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Caruso C, Ciasca G, Baglivo I, Di Santo R, Gasbarrini A, Firinu D, Bagnasco D, Passalacqua G, Schiappoli M, Caminati M, Canonica GW, Heffler E, Crimi C, Intravaia R, Basile V, Marino M, Colantuono S, Del Giacco S. Immunoglobulin free light chains in severe asthma patient: Could they be a new biomarker? Allergy 2024. [PMID: 38425088 DOI: 10.1111/all.16082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Increasing evidence is available about the presence of increased serum concentration of immunoglobulin (Ig) free light chains (FLCs) in both atopic and non-atopic inflammatory diseases, including severe asthma, providing a possible new biomarker of disease. METHODS We analyzed clinical and laboratory data, including FLCs, obtained from a cohort of 79 asthmatic subjects, clinically classified into different GINA steps. A control group of 40 age-matched healthy donors (HD) was considered. Particularly, HD have been selected according to the absence of monoclonal components (in order to exclude paraproteinemias), were tested for total IgE (that were in the normal ranges) and were negative for aeroallergens specific IgE. Moreover, no abnormality of common inflammatory markers (i.e., erythrocyte sedimentation rate and C-reactive protein) was detectable. RESULTS FLC-k levels were significantly increased in the asthmatic population, compared to the control group. Despite the absence of statistically significant differences in FLC-λ levels, the FLC-k/FLC-λ ratio displayed remarkable differences between the two groups. A positive correlation between FLC-κ and FLC-λ levels was found. FLC- λ level displayed a significant negative correlation with the FEV1 value. Moreover, the FLC-κ /FLC- λ ratio was negatively correlated with the SNOT-22 score and a positive correlation was observed between FLCs and Staphylococcus Aureus IgE enterotoxins sensitization. CONCLUSIONS Our findings confirmed the role of FLCs in asthma as a potential biomarker in an inflammatory disease characterized by different endotypes and phenotypes. In particular, FLC-κ and FLC-k/FLC-λ ratio could be a qualitative indicator for asthma, while FLC-λ levels could be a quantitative indicator for clinical severity parameters.
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Affiliation(s)
- C Caruso
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - I Baglivo
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - R Di Santo
- Dipartimento di Neuroscienze, Sezione di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - A Gasbarrini
- CEMAD Digestive Diseases Center, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - D Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - D Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - G Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Genoa, Italy
| | - M Schiappoli
- Allergy and Asthma Unit, Verona University Hospital, Verona, Italy
| | - M Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | - G W Canonica
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - E Heffler
- Personalized Medicine, Asthma and Allergy-IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - C Crimi
- Respiratory Medicine Unit, Policlinico "G. Rodolico-San Marco" University Hospital, Catania, Italy
| | - R Intravaia
- Unit of Cardiology, University Hospital Paolo Giaccone, University of Palermo, Palermo
| | - V Basile
- Clinical Pathology Unit and Cancer Biobank, Department of research and Advanced Technologies, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - M Marino
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - S Colantuono
- UOSD DH Internal Medicine and Gastroenterology, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - S Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Arroyo-Pereiro P, García-Serrano L, Morandeira F, Urban B, Mas V, Framil M, León I, Muñoz-Vendrell A, Matas E, Romero-Pinel L, Martínez-Yélamos A, Martínez-Yélamos S, Bau L. Kappa free light chains index in multiple sclerosis very long-term prognosis. Front Immunol 2023; 14:1223514. [PMID: 37885887 PMCID: PMC10598843 DOI: 10.3389/fimmu.2023.1223514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Introduction The role of the kappa-free light chain (kFLC) in the diagnosis of multiple sclerosis (MS) and, to a lesser extent, its role as a medium-term prognostic marker have been extensively studied. This study aimed to explore its potential as a long-term prognostic marker for MS. Methods We performed an exploratory retrospective observational study by selecting patients systemically followed up in our MS unit with available cerebrospinal fluid and serum samples at the time of initial evaluation. Two groups were defined: benign MS (bMS), defined as patients with Expanded Disability Status Scale (EDSS) ≤ 3 at 10 years of follow-up, and aggressive MS (aMS), defined as patients with EDSS ≥ 6 at 15 years of follow-up. Clinical variables were collected, and the immunoglobulin G (IgG) index, kFLC index, and oligoclonal bands (OCB) were determined for all patients and compared between the groups. Results Twenty bMS and 15 aMS patients were included in this study. Sixty percent (21/35) were female, and the mean age at the time of the first symptom was 31.5 ± 9.45 years, with no statistical differences between groups. Median follow-up time was 19.8 years (Interquartile range, IQR 15.9-24.6). The median EDSS scores at the last follow-up were 1.5 and 7.5 in the bMS and the aMS group, respectively. No statistically significant differences were found in the kFLC index between the two groups (136.6 vs. 140.27, p=0.59). The IgG index was positive in 62.9% of patients (55% bMS vs. 73.3% aMS, p>0.05), and OCB was positive in 88.6% (90% bMS vs. 86.7% aMS, p>0.05). A significant positive correlation was found between IgG and kFLC indices (rs = 0.85, p<0.001). Conclusion Given the absence of differences between the two groups with opposite disease courses, it is unlikely that the kFLC index is a reliable and powerful marker of long-term prognosis in MS.
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Affiliation(s)
- Pablo Arroyo-Pereiro
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Lydia García-Serrano
- Department of Immunology, Hospital Universitari de Bellvitge – Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Francisco Morandeira
- Department of Immunology, Hospital Universitari de Bellvitge – Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Blanca Urban
- Department of Immunology, Hospital Universitari de Bellvitge – Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Virginia Mas
- Department of Immunology, Hospital Universitari de Bellvitge – Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Mario Framil
- Department of Immunology, Hospital Universitari de Bellvitge – Institut d’Investigació Biomédica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Isabel León
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Albert Muñoz-Vendrell
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Elisabet Matas
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Lucía Romero-Pinel
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
| | - Antonio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Departament of Clinical Sciences, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Sergio Martínez-Yélamos
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Departament of Clinical Sciences, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona (UB), Barcelona, Spain
| | - Laura Bau
- Multiple Sclerosis Unit, Department of Neurology, Hospital Universitari de Bellvitge- Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
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Napodano C, Ciasca G, Chiusolo P, Pocino K, Gragnani L, Stefanile A, Gulli F, Lorini S, Minnella G, Fosso F, Di Santo R, Romanò S, Basile V, De Stefano V, Rapaccini GL, Zignego AL, Di Stasio E, Marino M, Basile U. Serological and Molecular Characterization of Hepatitis C Virus-Related Cryoglobulinemic Vasculitis in Patients without Cryoprecipitate. Int J Mol Sci 2023; 24:11602. [PMID: 37511357 PMCID: PMC10380893 DOI: 10.3390/ijms241411602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Prolonged B cells stimulation due to the Hepatitis C virus (HCV) can result in autoimmunity, stigmatized by rising levels of cryoglobulins (CGs), the rheumatoid factor (RF), and free light chains (FLC) of immunoglobulins (Ig) associated with a range of symptoms, from their absence to severe cryoglobulinemic vasculitis and lymphoma. Here, we aimed to identify an immunological signature for the earliest stages of vasculitis when cryoprecipitate is still not detectable. We firstly analyzed the IgG subclasses, FLC, and RF in 120 HCV-RNA-positive patients divided into four groups according to the type of cryoprecipitate and symptoms: 30 asymptomatic without cryoprecipitate (No Cryo), 30 with vasculitis symptoms but without CGs that we supposed were circulating but still not detectable (Circulating), 30 type II and 30 type III mixed cryoglobulinemia (Cryo II and Cryo III, respectively). Our results revealed that patients with supposed circulating CGs displayed a pattern of serological parameters that closely resembled Cryo II and Cryo III, with a stronger similarity to Cryo II. Accordingly, we analyzed the groups of Circulating and Cryo II for their immunoglobulin heavy chain (IgH) and T-cell receptor (TCR) gene rearrangements, finding a similar mixed distribution of monoclonal, oligoclonal, and polyclonal responses compared to a control group of ten HCV-RNA-negative patients recovered from infection, who displayed a 100% polyclonal response. Our results strengthened the hypothesis that circulating CGs are the origin of symptoms in HCV-RNA-positive patients without cryoprecipitate and demonstrated that an analysis of clonal IGH and TCR rearrangements is the best option for the early diagnosis of extrahepatic complications.
