fact that the use of many available drugs was associated with an increased risk of hypoglycemia. Paradoxically, hypoglycemia per se represents a risk factor for CVD. Recently, new drugs for the control of hyperglycemia have become available: many of them can determine a good control of hyperglycemia with minor risks of hypoglycemia. Among these new classes of drugs, glucagon-like peptide-1 receptor agonists (GLP-1RAs) offer many advantages. In addition to a strong anti-hyperglycemic action, they possess the ability to act on body weight and other relevant risk factors for CVD. Consistently, some of the GLP-1RAs have demonstrated, in RCT designed to assess their safety, to reduce the risk of major adverse cardiovascular events. Furthermore, GLP-1RAs possess properties useful to treat additional conditions, as the capability of improving liver damage in patients with NAFLD or NASH, highly prevalent conditions in people with T2DM. In this document, written by experts of the Italian diabetes society (SID), we will focus our attention on the therapy with GLP-1RAs in patients with T2DM, particularly on the effects on hyperglycemia, cardiovascular disease risk factors, NAFLD/NASH and CVD prevention.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine and Diabetes, Federico II University School of Medicine, Napoli, Italy.
| | - Angelo Avogaro
- Department of Medicine (DIMED), Chair of Endocrinology and Metabolic Diseases, University of Padua, Italy
| | - Gloria Formoso
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSI-Met), G. D'Annunzio University, Chieti-Pescara, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, Ex CeSI-Met), G. D'Annunzio University, Chieti-Pescara, Italy
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14
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Pignalosa FC, Desiderio A, Mirra P, Nigro C, Perruolo G, Ulianich L, Formisano P, Beguinot F, Miele C, Napoli R, Fiory F. Diabetes and Cognitive Impairment: A Role for Glucotoxicity and Dopaminergic Dysfunction. Int J Mol Sci 2021; 22:ijms222212366. [PMID: 34830246 PMCID: PMC8619146 DOI: 10.3390/ijms222212366] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/09/2021] [Accepted: 11/13/2021] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is a chronic metabolic disorder characterized by hyperglycemia, responsible for the onset of several long-term complications. Recent evidence suggests that cognitive dysfunction represents an emerging complication of DM, but the underlying molecular mechanisms are still obscure. Dopamine (DA), a neurotransmitter essentially known for its relevance in the regulation of behavior and movement, modulates cognitive function, too. Interestingly, alterations of the dopaminergic system have been observed in DM. This review aims to offer a comprehensive overview of the most relevant experimental results assessing DA’s role in cognitive function, highlighting the presence of dopaminergic dysfunction in DM and supporting a role for glucotoxicity in DM-associated dopaminergic dysfunction and cognitive impairment. Several studies confirm a role for DA in cognition both in animal models and in humans. Similarly, significant alterations of the dopaminergic system have been observed in animal models of experimental diabetes and in diabetic patients, too. Evidence is accumulating that advanced glycation end products (AGEs) and their precursor methylglyoxal (MGO) are associated with cognitive impairment and alterations of the dopaminergic system. Further research is needed to clarify the molecular mechanisms linking DM-associated dopaminergic dysfunction and cognitive impairment and to assess the deleterious impact of glucotoxicity.
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Affiliation(s)
- Francesca Chiara Pignalosa
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Antonella Desiderio
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Paola Mirra
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Cecilia Nigro
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Giuseppe Perruolo
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Luca Ulianich
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Francesco Beguinot
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
| | - Claudia Miele
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
- Correspondence: ; Tel.: +39-081-746-3248
| | - Raffaele Napoli
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
| | - Francesca Fiory
- Department of Translational Medical Sciences, University of Naples Federico II, 80131 Naples, Italy; (F.C.P.); (A.D.); (P.M.); (C.N.); (G.P.); (L.U.); (P.F.); (F.B.); (R.N.); (F.F.)
- URT “Genomic of Diabetes”, Institute of Experimental Endocrinology and Oncology, National Research Council, 80131 Naples, Italy
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15
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Cittadini A, Salzano A, Iacoviello M, Triggiani V, Rengo G, Cacciatore F, Maiello C, Limongelli G, Masarone D, Perticone F, Cimellaro A, Perrone Filardi P, Paolillo S, Mancini A, Volterrani M, Vriz O, Castello R, Passantino A, Campo M, Modesti PA, De Giorgi A, Monte IP, Puzzo A, Ballotta A, D'Assante R, Arcopinto M, Gargiulo P, Sciacqua A, Bruzzese D, Colao A, Napoli R, Suzuki T, Eagle KA, Ventura HO, Marra AM, Bossone E. Multiple hormonal and metabolic deficiency syndrome predicts outcome in heart failure: the T.O.S.CA. Registry. Eur J Prev Cardiol 2021; 28:1691-1700. [PMID: 33693736 DOI: 10.1093/eurjpc/zwab020] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/04/2021] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
AIMS Recent evidence supports the occurrence of multiple hormonal and metabolic deficiency syndrome (MHDS) in chronic heart failure (CHF). However, no large observational study has unequivocally demonstrated its impact on CHF progression and outcome. The T.O.S.CA. (Trattamento Ormonale nello Scompenso CArdiaco; Hormone Treatment in Heart Failure) Registry has been specifically designed to test the hypothesis that MHDS affects morbidity and mortality in CHF patients. METHODS AND RESULTS The T.O.S.CA. Registry is a prospective, multicentre, observational study involving 19 Italian centres. Thyroid hormones, insulin-like growth factor-1, total testosterone, dehydropianoandrosterone sulfate, insulin resistance, and the presence of diabetes were evaluated. A MHDS was defined as the presence of ≥2 hormone deficiencies (HDs). Primary endpoint was a composite of all-cause mortality and cardiovascular hospitalizations. Four hundred and eighty heart failure patients with ejection fraction ≤45% were enrolled. MHDS or diabetes was diagnosed in 372 patients (77.5%). A total of 271 events (97 deaths and 174 cardiovascular hospitalizations) were recorded, 41% in NO-MHDS and 62% in MHDS (P < 0.001). Median follow-up was of 36 months. MHDS was independently associated with the occurrence of the primary endpoint [hazard ratio 95% (confidence interval), 1.93 (1.37-2.73), P < 0.001] and identified a group of patients with a higher mortality [2.2 (1.28-3.83), P = 0.01], with a graded relation between HDs and cumulative events (P < 0.01). CONCLUSION MHDS is common in CHF and independently associated with increased all-cause mortality and cardiovascular hospitalization, representing a promising therapeutic target. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT023358017.