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Affiliation(s)
- Cecilia Napodano
- Department of Laboratory Medicine and Pathology, S. Agostino Estense Hospital, 41126 Modena, Italy;
| | - Gabriele Ciasca
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (R.D.S.); (S.R.)
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
| | - Patrizia Chiusolo
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Krizia Pocino
- Unità Operativa Complessa di Patologia Clinica, Ospedale Generale di Zona San Pietro Fatebenefratelli, 00189 Rome, Italy; (K.P.); (A.S.)
| | - Laura Gragnani
- Department of Translation Research and New Technologies in Medicine and Surgery, Università di Pisa, 56126 Pisa, Italy;
| | - Annunziata Stefanile
- Unità Operativa Complessa di Patologia Clinica, Ospedale Generale di Zona San Pietro Fatebenefratelli, 00189 Rome, Italy; (K.P.); (A.S.)
| | - Francesca Gulli
- Unit of Clinical Pathology, Bambino Gesù Children’s Hospital I.R.C.C.S., 00165 Rome, Italy;
| | - Serena Lorini
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, 50121 Florence, Italy; (S.L.); (A.L.Z.)
| | - Gessica Minnella
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Federica Fosso
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Riccardo Di Santo
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (R.D.S.); (S.R.)
| | - Sabrina Romanò
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (G.C.); (R.D.S.); (S.R.)
| | - Valerio Basile
- Clinical Pathology Unit and Cancer Biobank, Department of Research and Advanced Technologies, I.R.C.C.S. Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Valerio De Stefano
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Roma, Italy
| | - Gian Ludovico Rapaccini
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Centre MASVE, University of Florence, 50121 Florence, Italy; (S.L.); (A.L.Z.)
| | - Enrico Di Stasio
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Mariapaola Marino
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (P.C.); (G.M.); (F.F.); (V.D.S.); (G.L.R.)
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Umberto Basile
- Dipartimento di Patologia Clinica, Ospedale Santa Maria Goretti, A.U.S.L. Latina, 04100 Latina, Italy;
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Michetti L, Maffina F, Ravasio R, Barcella V, Radaelli M, Chiudinelli L, Sessa M, Alessio MG. Free light chains as a reliable biomarker of intrathecal synthesis in the diagnosis of CNS inflammatory diseases. J Neuroimmunol 2023; 379:578091. [PMID: 37210840 DOI: 10.1016/j.jneuroim.2023.578091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 02/20/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Abstract
OBJECTIVE To address the diagnostic performances of cerebrospinal fluid (CSF) free light chains (FLC) measurements compared to oligoclonal bands (OCB) to support multiple sclerosis (MS) diagnosis. RESULTS kFLC index showed the highest diagnostic accuracy to detect MS patients with the highest AUC compared to OCB, IgG index, IF kFLC R, kFLC H, λFLC index and IF λFLC. CONCLUSIONS FLC indices are biomarkers of intrathecal Immunoglobulin synthesis and central nervous system (CNS) inflammation. kFLC index can discriminate between MS and other CNS inflammatory disorders, while λFLC index is less informative for MS but can play a role to support the diagnosis of other inflammatory CNS disorders.