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Affiliation(s)
- Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Andrea Salzano
- IRCCS SDN, Diagnostic and Nuclear Research Institute, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari 'A Moro', Bari, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Istituti Clinici Scientifici Maugeri SpA Società Benefit (ICS Maugeri SpA SB), IRCCS, Scientific Institute of Telese Terme, Telese BN, Italy
| | - Francesco Cacciatore
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ciro Maiello
- Heart Transplantation Unit, Monaldi Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Giuseppe Limongelli
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Daniele Masarone
- Division of Cardiology, Monaldi Hospital, Azienda Ospedaliera dei Colli, University of Campania Luigi Vanvitelli, Caserta, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Antonio Cimellaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.,Mediterranea Cardiocentro, Naples, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Olga Vriz
- Heart Center Department, King Faisal Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Roberto Castello
- Division of General Medicine, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Michela Campo
- Department of Medical and Surgical Sciences, Unit of Endocrinology and Metabolic Diseases, University of Foggia, Foggia, Italy
| | - Pietro A Modesti
- Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Florence, Italy
| | - Alfredo De Giorgi
- Department of Medical Sciences, School of Medicine, Pharmacy and Prevention, University of Ferrara, Ferrara, Italy
| | - Ines P Monte
- Department of General Surgery and Medical-Surgery Specialties, University of Catania, Catania, Italy
| | | | - Andrea Ballotta
- IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | - Roberta D'Assante
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Michele Arcopinto
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Catanzaro, Italy
| | - Dario Bruzzese
- Department of Public Health, Federico II University, Naples, Italy
| | - Annamaria Colao
- Clinical Medicine and Surgery Department, Federico II University, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy
| | - Toru Suzuki
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Kim A Eagle
- Michigan Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, USA
| | - Hector O Ventura
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Alberto M Marra
- Department of Translational Medical Sciences, Federico II University, Via Sergio Pansini, 5, 80131 Naples, Italy.,Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Center for Pulmonary Hypertension, Thoraxclinic at Heidelberg University Hospital, Heidelberg, Germany
| | - Eduardo Bossone
- Italian Clinical Outcome Research and Reporting Program (I-CORRP), Naples, Italy.,Cardiology Division, A Cardarelli Hospital, Naples, Italy
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Napoli R. Diabetes and Covid-19: An interplay difficult to dissect. Diabetes Metab Res Rev 2021; 37:e3387. [PMID: 32818297 PMCID: PMC7461015 DOI: 10.1002/dmrr.3387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 06/05/2020] [Accepted: 07/16/2020] [Indexed: 12/15/2022]
Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical SciencesFederico II University School of MedicineNaplesItaly
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17
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Giorgino F, Caruso I, Napoli R. Titratable fixed-ratio combination of insulin glargine plus lixisenatide: A simplified approach to glycemic control in type 2 diabetes mellitus. Diabetes Res Clin Pract 2020; 170:108478. [PMID: 33002548 DOI: 10.1016/j.diabres.2020.108478] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 07/03/2020] [Revised: 09/11/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022]
Abstract
Approximately 50% of patients with type 2 diabetes mellitus (T2DM) do not achieve glycemic targets and require treatment intensification. A fixed-ratio combination of a glucagon-like peptide-1 receptor agonist (GLP-1 RA) with basal insulin, such as lixisenatide with insulin glargine (iGlarLixi), exploits the complementary mechanisms of action of each component to address hyperglycemia while mitigating potential adverse events (AEs). The iGlarLixi dose is titrated considering the effect of basal insulin on fasting plasma glucose, and the fixed-ratio combination ensures that the lixisenatide dose never exceeds 20 μg/day. We describe the characteristics of iGlarLixi therapy, based on the LixiLan clinical program, and provide guidance on the characteristics of patients likely to benefit from such treatment in routine clinical practice. In the phase III LixiLan trials, iGlarLixi resulted in significantly greater reductions in glycated hemoglobin (HbA1c), better achievement of HbA1c targets, less glycemic variability versus insulin glargine, lixisenatide or GLP-1 RA alone, and was associated with weight control, less hypoglycemia versus insulin glargine, and fewer GI AEs versus lixisenatide. Findings were consistent regardless of age, diabetes duration, and baseline HbA1c. The efficacy, safety, and convenient once-daily administration schedule of iGlarLixi make it a valuable treatment option for patients with T2DM requiring treatment intensification.
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Affiliation(s)
- Francesco Giorgino
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Umberto I, 1, 70121 Bari BA, Italy.
| | - Irene Caruso
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, University of Bari Aldo Moro, Piazza Umberto I, 1, 70121 Bari BA, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Via Sergio Pansini, 5, 80131 Napoli NA, Italy.
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18
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Napoli R, Ruvolo A, Triggianese P, Prevete N, Schiattarella GG, Nigro C, Miele C, Magliulo F, Grassi S, Pecoraro A, Cittadini A, Esposito G, de Paulis A, Spadaro G. Immunoglobulins G modulate endothelial function and affect insulin sensitivity in humans. Nutr Metab Cardiovasc Dis 2020; 30:2085-2092. [PMID: 32807637 DOI: 10.1016/j.numecd.2020.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/12/2020] [Accepted: 07/01/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND AIMS Data from animals suggest that immunoglobulins G (IgG) play a mechanistic role in atherosclerosis and diabetes through endothelial dysfunction and insulin resistance. Patients with common variable immunodeficiency (CVID), who have low circulating levels of IgG and are treated with intravenous polyclonal IgG (IVIgG), may provide an ideal model to clarify whether circulating IgG modulate endothelial function and affect insulin sensitivity in humans. METHODS AND RESULTS We studied 24 patients with CVID and 17 matched healthy controls (HC). Endothelial function was evaluated as flow mediated dilation (FMD) of the brachial artery at baseline and 1, 7, 14, and 21 days after IVIgG infusion in the CVID patients. We measured also plasma glucose, insulin, and calculated the HOMA-IR index. We also investigated the role of human IgG on the production of Nitric Oxide (NO) in vitro in Human Coronary Artery Endothelial Cells (HCAEC). Compared to HC, FMD of CVID patients was significantly impaired at baseline (9.4 ± 0.9 and 7.6 ± 0.6% respectively, p < 0.05) but rose above normal levels 1 and 7 days after IVIgG infusion to return at baseline at 14 and 21 days. Serum insulin concentration and HOMA-IR index dropped by 50% in CVID patients after IVIgG (p < 0.002 vs. baseline). In vitro IgG stimulated NO production in HCAEC. CONCLUSIONS Reduced IgG levels are associated with endothelial dysfunction and IVIgG stimulates endothelial function directly while improving insulin sensitivity. The current findings may suggest an anti-atherogenic role of human IgG.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy.
| | - Antonio Ruvolo
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Paola Triggianese
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Nella Prevete
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Gabriele G Schiattarella
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Cecilia Nigro
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Claudia Miele
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Fabio Magliulo
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Simona Grassi
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Amato de Paulis
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
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19
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Napoli R, Fanelli F, Gazzi L, Larosa M, Bitonti R, Furneri G. Using 2nd generation basal insulins in type 2 diabetes: Costs and savings in a comparative economic analysis in Italy, based on the BRIGHT study. Nutr Metab Cardiovasc Dis 2020; 30:1937-1944. [PMID: 32912786 DOI: 10.1016/j.numecd.2020.07.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/11/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS To evaluate the economic impact of using 2nd generation basal insulin analogs, Glargine 300 Units/ml (Gla-300) vs Degludec 100 Units/ml (IDeg-100), in patients with type 2 diabetes (T2D). METHODS AND RESULTS An economic analysis was conducted using findings from the BRIGHT study (the first controlled, head-to-head study comparing Gla-300 vs IDeg-100), and costs for the Italian National Healthcare Service (NHS). A cost-minimization analysis (CMA) and a budget impact analysis (BIA) were conducted. Only pharmacological costs were included in the analysis. The CMA estimated patient treatment costs at 24 weeks and 1 year; the BIA assessed the economic impact of treating the overall Italian population of T2D insulin-naïve patients, who initiated insulin treatment during the period September 2017-August 2018 (N = 55 318). In the BIA, four different scenarios were compared: i) all patients receive IDeg-100 (Scenario A); ii) 61% of patients receive Gla-300, 39% IDeg-100 (Scenario B); iii) 80% of patients receive Gla-300, 20% IDeg-100 (Scenario C); iv) all patients treated with Gla-300 (Scenario D). The average treatment costs per patient were lower with Gla-300 vs IDeg-100 (at 24 weeks: €129 vs €161; at 1 year: €324 vs €409, respectively). Results of the BIA showed that comparing Scenario D vs Scenario A, total savings would amount to €1.76 million at 24 weeks, €4.73 million at 1 year, €5.53 million at 2 years. CONCLUSION A larger use of Gla-300 vs IDeg-100 for the treatment of T2D patients would lead to a relevant reduction of therapy costs in Italy.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
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20
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Napoli R, Formoso G, Piro S, Targher G, Consoli A, Purrello F. Management of type 2 diabetes for prevention of cardiovascular disease. An expert opinion of the Italian Diabetes Society. Nutr Metab Cardiovasc Dis 2020; 30:1926-1936. [PMID: 32928628 DOI: 10.1016/j.numecd.2020.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 06/08/2020] [Revised: 07/07/2020] [Accepted: 07/10/2020] [Indexed: 12/28/2022]
Abstract
AIMS Type 2 diabetes mellitus is characterized by an increased risk of developing long-term cardiovascular complications. Several underlying mechanisms have been proposed for the diabetes-related increase in cardiovascular risk, i.e. chronic hyperglycemia, duration of the disease, drug-induced hypoglycemia, coexistence of multiple cardiovascular risk factors, etc. In the last few years, new pharmacological approaches capable of treating chronic hyperglycemia without increasing the risk of hypoglycemia have emerged for the treatment of diabetes. DATA SYNTHESIS With data mainly obtained from randomized controlled trials recruiting patients with type 2 diabetes in secondary prevention of cardiovascular disease, some of these newer antihyperglycemic drugs have shown to significantly reduce the risk of cardiovascular disease. In addition, the combined control of traditional cardiovascular risk factors, e.g. dyslipidemia, hypertension, etc., has demonstrated to be effective in reducing the burden of cardiovascular diseases in patients with type 2 diabetes. CONCLUSIONS In this document written by some experts of the Italian diabetes society (SID), we will focus our attention on oral antihyperglycemic agents for people with type 2 diabetes in primary or secondary prevention of cardiovascular disease, excluding for brevity the injection therapies for diabetes, such as insulin and glucagon-like peptide-1 receptor agonists.
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Affiliation(s)
- Raffaele Napoli
- Department of Translational Medical Sciences, Internal Medicine and Diabetes, Federico II University School of Medicine, Napoli, Italy.
| | - Gloria Formoso
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, ex CeSI-Met), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Salvatore Piro
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, Center for Advanced Studies and Technology (CAST, ex CeSI-Met), G. d'Annunzio University, Chieti-Pescara, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
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Bosso G, Valvano A, Apuzzi V, Mercurio V, Di Simone V, Cittadini A, Napoli R, Oliviero U. Peripheral Vascular Function in Dilated Cardiomyopathy of Different Etiology. Angiology 2020; 71:726-733. [DOI: 10.1177/0003319720932803] [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: 11/16/2022]
Abstract
Vascular function in dilated cardiomyopathy of different etiology has been poorly investigated. Moreover, reference values of flow-mediated dilation (FMD) in chronic heart failure (CHF) need to be updated according to the new standardized protocols. We characterized the vascular impairment in different stages of post-ischemic dilated cardiomyopathy (PI-DC) or idiopathic dilated cardiomyopathy (I-DC). Eighty consecutive outpatients with CHF in different New York Heart Association (NYHA) classes (45 PI-DC, 35 I-DC) and 50 control subjects underwent FMD and brachial distensibility coefficient measurement. Patients with CHF showed a marked impairment in FMD compared with controls that worsened from classes NYHA I-II to III-IV, independently of etiology ( P < .05). New York Heart Association I-II PI-DC patients showed a worse FMD compared with NYHA I-II I-DC patients ( P < .05). Brachial distensibility coefficient values were significantly lower in patients with CHF compared with controls ( P < .001) without differences between PI-DC and I-DC. In conclusion, advanced CHF is characterized by vascular impairment that is independent of etiology. In the early stages of CHF, endothelial dysfunction is more severe in patients with PI-DC compared with I-DC probably due to the high cardiovascular risk profile. In I-DC, vascular function impairment is independent of cardiovascular risk factors and could participate in the pathogenesis of I-DC.
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Affiliation(s)
- Giorgio Bosso
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Antonio Valvano
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Valentina Apuzzi
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Valentina Mercurio
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Valeria Di Simone
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Ugo Oliviero
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
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Angelini L, Gioulis E, Civitareale N, Zago A, Coss M, Giusti G, Di Cristofano F, Petrucci F, Napoli R, Salemi M, Piccoli G, Valerio S. Adding contrast enhanced ultrasound to computed tomography can improve the diagnostic accuracy for the characterization of complex renal cysts. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33077-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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23
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D'Assante R, Napoli R, Salzano A, Pozza C, Marra AM, Arcopinto M, Perruolo G, Milano S, Formisano P, Saldamarco L, Cirillo P, Cittadini A. Human heart shifts from IGF-1 production to utilization with chronic heart failure. Endocrine 2019; 65:714-716. [PMID: 31267324 DOI: 10.1007/s12020-019-01993-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 06/22/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Roberta D'Assante
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Andrea Salzano
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Arcopinto
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
- Emergency Department, A Cardarelli Hospital, Naples, Italy
| | - Giuseppe Perruolo
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, CoreLab, AOUP "P. Giaccone", University of Palermo, Palermo, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy.
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24
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D'Assante R, Napoli R, Salzano A, Pozza C, Marra AM, Arcopinto M, Perruolo G, Milano S, Formisano P, Saldamarco L, Cirillo P, Cittadini A. Correction to: Human heart shifts from IGF-1 production to utilization with chronic heart failure. Endocrine 2019; 65:717. [PMID: 31359246 DOI: 10.1007/s12020-019-02020-w] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
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Affiliation(s)
- Roberta D'Assante
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Andrea Salzano
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Groby Road, Leicester, LE3 9QP, UK
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Michele Arcopinto
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
- Emergency Department, A Cardarelli Hospital, Naples, Italy
| | - Giuseppe Perruolo
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | - Salvatore Milano
- Department of Laboratory Medicine, CoreLab, AOUP "P. Giaccone", University of Palermo, Palermo, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy
| | | | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, Division of Cardiology, Federico II University of Naples, Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Unit of Internal Medicine, Metabolism & Rehabilitation, Federico II University of Naples, Via S. Pansini n. 5, Bld. 18, 1st floor, Naples, 80131, Italy.
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Nicolucci A, Prosperini G, Buzzetti R, De Cosmo S, Fanelli CG, Napoli R, Giorgino F. A multistep approach for the stratification of the risk of severe hypoglycemia in patients with type 2 diabetes. MINERVA ENDOCRINOL 2018; 43:501-510. [PMID: 30463398 DOI: 10.23736/s0391-1977.18.02850-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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 Hypoglycemia is the major limiting factor in the glycemic management of diabetes. Aim of this study was to produce a risk stratification tool to support the medical decision making, by facilitating the identification of patients at higher risk of hypoglycemia. EVIDENCE ACQUISITION A multistep approach was adopted, including a systematic review of observational studies investigating risk factors for severe hypoglycemia in type 2 diabetes (T2DM), followed by an expert input forum to identify factors perceived as relevant and at the same time reliably detectable, to be used for the development of a risk score. EVIDENCE SYNTHESIS The systematic review led to the identification of 41 studies. Many factors have been seldom investigated, and their association with the risk of hypoglycemia is still unclear. Factors more frequently associated with a high risk of hypoglycemia were: low level of education, ethnicity, irregular meals/malnutrition, insulin and sulfonylurea therapy, polypharmacy, previous hypoglycemia, impaired renal function, cognitive impairment, depression and frailty. The expert input forum involved 35 diabetologists. Following the ranking of the relevance of the factors identified, a parsimonious yet comprehensive set of risk factors was identified. CONCLUSIONS The process led to the identification of relevant factors, to be used for the development of a hypoglycemia risk score. An ad-hoc study will be performed to assess the contribution of these risk factors and their relative weight. If the risk score will confirm its ability to correctly stratify patients according to their risk of hypoglycemia, it will represent a useful support to optimize the care of people with T2DM.