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Affiliation(s)
- Laura Michetti
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy.
| | - Francesca Maffina
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Rudi Ravasio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Valeria Barcella
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Marta Radaelli
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | | | - Maria Sessa
- Department of Neurology and Multiple Sclerosis Center, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
| | - Maria Grazia Alessio
- Department of Laboratory Medicine, Papa Giovanni XXIII Hospital, Piazza OMS, 1, 24127 Bergamo, Italy
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Kreiniz N, Gertz MA. Bad players in AL amyloidosis in the current era of treatment. Expert Rev Hematol 2023; 16:33-49. [PMID: 36620914 PMCID: PMC9905376 DOI: 10.1080/17474086.2023.2166924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Systemic AL amyloidosis (ALA) is a clonal plasma cell (PC) disease characterized by deposition of amyloid fibrils in different organs and tissues. Traditionally, the prognosis of ALA is poor and is primarily defined by cardiac involvement. The modern prognostic models are based on cardiac markers and free light chain difference (dFLC). Cardiac biomarkers have low specificity and are dependent on renal function, volume status, and cardiac diseases other than ALA. New therapies significantly improved the prognosis of the disease. The advancements in technologies - cardiac echocardiography (ECHO) and cardiac MRI (CMR), as well as new biological markers, relying on cardiac injury, inflammation, endothelial damage, and clonal and non-clonal PC markers are promising. AREAS COVERED An update on the prognostic significance of cardiac ALA, number of involved organs, response to treatment, including minimal residual disease (MRD), ECHO, MRI, and new biological markers will be discussed. The literature search was done in PubMed and Google Scholar, and the most recent and relevant data are included. EXPERT OPINION Prospective multicenter trials, evaluating multiple clinical and laboratory parameters, should be done to improve the risk assessment models in ALA in the modern era of therapy.
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Affiliation(s)
- Natalia Kreiniz
- Division of Hematology, Bnai Zion Medical Centre, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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Arneth B, Kraus J. The Use of Kappa Free Light Chains to Diagnose Multiple Sclerosis. Medicina (B Aires) 2022; 58:medicina58111512. [PMID: 36363469 PMCID: PMC9698214 DOI: 10.3390/medicina58111512] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The positive implications of using free light chains in diagnosing multiple sclerosis have increasingly gained considerable interest in medical research and the scientific community. It is often presumed that free light chains, particularly kappa and lambda free light chains, are of practical use and are associated with a higher probability of obtaining positive results compared to oligoclonal bands. The primary purpose of the current paper was to conduct a systematic review to assess the up-to-date methods for diagnosing multiple sclerosis using kappa and lambda free light chains. Method: An organized literature search was performed across four electronic sources, including Google Scholar, Web of Science, Embase, and MEDLINE. The sources analyzed in this systematic review and meta-analysis comprise randomized clinical trials, prospective cohort studies, retrospective studies, controlled clinical trials, and systematic reviews. Results: The review contains 116 reports that includes 1204 participants. The final selection includes a vast array of preexisting literature concerning the study topic: 35 randomized clinical trials, 21 prospective cohort studies, 19 retrospective studies, 22 controlled clinical trials, and 13 systematic reviews. Discussion: The incorporated literature sources provided integral insights into the benefits of free light chain diagnostics for multiple sclerosis. It was also evident that the use of free light chains in the diagnosis of clinically isolated syndrome (CIS) and multiple sclerosis is relatively fast and inexpensive in comparison to other conventional state-of-the-art diagnostic methods, e.g., using oligoclonal bands (OCBs).