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Affiliation(s)
- Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy -
| | | | | | - Salvatore De Cosmo
- Department of Medical Sciences, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Foggia, Italy
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Francesco Giorgino
- Department of Endocrinology and Metabolic Diseases, Aldo Moro University, Bari, Italy
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Frias J, Puig Domingo M, Meneghini L, Napoli R, Liu M, Soltes Rak E, Aroda VR. More patients reach glycaemic control with a fixed-ratio combination of insulin glargine and lixisenatide (iGlarLixi) than with basal insulin at 12 weeks of treatment: A post hoc time-to-control analysis of LixiLan-O and LixiLan-L. Diabetes Obes Metab 2018; 20:2314-2318. [PMID: 29785837 PMCID: PMC6099242 DOI: 10.1111/dom.13368] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/24/2018] [Accepted: 05/02/2018] [Indexed: 01/24/2023]
Abstract
The present post hoc analysis of two 30-week clinical trials compared efficacy and hypoglycaemia outcomes at early study visits with iGlarLixi (insulin glargine U100 [iGlar] and lixisenatide) vs iGlar alone in patients with type 2 diabetes (T2D) uncontrolled on oral antidiabetic drugs (OADs; LixiLan-O trial) or basal insulin (LixiLan-L trial). Time to control, defined as days to achieve glycated haemoglobin (HbA1c) <53 mmol/mol (<7%) or fasting plasma glucose (FPG) ≤7.2 mmol/L, was estimated using the Kaplan-Meier method. In the LixiLan-O and LixiLan-L trials, 60% and 46% of patients, respectively, reached HbA1c <53 mmol/mol (<7%) with iGlarLixi at 12 weeks, vs 45% and 24%, respectively, with iGlar. In the LixiLan-O trial, the median time to target HbA1c was approximately half with iGlarLixi vs iGlar (85.0 vs 166.0 days; P < .0001). In the LixiLan-L trial, the median time to target HbA1c was 153.0 days with iGlarLixi, while target HbA1c was never reached by 50% of patients with iGlar (P < .0001). Time-to-target FPG and hypoglycaemia outcomes were similar between treatments. In T2D uncontrolled on OADs or basal insulin, iGlarLixi resulted in glycaemic control in more patients than did iGlar at early treatment time points.
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Affiliation(s)
- Juan Frias
- National Research InstituteLos AngelesCalifornia
| | - Manuel Puig Domingo
- Germans Trias i Pujol Research Institute, UABBadalonaSpain
- CIBERDEM and CIBERERMadridSpain
| | - Luigi Meneghini
- Department of Internal MedicineUniversity of Texas Southwestern Medical Center and Parkland Health & Hospital SystemDallasTexas
| | - Raffaele Napoli
- Department of Translational MedicineFederico II University School of MedicineNaplesItaly
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Salzano A, D'Assante R, Heaney LM, Monaco F, Rengo G, Valente P, Pasquali D, Bossone E, Gianfrilli D, Lenzi A, Cittadini A, Marra AM, Napoli R. Klinefelter syndrome, insulin resistance, metabolic syndrome, and diabetes: review of literature and clinical perspectives. Endocrine 2018; 61:194-203. [PMID: 29572708 DOI: 10.1007/s12020-018-1584-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 12/12/2017] [Accepted: 03/15/2018] [Indexed: 01/19/2023]
Abstract
PURPOSE Klinefelter syndrome (KS), the most frequent chromosomic abnormality in males, is associated with hypergonadotropic hypogonadism and an increased risk of cardiovascular diseases (CVD). The mechanisms involved in increasing risk of cardiovascular morbidity and mortality are not completely understood. This review summarises the current understandings of the complex relationship between KS, metabolic syndrome and cardiovascular risk in order to plan future studies and improve current strategies to reduce mortality in this high-risk population. METHODS We searched PubMed, Web of Science, and Scopus for manuscripts published prior to November 2017 using key words "Klinefelter syndrome" AND "insulin resistance" OR "metabolic syndrome" OR "diabetes mellitus" OR "cardiovascular disease" OR "testosterone". Manuscripts were collated, studied and carried forward for discussion where appropriate. RESULTS Insulin resistance, metabolic syndrome, and type 2 diabetes are more frequently diagnosed in KS than in the general population; however, the contribution of hypogonadism to metabolic derangement is highly controversial. Whether this dangerous combination of risk factors fully explains the CVD burden of KS patients remains unclear. In addition, testosterone replacement therapy only exerts a marginal action on the CVD system. CONCLUSION Since fat accumulation and distribution seem to play a relevant role in triggering metabolic abnormalities, an early diagnosis and a tailored intervention strategy with drugs aimed at targeting excessive visceral fat deposition appear necessary in patients with KS.
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Affiliation(s)
- Andrea Salzano
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | | | - Liam M Heaney
- Department of Cardiovascular Sciences and NIHR Leicester Biomedical Research Centre, University of Leicester, Glenfield Hospital, Leicester, UK
| | - Federica Monaco
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Pietro Valente
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
| | - Daniela Pasquali
- Department of Neurological, Metabolic, and Geriatric Science, Endocrinology Unit, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy.
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University School of Medicine, Naples, Italy
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Schiavo A, Stagnaro FM, Salzano A, Marra AM, Bobbio E, Valente P, Grassi S, Miniero M, Arcopinto M, Matarazzo M, Napoli R, Cittadini A. Pregabalin-induced first degree atrioventricular block in a young patient treated for pain from extrapulmonary tuberculosis. Monaldi Arch Chest Dis 2017; 87:838. [DOI: 10.4081/monaldi.2017.838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 09/17/2017] [Accepted: 09/20/2017] [Indexed: 11/23/2022] Open
Abstract
<p>Pregabalin, widely used in the treatment of several pain disorders, is usually well tolerated. Uncommonly, the drug may induce cardiac side effects, rarely prolongation of the PR interval. The latter has never been described in patients with healthy heart or normal renal function. We characterize a unique case of a young man with extrapulmonary tuberculosis and no detectable or known cardiac or kidney diseases, treated with pregabalin to control the severe pain due to the involvement of the spinal cord by the tuberculosis, showing an atrioventricular (AV) block due to pregabalin administration. The reported case emphasizes the need of monitoring PR interval during treatment with pregabalin, even in patients without background of cardiac or renal diseases. </p>
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Matarazzo M, Giardina MG, Guardasole V, Davalli AM, Horton ES, Weir GC, Saccà L, Napoli R. Islet Transplantation under the Kidney Capsule Corrects the Defects in Glycogen Metabolism in Both Liver and Muscle of Streptozocin-Diabetic Rats. Cell Transplant 2017. [DOI: 10.3727/096020198389834] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Insulin-deficient rats are characterized by multiple defects in the pathway of glycogen synthesis and breakdown in both liver and skeletal muscle. The aim of this study was to clarify whether islet transplantation under the kidney capsule, which is associated with delivery of insulin into the peripheral circulation, is able to normalize glycogen metabolism in liver and muscle of streptozotocin-diabetic rats. Three groups of male Lewis rats were studied under fasting condition: controls, untreated diabetics, and islet transplanted diabetics. Glycogen content, glucose-6-phosphate concentration, and glycogen synthase activity were measured in both liver and skeletal muscle. Untreated diabetic rats were characterized by an increase in glycogen content of 178% and a reduction of glucose-6-phosphate level of 50%. Both glycogen and glucose-6-phosphate contents were restored to normal in transplanted diabetic rats. Active glycogen synthase (0.35 ± 0.1 nmol/min/mg) and activity ratio (0.22 ± 0.04) were significantly impaired compared with controls (0.99 ± 0.2 nmol/min/mg and 0.43 ± 0.06, respectively) and were normalized by islet transplantation. In the skeletal muscle, glycogen content was similar in the three groups of animals, whereas muscle glucose-6-phosphate level was reduced by 28% and glycogen synthase was in a less active state in the untreated diabetic rats. Both the glucose-6-phosphate concentration and the kinetic profile of glycogen synthase were normalized by islet transplantation. In conclusion, islet transplantation under the kidney capsule corrects the diabetes-induced abnormalities in glycogen and glucose-6-phosphate content and glycogen synthase activity in both liver and skeletal muscle.
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Affiliation(s)
- Margherita Matarazzo
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Napoli, Italy
| | - Maria Grazia Giardina
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Napoli, Italy
| | - Vincenzo Guardasole
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Napoli, Italy
| | - Alberto M. Davalli
- Scientific Institute S. Raffaele, Milano, Italy
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | | | - Gordon C. Weir
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Luigi Saccà
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Napoli, Italy
| | - Raffaele Napoli
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II School of Medicine, Napoli, Italy
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
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30
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Broglio F, Mannucci E, Napoli R, Nicolucci A, Purrello F, Nikonova E, Stager W, Trevisan R. Beneficial effect of lixisenatide after 76 weeks of treatment in patients with type 2 diabetes mellitus: A meta-analysis from the GetGoal programme. Diabetes Obes Metab 2017; 19:248-256. [PMID: 27762096 DOI: 10.1111/dom.12810] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 07/21/2016] [Revised: 10/12/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022]
Abstract
AIMS To evaluate the long-term efficacy and safety of lixisenatide, a short-acting, prandial glucagon-like peptide-1 receptor agonists (GLP-1 RA) as add-on therapy in type 2 diabetes mellitus. METHODS A meta-analysis of 76-week results of 5 placebo-controlled clinical trials from the GetGoal programme was performed, including 3000 inadequately controlled adult diabetic patients where lixisenatide 20 µg once-daily was administered in combination with metformin (GetGoal-M and GetGoal-F1), sulphonylurea ± metformin (GetGoal-S), basal insulin ± metformin (GetGoal-L) or pioglitazone ± metformin (GetGoal-P). RESULTS A significant reduction in HbA1c at 76 weeks was observed in the intervention arm compared to placebo (LSM difference: -0.41%, 95%CI: -0.51, -0.32, P < .00001). Compared to placebo, lixisenatide induced a larger decrease in fasting plasma glucose (LSM difference -0.49 mmol/L, 95% CI -0.71, -0.27, P < .0001) and postprandial glucose excursion after a standard test meal (LSM difference -3.29 mmol/L, 95% CI -4.17, -2.42, P < .00001). A bodyweight reduction was observed in the lixisenatide arm (LSM difference -0.40 kg, 95%CI: -0.8, -0.01, P = .05). The risk of hypoglycaemia was slightly higher with lixisenatide vs placebo (risk difference +0.02, 95% CI: 0, 0.04, P = .04). The most commonly observed non-severe adverse events were nausea and vomiting, which after week 16 and week 8, were steadily <4% and <1% in the lixisenatide arm, respectively. CONCLUSIONS Lixisenatide, a once-daily prandial GLP-1 RA, provides long-term glycaemic control, a sustained beneficial effect on weight and with a good safety profile.
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Affiliation(s)
- Fabio Broglio
- S.C.D.U. Endocrinology, Diabetology and Metabolism Diseases, Azienda Ospedaliero-Universitaria San Giovanni Battista "le Molinette", Turin, Italy
| | | | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, CORESEARCH, Pescara, Italy
| | - Francesco Purrello
- Department of Clinical and Experimental Medicine, UOC Internal Medicine, Garibaldi-Nesima Hospital, University of Catania, Catania, Italy
| | - Elena Nikonova
- Endocrinology and Diabetes Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - William Stager
- Endocrinology and Diabetes Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Salzano A, Marra AM, Ferrara F, Arcopinto M, Bobbio E, Valente P, Polizzi R, De Vincentiis C, Matarazzo M, Saldamarco L, Saccà F, Napoli R, Monti MG, D'Assante R, Isidori AM, Isgaard J, Ferrara N, Filardi PP, Perticone F, Vigorito C, Bossone E, Cittadini A. Multiple hormone deficiency syndrome in heart failure with preserved ejection fraction. Int J Cardiol 2016; 225:1-3. [PMID: 27689528 DOI: 10.1016/j.ijcard.2016.09.085] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/20/2016] [Accepted: 09/23/2016] [Indexed: 11/16/2022]
Affiliation(s)
- Andrea Salzano
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | | | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Michele Arcopinto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Emanuele Bobbio
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Pietro Valente
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Roberto Polizzi
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | | | - Margherita Matarazzo
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Lavinia Saldamarco
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurological Sciences, University Federico II, Naples, Italy
| | - Raffaele Napoli
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Maria Gaia Monti
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Roberta D'Assante
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Jorgen Isgaard
- Department of Internal Medicine, Sahlgrenska Academy, University of Göteborg, Sweden
| | - Nicola Ferrara
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | | | - Francesco Perticone
- Department of Medical and Surgical Sciences, Magna Graecia of Catanzaro University, Catanzaro, Italy
| | - Carlo Vigorito
- Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Science, Federico II University, Naples, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), University of Naples, Naples, Italy.
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32
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Marra AM, Arcopinto M, Salzano A, Bobbio E, Milano S, Misiano G, Ferrara F, Vriz O, Napoli R, Triggiani V, Perrone-Filardi P, Saccà F, Giallauria F, Isidori AM, Vigorito C, Bossone E, Cittadini A. Detectable interleukin-9 plasma levels are associated with impaired cardiopulmonary functional capacity and all-cause mortality in patients with chronic heart failure. Int J Cardiol 2016; 209:114-7. [PMID: 26889593 DOI: 10.1016/j.ijcard.2016.02.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 02/01/2016] [Indexed: 12/20/2022]
Affiliation(s)
| | - Michele Arcopinto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Andrea Salzano
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Emanuele Bobbio
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Salvatore Milano
- Sezione Biochimica Clinica e Medicina Molecolare Clinica, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli Studi di Palermo, Italy
| | - Gabriella Misiano
- Sezione di Patologia Generale, Dipartimento di Biopatologia e Biotecnologie Mediche, Università degli Studi di Palermo, Italy
| | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Olga Vriz
- Department of Emergency and Cardiology, "S. Antonio" Community Hospital, San Daniele del Friuli (UD), Italy
| | - Raffaele Napoli
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Endocrinology and Metabolic Diseases, University of Bari, Italy
| | - Pasquale Perrone-Filardi
- Department of Advanced Biomedical Sciences, Section of Cardiology, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurological Sciences, Federico II University, Naples, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, Federico II University, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, Naples, Italy; Interdisciplinary Research Centre in Biomedical Materials (CRIB), University of Naples, Naples, Italy.
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Simonelli F, Nesti A, Picardi A, Napoli R, De Rosa G, Lauro G, Di Meo A, Rinaldi E, Auricchio G. Cataract formation in patients with lactose and galactose disorders. Dev Ophthalmol 2015; 17:82-6. [PMID: 2507367 DOI: 10.1159/000417006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- F Simonelli
- Eye Clinic, First School of Medicine, Naples, Italy
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Arcopinto M, Salzano A, Bossone E, Ferrara F, Bobbio E, Sirico D, Vriz O, De Vincentiis C, Matarazzo M, Saldamarco L, Saccà F, Napoli R, Iacoviello M, Triggiani V, Isidori AM, Vigorito C, Isgaard J, Cittadini A. Multiple hormone deficiencies in chronic heart failure. Int J Cardiol 2015; 184:421-423. [PMID: 25755056 DOI: 10.1016/j.ijcard.2015.02.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 02/21/2015] [Indexed: 11/19/2022]
Affiliation(s)
- Michele Arcopinto
- Department of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Andrea Salzano
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital "Scuola Medica Salernitana", Salerno, Italy
| | - Emanuele Bobbio
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Domenico Sirico
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Olga Vriz
- Division of Cardiology, San Daniele del Friuli Hospital, Udine, Italy
| | - Carlo De Vincentiis
- Department of Cardiac Surgery, IRCCS Policlinico San Donato Milanese, Milan, Italy
| | - Margherita Matarazzo
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Lavinia Saldamarco
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Francesco Saccà
- Department of Neurological Sciences, University Federico II, Naples, Italy
| | - Raffaele Napoli
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Massimo Iacoviello
- Cardiology Unit and Cardiothoracic Department, Policlinico Consorziale University Hospital, Bari, Italy
| | | | - Andrea M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Italy
| | - Carlo Vigorito
- Department of Medical Translational Sciences, Federico II University, Naples, Italy
| | - Jorgen Isgaard
- Department of Internal Medicine, Sahlgrenska Academy, University of Götenborg, Sweden
| | - Antonio Cittadini
- Department of Medical Translational Sciences, Federico II University, Naples, Italy.