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Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Justus Liebig University, Feulgenstr. 12, 35392 Giessen, Germany
- Correspondence:
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Strubergasse 21, 5020 Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
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Bracht T, Kleefisch D, Schork K, Witzke KE, Chen W, Bayer M, Hovanec J, Johnen G, Meier S, Ko YD, Behrens T, Brüning T, Fassunke J, Buettner R, Uszkoreit J, Adamzik M, Eisenacher M, Sitek B. Plasma Proteomics Enable Differentiation of Lung Adenocarcinoma from Chronic Obstructive Pulmonary Disease (COPD). Int J Mol Sci 2022; 23:ijms231911242. [PMID: 36232544 PMCID: PMC9569607 DOI: 10.3390/ijms231911242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a major risk factor for the development of lung adenocarcinoma (AC). AC often develops on underlying COPD; thus, the differentiation of both entities by biomarker is challenging. Although survival of AC patients strongly depends on early diagnosis, a biomarker panel for AC detection and differentiation from COPD is still missing. Plasma samples from 176 patients with AC with or without underlying COPD, COPD patients, and hospital controls were analyzed using mass-spectrometry-based proteomics. We performed univariate statistics and additionally evaluated machine learning algorithms regarding the differentiation of AC vs. COPD and AC with COPD vs. COPD. Univariate statistics revealed significantly regulated proteins that were significantly regulated between the patient groups. Furthermore, random forest classification yielded the best performance for differentiation of AC vs. COPD (area under the curve (AUC) 0.935) and AC with COPD vs. COPD (AUC 0.916). The most influential proteins were identified by permutation feature importance and compared to those identified by univariate testing. We demonstrate the great potential of machine learning for differentiation of highly similar disease entities and present a panel of biomarker candidates that should be considered for the development of a future biomarker panel.
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Affiliation(s)
- Thilo Bracht
- Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Medical Center Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Correspondence: (T.B.); (B.S.); Tel.: +49-234-32-29985 (T.B.); +49-234-32-24362 (B.S.)
| | - Daniel Kleefisch
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Center for Protein Diagnostics (PRODI), Medical Proteome Analysis, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Karin Schork
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Center for Protein Diagnostics (PRODI), Medical Proteome Analysis, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Kathrin E. Witzke
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Center for Protein Diagnostics (PRODI), Medical Proteome Analysis, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Weiqiang Chen
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Malte Bayer
- Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Medical Center Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Jan Hovanec
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Georg Johnen
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Swetlana Meier
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Yon-Dschun Ko
- Department of Internal Medicine, Johanniter-Kliniken Bonn GmbH, Johanniter Krankenhaus, 53113 Bonn, Germany
| | - Thomas Behrens
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Thomas Brüning
- Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of the Ruhr University Bochum (IPA), 44789 Bochum, Germany
| | - Jana Fassunke
- Institute of Pathology, Medical Faculty and Center for Molecular Medicine (CMMC), University of Cologne, 50924 Cologne, Germany
| | - Reinhard Buettner
- Institute of Pathology, Medical Faculty and Center for Molecular Medicine (CMMC), University of Cologne, 50924 Cologne, Germany
| | - Julian Uszkoreit
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Center for Protein Diagnostics (PRODI), Medical Proteome Analysis, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Michael Adamzik
- Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Medical Center Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany
| | - Martin Eisenacher
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Center for Protein Diagnostics (PRODI), Medical Proteome Analysis, Ruhr-University Bochum, 44801 Bochum, Germany
| | - Barbara Sitek
- Clinic for Anesthesiology, Intensive Care and Pain Therapy, University Medical Center Knappschaftskrankenhaus Bochum, 44892 Bochum, Germany
- Medizinisches Proteom-Center, Ruhr-University Bochum, 44801 Bochum, Germany
- Correspondence: (T.B.); (B.S.); Tel.: +49-234-32-29985 (T.B.); +49-234-32-24362 (B.S.)