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35
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Arcopinto M, Bobbio E, Bossone E, Perrone-Filardi P, Napoli R, Sacca L, Cittadini A. The GH/IGF-1 axis in chronic heart failure. Endocr Metab Immune Disord Drug Targets 2014; 13:76-91. [PMID: 23369140 DOI: 10.2174/1871530311313010010] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 12/18/2012] [Indexed: 11/22/2022]
Abstract
The classic model of Chronic Heart Failure (CHF) is rooted in the overexpression of neurohormonal molecules. To complement this paradigm, increasing evidence indicates that a variety of hormones may be down-regulated in CHF patients. The list includes growth hormone (GH) and its tissue effector insulin-like growth factor-1 (IGF-1). The GH/IGF-1 axis regulates cardiac growth, stimulates myocardial contractility, and influences the vascular system. The relationship between the GH/IGF-1 axis and the cardiovascular system has been extensively demonstrated in numerous studies in animals models and confirmed by the cardiac derangements secondary to both GH excess and deficiency in humans. Impaired activity of the GH/IGF-1 axis in CHF has been described by several independent groups and includes a wide array of abnormalities, including low IGF-1 levels, GH deficiency (GHD), and GH resistance that may be related to the severity of heart disease. According to several observations, these derangements are associated with poor clinical status and outcome. Since the first study of GH therapy in CHF in 1996, several placebo-controlled trials have been conducted with conflicting results. These discordant findings are likely explained by the degree of CHF-associated GH/IGF-1 impairment that may impact on individual responsiveness to GH administration. Biological actions of GH and IGF-1, cardiovascular implication of GH deficiency and GH excess, relation between somatotrophic axis and CHF are discussed. Results from trials of GH therapy, emerging therapeutic strategies, safety issues, and lack in evidence are also reported.
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Affiliation(s)
- Michele Arcopinto
- Department of Internal Medicine, Cardiovascular Sciences and Clinical Immunology, University Federico II, Naples, Italy
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Napoli R, Guardasole V, Zarra E, Sena AD, Saccà F, Ruvolo A, Grassi S, Giugliano S, Michele GD, Cittadini A, Carrieri PB, Saccà L. Migraine attack restores the response of vascular smooth muscle cells to nitric oxide but not to norepinephrine. World J Cardiol 2013; 5:375-381. [PMID: 24198907 PMCID: PMC3817279 DOI: 10.4330/wjc.v5.i10.375] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 07/31/2013] [Accepted: 09/13/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To clarify whether the vasoconstrictory response is impaired and to study vascular function in patients with migraine during the headache attack.
METHODS: We studied vascular reactivity in the resistance arteries by using the forearm perfusion technique associated with plethysmography. We measured forearm blood flow by strain-gauge plethysmography during intra-brachial infusion of acetylcholine, sodium nitroprusside or norepinephrine in 11 controls and 13 patients with migraine, 11 of them (M) in the interval between the migraine attacks and 4 during a headache attack (MH). Written informed consent was obtained from patients and healthy controls, and the study was approved by the Ethics Committee of the University Federico II.
RESULTS: Compared to healthy control subjects, in patients with migraine studied during the interictal period, the vasodilating effect of acetylcholine, that acts through the stimulation of endothelial cells and the release of nitric oxide, was markedly reduced, but became normal during the headache attack (P < 0.05 by analysis of variance). The response to nitroprusside, which directly relaxes vascular smooth muscle cells (VSMCs), was depressed in patients with migraine studied during the interictal period, but normal during the headache attack (P < 0.005). During norepinephrine infusion, forearm blood flow decreased in control subjects (-40% ± 5%, P < 0.001). In contrast, in patients with migraine, either when studied during or free of the headache attack forearm blood flow did not change compared to the baseline value (-3% ± 13% and -10.4% ± 15%, P > 0.05).
CONCLUSION: In migrainers, the impaired relaxation of VSMCs is restored during the headache attack. The vasoconstrictory response is impaired and remains unchanged during the migraine attack.
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Cittadini A, Marra AM, Arcopinto M, Bobbio E, Salzano A, Sirico D, Napoli R, Colao A, Longobardi S, Baliga RR, Bossone E, Saccà L. Growth hormone replacement delays the progression of chronic heart failure combined with growth hormone deficiency: an extension of a randomized controlled single-blind study. JACC Heart Fail 2013; 1:325-330. [PMID: 24621936 DOI: 10.1016/j.jchf.2013.04.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [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: 03/23/2013] [Accepted: 04/01/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study sought to evaluate the efficacy and safety of long-term growth hormone (GH) replacement therapy in GH-deficient patients with chronic heart failure (CHF). BACKGROUND Recent evidence indicates that growth hormone deficiency (GHD) affects as many as 40% of patients with CHF, and short-term GH replacement causes functional benefit. Whether long-term GH replacement also affects CHF progression is unknown. METHODS The study is an extension of a previous randomized, controlled single-blind trial that screened 158 consecutive CHF patients (New York Heart Association classes II to IV) and identified 63 who had GHD by the growth hormone releasing hormone plus arginine test. Fifty-six patients were randomized to receive either GH therapy or standard CHF therapy. Patients were evaluated at baseline and after a 4-year follow-up. The primary endpoint was peak oxygen consumption (VO2). Secondary endpoints included left ventricular (LV) ejection fraction and volumes, serum amino terminal fragment of the pro-hormone brain-type natriuretic peptide, quality of life, and safety. RESULTS Seventeen patients in the GH group and 14 in the control group completed the study. In the GH group, peak VO2 improved over the 4-year follow-up. The treatment effect was 7.1 ± 0.7 ml/kg/min versus -1.8 ± 0.5 ml/kg/min in the GH and control groups, respectively. At 4 years, LV ejection fraction increased by 10 ± 3% in the GH group, whereas it decreased by 2 ± 5% in control patients. The treatment effect on LV end-systolic volume index was -22 ± 6 ml and 8 ± 3 ml/m(2) in the GH and control groups, respectively (all p < 0.001). No major adverse events were reported in the patients who received GH. CONCLUSIONS Although this is a preliminary study, the finding suggests a new therapeutic approach to a large proportion of GHD patients with CHF.
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Affiliation(s)
- Antonio Cittadini
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy.
| | - Alberto M Marra
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Michele Arcopinto
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Emanuele Bobbio
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Andrea Salzano
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Domenico Sirico
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Raffaele Napoli
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
| | - Annamaria Colao
- Department of Molecular and Clinical Endocrinology and Oncology, University "Federico II," Naples, Italy
| | | | - Ragavendra R Baliga
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Eduardo Bossone
- Cardiology Division, Cava dei Tirreni-Amalfi Coast Hospital, Heart Department, University of Salerno, Salerno, Italy
| | - Luigi Saccà
- Department of Internal Medicine, Cardiovascular and Immunological Sciences, University "Federico II," Naples, Italy
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Pasquali D, Arcopinto M, Renzullo A, Rotondi M, Accardo G, Salzano A, Esposito D, Saldamarco L, Isidori AM, Marra AM, Ruvolo A, Napoli R, Bossone E, Lenzi A, Baliga RR, Saccà L, Cittadini A. Cardiovascular abnormalities in Klinefelter syndrome. Int J Cardiol 2012; 168:754-9. [PMID: 23092857 DOI: 10.1016/j.ijcard.2012.09.215] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/18/2012] [Accepted: 09/29/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Several epidemiological studies have demonstrated an increased mortality from cardiovascular causes in patients with Klinefelter Syndrome (KS). Little information is available about the nature of the underlying cardiovascular abnormalities. Aim of the study was to investigate exercise performance, left ventricular architecture and function, vascular reactivity, and carotid intima-media thickness in a group of patients with KS. MATERIALS AND METHODS Sixty-nine patients with KS and 48 age-matched controls participated in our population-controlled study. Forty-eight Klinefelter subjects were on testosterone treatment at the time of the investigation while 21 were naive and underwent a complete Doppler echocardiographic examination, a cardiopulmonary exercise test as well as a vascular study including measures of carotid intima-media thickness and endothelial function with flow-mediated dilation of the brachial artery. Patients with KS on testosterone therapy (n=48) were also matched against a population of men with treated secondary hypogonadism (n=21). RESULTS Patients with KS exhibited a wide array of cardiovascular abnormalities including left ventricular diastolic dysfunction, reduced maximal oxygen consumption (p<0.01), increased intima-media thickness (p<0.05) (-34% and +42% vs. controls, respectively) and a high prevalence of chronotropic incompetence (55% of patients, p<0.01). No significant difference was found between treated and untreated KS in variance with men treated for secondary hypogonadism. CONCLUSION Left ventricular diastolic dysfunction, impaired cardiopulmonary performance, chronotropic incompetence, and increased intima-media thickness suggest that cardiovascular abnormalities are a common finding in KS that is not reversed by testosterone replacement therapy and may represent the pathophysiological underpinnings of the increased risk of dying from heart disease.