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A method to obtain purified free light chain monomers and dimers from urine samples of patients with multiple myeloma. Immunol Res 2022; 70:844-849. [DOI: 10.1007/s12026-022-09314-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 08/20/2022] [Indexed: 11/05/2022]
Abstract
AbstractAntibody light chains are synthesized in excess by plasma cells, and this excess can be secreted into biological fluids as dimers or monomers in various proportions. Structural differences between monomers or dimers of free light chains (FLC) can affect their biological functions and possibly their pathogenicity. They also may exhibit differential immune reactivity, perhaps explaining discrepant quantifications when measured by different immunoreagents. Having purified FLC monomers and dimers available can be useful for studying their properties. Here we propose a simple preparatory procedure to purify FLC monomers and dimers from urine samples of patients with plasma cell disorders. Two representative urine samples containing lambda or kappa FLC were loaded into a nonreducing sodium dodecyl sulfate–polyacrylamide gel electrophoresis (SDS-PAGE). The gel strips containing separate monomers and dimers were excised, electroeluted, and the FLC recovered. The FLC were recovered from SDS-PAGE gel in sufficient amounts to be quantified by UV and two automated nephelometric assays immunochemical. The procedure was found to be simple, reproducible, and with a high yield, thus offering the opportunity to compare different assays. Not all urine samples are suitable for this procedure, but this approach allows for the purification of FLC monomers and dimers from many selected urine samples which maintain their oligomeric organization.
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A Scoping Review on Body Fluid Biomarkers for Prognosis and Disease Activity in Patients with Multiple Sclerosis. J Pers Med 2022; 12:jpm12091430. [PMID: 36143216 PMCID: PMC9501898 DOI: 10.3390/jpm12091430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/22/2022] [Accepted: 08/27/2022] [Indexed: 11/30/2022] Open
Abstract
Multiple sclerosis (MS) is a complex demyelinating disease of the central nervous system, presenting with different clinical forms, including clinically isolated syndrome (CIS), which is a first clinical episode suggestive of demyelination. Several molecules have been proposed as prognostic biomarkers in MS. We aimed to perform a scoping review of the potential use of prognostic biomarkers in MS clinical practice. We searched MEDLINE up to 25 November 2021 for review articles assessing body fluid biomarkers for prognostic purposes, including any type of biomarkers, cell types and tissues. Original articles were obtained to confirm and detail the data reported by the review authors. We evaluated the reliability of the biomarkers based on the sample size used by various studies. Fifty-two review articles were included. We identified 110 molecules proposed as prognostic biomarkers. Only six studies had an adequate sample size to explore the risk of conversion from CIS to MS. These confirm the role of oligoclonal bands, immunoglobulin free light chain and chitinase CHI3L1 in CSF and of serum vitamin D in the prediction of conversion from CIS to clinically definite MS. Other prognostic markers are not yet explored in adequately powered samples. Serum and CSF levels of neurofilaments represent a promising biomarker.
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10
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Napodano C, Pocino K, Gulli F, Rossi E, Rapaccini GL, Marino M, Basile U. Mono/polyclonal free light chains as challenging biomarkers for immunological abnormalities. Adv Clin Chem 2022; 108:155-209. [PMID: 35659060 DOI: 10.1016/bs.acc.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Free light chain (FLC) kappa (k) and lambda (λ) consist of low molecular weight proteins produced in excess during immunoglobulin synthesis and secreted into the circulation. In patients with normal renal function, over 99% of FLCs are filtered and reabsorbed. Thus, the presence of FLCs in the serum is directly related to plasma cell activity and the balance between production and renal clearance. FLCs are bioactive molecules that may exist as monoclonal (m) and polyclonal (p) FLCs. These have been detected in several body fluids and may be key indicators of ongoing damage and/or illness. International guidelines now recommend mFLC for screening, diagnosis and monitoring multiple myeloma and other plasma cell dyscrasias. In current clinical practice, FLCs in urine indicate cast nephropathy and other renal injury, whereas their presence in cerebrospinal fluid is important for identifying central nervous system inflammatory diseases such as multiple sclerosis. Increased pFLCs have also been detected in various conditions characterized by B cell activation, i.e., chronic inflammation, autoimmune disease and HCV infection. Monitoring the coronavirus (COVID-19) pandemic by analysis of salivary FLCs presents a significant opportunity in clinical immunology worthy of scientific pursuit.