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Affiliation(s)
- Daniela Pasquali
- Department of Cardiothoracic and Respiratory Science, Endocrinology Unit, Second University of Naples, Italy
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Cittadini A, Napoli R, Monti MG, Rea D, Longobardi S, Netti PA, Walser M, Samà M, Aimaretti G, Isgaard J, Saccà L. Metformin prevents the development of chronic heart failure in the SHHF rat model. Diabetes 2012; 61:944-53. [PMID: 22344560 PMCID: PMC3314362 DOI: 10.2337/db11-1132] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.1] [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: 12/19/2022]
Abstract
Insulin resistance is a recently identified mechanism involved in the pathophysiology of chronic heart failure (CHF). We investigated the effects of two insulin-sensitizing drugs (metformin and rosiglitazone) in a genetic model of spontaneously hypertensive, insulin-resistant rats (SHHF). Thirty SHHF rats were randomized into three treatment groups as follows: 1) metformin (100 mg/kg per day), 2) rosiglitazone (2 mg/kg per day), and 3) no drug. Ten Sprague-Dawley rats served as normal controls. At the end of the treatment period (12 months), the cardiac phenotype was characterized by histology, echocardiography, and isolated perfused heart studies. Metformin attenuated left ventricular (LV) remodeling, as shown by reduced LV volumes, wall stress, perivascular fibrosis, and cardiac lipid accumulation. Metformin improved both systolic and diastolic indices as well as myocardial mechanical efficiency, as shown by improved ability to convert metabolic energy into mechanical work. Metformin induced a marked activation of AMP-activated protein kinase, endothelial nitric oxide synthase, and vascular endothelial growth factor and reduced tumor necrosis factor-α expression and myocyte apoptosis. Rosiglitazone did not affect LV remodeling, increased perivascular fibrosis, and promoted further cardiac lipid accumulation. In conclusion, long-term treatment with metformin, but not with rosiglitazone, prevents the development of severe CHF in the SHHF model by a wide-spectrum interaction that involves molecular, structural, functional, and metabolic-energetic mechanisms.
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Affiliation(s)
- Antonio Cittadini
- Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
| | - Raffaele Napoli
- Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
| | - Maria Gaia Monti
- Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
| | - Domenica Rea
- Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
| | | | - Paolo Antonio Netti
- Interdisciplinary Research Centre on Biomaterials, University Federico II, Naples, Italy
- Center for Advanced Biomaterial for Health Care, Interdisciplinary Research Centre on Biomaterials, Italian Institute of Technology, Naples, Italy
| | - Marion Walser
- Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Mariateresa Samà
- Department of Clinical and Experimental Medicine, University A. Avogadro, Novara, Italy
| | - Gianluca Aimaretti
- Department of Clinical and Experimental Medicine, University A. Avogadro, Novara, Italy
| | - Jörgen Isgaard
- Department of Internal Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Luigi Saccà
- Department of Clinical Medicine and Cardiovascular and Immunological Sciences, University Federico II, Naples, Italy
- Corresponding author: Luigi Saccà,
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Carlomagno G, Affuso F, Napoli R, Mercurio V, Fazio V, Micillo F, Pirozzi C, Ruvolo A, Saccá L, Fazio S. A NUTRACEUTICAL COMBINATION IMPROVES INSULIN SENSITIVITY IN PATIENTS WITH METABOLIC SYNDROME: RESULTS OF A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL. J Am Coll Cardiol 2011. [DOI: 10.1016/s0735-1097(11)60546-9] [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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Corrigan C, Napoli R, Meng Q, Fang C, Wu H, Tochiki K, Reay V, Lee T, Ying S. Reduced Expression Of Prostaglandin E (pge2) Receptor Ep2 On Bronchial Mucosal Leukocytes In Aspirin Sensitive Asthma (asa) Compared With Non-aspirin-sensitive Asthma (nasa) And Healthy Controls (hc). J Allergy Clin Immunol 2011. [DOI: 10.1016/j.jaci.2010.12.1071] [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: 11/26/2022]
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Oliviero U, Bonadies G, Bosso G, Foggia M, Apuzzi V, Cotugno M, Valvano A, Leonardi E, Borgia G, Castello G, Napoli R, Saccà L. Impaired diastolic function in naïve untreated human immunodeficiency virus infected patients. World J Cardiol 2010; 2:98-103. [PMID: 21160704 PMCID: PMC2999046 DOI: 10.4330/wjc.v2.i4.98] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Revised: 04/06/2010] [Accepted: 04/09/2010] [Indexed: 02/07/2023] Open
Abstract
AIM To evaluate cardiac function and structure in untreated human immunodeficiency virus (HIV) patients without clinical evidence of cardiovascular disease. METHODS Fifty-three naïve untreated HIV-infected patients and 56 healthy control subjects underwent clinical assessment, electrocardiography (ECG) and echocardiography, including tissue doppler imaging. Moreover, a set of laboratory parameters was obtained from all subjects, including HIV-RNA plasma levels, CD4 cell counts and tumor necrosis factor-α levels. RESULTS The two groups showed normal ECG traces and no differences regarding systolic morphologic parameters. In contrast, a higher prevalence of left ventricular diastolic dysfunction (abnormal relaxation or pseudonormal filling pattern) was found in the HIV patients (36% vs 9% in patients and controls, respectively, P <0.001). CONCLUSION Subclinical cardiac abnormalities appear in an early stage of the HIV infection, independent of antiretroviral therapy. The data suggest that HIV per se plays a role in the genesis of diastolic dysfunction.