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Affiliation(s)
- Cecilia Napodano
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Elena Rossi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
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11
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Inflammation and Oxidative Stress in Seminal Plasma: Search for Biomarkers in Diagnostic Approach to Male Infertility. J Pers Med 2022; 12:jpm12060857. [PMID: 35743642 PMCID: PMC9224911 DOI: 10.3390/jpm12060857] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/20/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Oxidative and inflammatory damage underlie several conditions related to male infertility, including varicocele. Free light chains of immunoglobulins (FLCs) are considered markers of low-grade inflammation in numerous diseases. Coenzyme Q10 (CoQ10), a lipidic antioxidant and anti-inflammatory compound, is involved in spermatozoa energy metabolism and motility. We aimed to evaluate FLCs’ seminal levels in patients with varicocele in comparison to control subjects and to correlate them with CoQ10 and Total Antioxidant Capacity (TAC) in human semen. Sixty-five patients were enrolled. Semen analysis was performed; patients were divided into three groups: controls, 12 normozoospermic patients, aged 34 (33–41) years; varicocele (VAR), 29 patients, aged 33 (26–37) years; and idiopathic, 24 oligo-, astheno- and oligoasthenozoospermic patients aged 37 (33.5–40.5) years. FLCs (κ and λ) were assayed by turbidimetric method; CoQ10 by HPLC; TAC by spectrophotometric method. λ FLCs showed a trend toward higher levels in VAR vs. controls and the idiopathic group. VAR showed a trend toward lower κ FLCs levels vs. the other two groups. When comparing κ/λ ratio, VAR showed significantly lower levels vs. controls and idiopathic. Moreover, CoQ10 seminal levels showed higher levels in VAR and idiopathic compared to controls. Data reported here confirm lower levels of κ/λ ratio in VAR and suggest a possible application in personalized medicine as clinical biomarkers for male infertility.
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12
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Jiang J, Zhao J, Liu D, Zhang M. Different roles of urinary light chains and serum light chains as potential biomarkers for monitoring disease activity in systemic lupus erythematosus. PeerJ 2022; 10:e13385. [PMID: 35602892 PMCID: PMC9121880 DOI: 10.7717/peerj.13385] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 04/15/2022] [Indexed: 01/13/2023] Open
Abstract
Objective The assessment system for monitoring systemic lupus erythematosus (SLE) disease activity is complex and lacks reliable laboratory indicators. It is necessary to find rapid and noninvasive biomarkers. The aim of this study was to screen and identify the differentially expressed proteins in urine samples between active SLE and stable SLE and to further explore the expression of light chains. Methods First, we used a label-free quantitative proteomics approach to establish the urine protein expression profile of SLE, and then screened differentially expressed proteins. Subsequently, the expression of overall light chains was examined by immunofixation electrophoresis and immunoturbidimetric methods, respectively. Results Mass spectrometry data analysis found a total of 51 light chain peptides in the urinary protein expression spectrum, of which 27 light chain peptides were differentially expressed between the two groups. The largest difference was IGLV5-45 located in the variable region of the immunoglobulin Lambda light chain. The levels of urinary light chains and serum light chains were both significantly elevated in active SLE, and the levels of urinary light chains increased with the severity of disease activity. Conclusions The measurement of light chains would help to monitor SLE disease activity. Serum light chains had better discriminatory capacity than urinary light chains, while urine light chains were closely related to the severity of disease activity and could be used for dynamically monitoring the progress of disease activity.