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Affiliation(s)
- Ugo Oliviero
- Ugo Oliviero, Giorgio Bosso, Valentina Apuzzi, Antonio Valvano, Raffaele Napoli, Luigi Saccà, Department of Internal Medicine, University Federico II, 80131 Naples, Italy
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Napoli R, Guardasole V, Zarra E, D'Anna C, De Sena A, Lupoli GA, Oliviero U, Matarazzo M, Lupoli G, Saccà L. Impaired endothelial- and nonendothelial-mediated vasodilation in patients with acute or chronic hypothyroidism. Clin Endocrinol (Oxf) 2010; 72:107-11. [PMID: 19508590 DOI: 10.1111/j.1365-2265.2009.03609.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Vascular dysfunction and accelerated atherosclerosis are prominent features of hypothyroidism. The relative roles of thyroid hormone (TH) deficiency and the associated vascular risk conditions are still unclear. We studied the impact of acute and chronic hypothyroidism on vascular reactivity. PATIENTS We studied 12 patients with chronic primary hypothyroidism (cHY; TSH: 52 +/- 14 mU/l), seven patients with acute hypothyroidism secondary to total thyroidectomy (aHY; TSH: 97 +/- 24) and 13 healthy subjects (TSH: 1.2 +/- 0.5). MEASUREMENTS We measured forearm blood flow (FBF) using plethysmography during intra-brachial infusion of: acetylcholine (ACh), sodium nitroprusside (NP) and norepinephrine (NE). We also measured serum C-reactive protein (CRP), TNF-alpha, asymmetric dimethylarginine (ADMA) and the forearm balance of nitric oxide (NO) during ACh infusion. RESULTS As compared with the controls, the vasodilatory response to ACh was reduced in cHY (P = 0.001) and aHY (P = 0.04), as was the forearm release of NO (P < 0.05). During NP infusion, FBF rose to 24 +/- 2 ml/dl/min in the controls and to significantly lower values in cHY (12 +/- 1; P = 0.001) and aHY (15 +/- 2; P = 0.004). NE-induced vasoconstriction was similar in the controls and aHY, but blunted in cHY. Serum CRP, TNF-alpha and ADMA were not different in the three groups. CONCLUSIONS (i) Hypothyroidism associates with endothelial and nonendothelial mediated vascular dysfunction; (ii) these defects are evident even after short-term hypothyroidism, indicating that TH deficiency per se is sufficient to alter vascular homeostasis; and (iii) chronic, but not acute, hypothyroidism impairs the vasoconstrictory effect of NE in the resistance vessels.
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Affiliation(s)
- Raffaele Napoli
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II, Naples, Italy.
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Cittadini A, Monti MG, Castiello MC, D'Arco E, Galasso G, Sorriento D, Saldamarco L, De Paulis A, Napoli R, Iaccarino G, Saccà L. Insulin-like growth factor-1 protects from vascular stenosis and accelerates re-endothelialization in a rat model of carotid artery injury. J Thromb Haemost 2009; 7:1920-8. [PMID: 19740101 DOI: 10.1111/j.1538-7836.2009.03607.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND IGF-1 is a potent mitogen for vascular smooth muscle cells, but exerts protective effects on endothelial cells that may trigger antiatherogenic mechanisms. OBJECTIVES This study was designed to test the hypothesis that an IGF-1 excess following arterial injury prevents neointima formation and vascular stenosis. METHODS Rats were subjected to carotid balloon injury and treated with IGF-1 (1.2 mg kg(-1) per die) or saline for 10 days. RESULTS In IGF-1 treated animals, high tissue levels of eNOS, Akt and its phosphorylated form were found, confirming activation of IGF-1-dependent signaling pathways. IGF-1 markedly reduced neointima formation and post-injury arterial stenosis. IGF-1 exerted proliferative and anti-apoptotic effects in the media of injured carotids, but inhibited mitotic activity and induced apoptosis in the neointima. Furthermore, IGF-1 stimulated mobilization of progenitor endothelial cells and re-endothelialization of the injured arteries. L-NAME administration inhibited IGF-1 vasculoprotective effects. CONCLUSIONS IGF-1 attenuates post-injury carotid stenosis by exerting differential effects in the neointima and tunica media with regard to the key components of the response to injury. The data point to a novel role of IGF-1 as a potent vasculoprotective factor.
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Affiliation(s)
- A Cittadini
- Department of Internal Medicine, University Federico II, Naples, Italy
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Napoli R, Guardasole V, Zarra E, Matarazzo M, D'Anna C, Saccà F, Affuso F, Cittadini A, Carrieri PB, Saccà L. Vascular smooth muscle cell dysfunction in patients with migraine. Neurology 2009; 72:2111-4. [PMID: 19528518 DOI: 10.1212/wnl.0b013e3181aa53ce] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Migraine is associated with increased risk of cardiovascular disease, but the mechanisms are unclear. OBJECTIVE To investigate the activity of endothelial and vascular smooth muscle cells (VSMCs) in patients with migraine. METHODS Case-control study of 12 patients with migraine without aura and 12 matched healthy control subjects. Endothelial and VSMC components of vascular reactivity were explored by plethysmography measurement of forearm blood flow (FBF) during infusions of vasoactive agents into the brachial artery. Forearm production of nitric oxide (NO) and cyclic guanosine monophosphate (cGMP) was also quantified. RESULTS In patients with migraine, the vasodilating effect of acetylcholine (ACh), an endothelium-dependent vasodilator, was markedly reduced (p < 0.001 by analysis of variance). In response to the highest dose of ACh, FBF rose to 8.6 +/- 2.2 in patients with migraine and to 22.7 +/- 3.0 mL x dL(-1) x min(-1) in controls (p = 0.001). The dose-response curve to nitroprusside, a vasodilator directly acting on VSMCs, was depressed in patients with migraine (p < 0.001 by analysis of variance). The maximal response of FBF to nitroprusside was 12.1 +/- 2.0 in patients with migraine and 24.1 +/- 1.8 mL x dl(-1) x min(-1) in controls (p < 0.001). During ACh infusion, NO release from the endothelium was similar in patients and controls. In contrast, there was a marked release of cGMP from VSMCs in controls, but not in patients with migraine (-1.9 +/- 2.2 in patients with migraine and -19.1 +/- 5.4 nmol x dL(-1) x min(-1) in controls; p = 0.03). CONCLUSIONS Patients with migraine are characterized by a distinct vascular smooth muscle cell dysfunction, revealed by impaired cyclic guanosine monophosphate and hemodynamic response to nitric oxide.
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Affiliation(s)
- R Napoli
- Department of Internal Medicine, University Federico II School of Medicine, Naples, Italy.
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Saccà L, Napoli R. Insulin resistance in chronic heart failure: a difficult bull to take by the horns. Nutr Metab Cardiovasc Dis 2009; 19:303-305. [PMID: 19097875 DOI: 10.1016/j.numecd.2008.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 09/05/2008] [Indexed: 02/01/2023]
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Napoli R, Apuzzi V, Bosso G, D'Anna C, De Sena A, Pirozzi C, Marano A, Lupoli GA, Cudemo G, Oliviero U, Matarazzo M, Lupoli G, Saccá L. Recombinant human thyrotropin enhances endothelial-mediated vasodilation of conduit arteries. J Clin Endocrinol Metab 2009; 94:1012-6. [PMID: 19106266 DOI: 10.1210/jc.2008-2298] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Endothelial cells possess receptors to TSH. Their role is largely unknown. OBJECTIVES The objective of the study was to determine whether elevated serum TSH levels, as occur in hypothyroidism, affect endothelial function of large arteries and vascular risk biomarkers. SUBJECTS AND METHODS Thirty-four consecutively recruited patients, who had undergone thyroidectomy for thyroid carcinoma, were studied in connection with one of the monitoring procedures based on recombinant human (rh) TSH administration. Flow-mediated dilation (FMD) of the brachial artery and serum vascular risk markers were measured at baseline and for 5 d after the administration of rhTSH (0.9 mg im on d 1 and 2). Holter electrocardiogram and echocardiography were performed on d 2. RESULTS rhTSH caused a rapid increase in flow-mediated dilation from the basal value of 10.2 to 15.6% at 6 h (P < 0.0000001), to 16.1% on d 2 (P < 0.0000001), and to 14.9% on d 6 (P = 0.0015). The results were identical when the analysis was made in a subgroup of 19 patients free of vascular risk conditions. Vascular cell adhesion molecule-1, TNFalpha, IL-6, and high sensitive C-reactive protein were unaffected by rhTSH, whereas homocysteine was decreased. Arterial blood pressure, mean 24-h heart rate, and left ventricular function were unaffected by rhTSH. CONCLUSIONS rhTSH causes marked and persistent activation of the endothelial mediated vasodilation, independent of systemic hemodynamic changes.
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Affiliation(s)
- Raffaele Napoli
- Department of Internal Medicine and Cardiovascular Sciences, University Federico II, 80131 Naples, Italy.
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