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Affiliation(s)
- Jun Jiang
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Jin Zhao
- Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dan Liu
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Beijing, China
| | - Man Zhang
- Clinical Laboratory Medicine, Peking University Ninth School of Clinical Medicine, Beijing, China
- Clinical Laboratory Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Urinary Cellular Molecular Diagnostics, Beijing, China
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13
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Basile U, Vergani E, Napodano C, Bruno C, Marino M, Oliva A, Gulli F, Mancini A. Evaluation of free light chains of immunoglobulins in normal and pathological seminal fluids: Preliminary data. Andrologia 2021; 54:e14317. [PMID: 34850444 DOI: 10.1111/and.14317] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 10/28/2021] [Accepted: 11/05/2021] [Indexed: 11/27/2022] Open
Abstract
Immunoglobulins free light chains (FLCs) are assayable in several biological fluids. Currently, there are no reports on FLCs in seminal plasma. The aims of our study were to investigate the presence and detectability of FLCs in seminal plasma and to evaluate the usefulness of this assay in the diagnostic approach to infertile patients. We enrolled 61 patients aged 18-50 years. Semen analysis was performed. They were divided into four groups: controls-normozoospermic, 10 patients, mean ± SEM age 35 ± 1.5 years; varicoceles (VAR), 18 patients aged 24.3 ± 0.96 years; inflammatory (INF) seminal fluids, 24 patients, aged 38.8 ± 2.2 years; and varicoceles and inflammatory (VAR/INF) seminal fluids, 9 patients, aged 29.5 ± 0.71 years. A trend towards higher λ FLCs levels was evidenced in the INF and VAR/INF groups. κ FLCs were higher in normozoospermic patients with lower levels in VAR, both isolated and associated with inflammatory parameters. This differential pattern of the two types of FLCs reached statistical significance when comparing κ/λ ratio, with significant lower levels in VAR vs controls. This is the first report of FLCs assay in seminal plasma. We can hypothesize that λ FLCs are increased in inflammatory processes, whether κ FLCs seem to be influenced by other molecular mechanisms related to varicocele.
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Affiliation(s)
- Umberto Basile
- Dipartimento di Scienze di laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Vergani
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Carmine Bruno
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Oliva
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Antonio Mancini
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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14
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Gragnani L, Lorini S, Marri S, Basile U, Santarlasci V, Monti M, Madia F, Petraccia L, Stasi C, Marello N, Napodano C, Annunziato F, Zignego AL. Hematological and Genetic Markers in the Rational Approach to Patients With HCV Sustained Virological Response With or Without Persisting Cryoglobulinemic Vasculitis. Hepatology 2021; 74:1164-1173. [PMID: 33721342 PMCID: PMC8519006 DOI: 10.1002/hep.31804] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/02/2021] [Accepted: 02/28/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS Direct-acting antivirals (DAAs) usually lead to improvement/remission of cryoglobulinemic vasculitis (CV), although symptoms may persist/recur after a sustained virological response (SVR). We evaluated hematological and genetic markers in patients with HCV-SVR vasculitis with and without persisting/recurring symptoms to early predict the CV outcome. APPROACH AND RESULTS Ninety-eight patients with HCV-CV were prospectively enrolled after a DAA-induced SVR: Group A: 52 with complete clinical response; Group B: 46 with symptom maintenance/recurrence. Monoclonal B-cell lymphocytosis, t(14;18) translocation, and abnormal free light chains κ/λ ratios were detected by flow cytometry or nested-PCR or nephelometry in 4% Group A versus 17% Group B (P = 0.04) patients, 17% Group A versus 40% Group B patients (P = 0.02), and 17% Group A versus 47% Group B (P = 0.003) patients, respectively. At least 1 out of 3 clonality markers was altered/positive in 29% of Group A versus 70% of Group B patients (P < 0.0001). When available, pretherapy samples were also tested for t(14;18) translocation (detected in 12/37 [32%] Group A and 21/38 [55%] Group B) and κ/λ ratios (abnormal in 5/35 [14%] Group A and 20/38 [53%] Group B) (P = 0.0006), whereas at least one clonality marker was detected/altered in 16/37 (43%) Group A and 30/38 (79%) Group B (P = 0.002). CV-associated single-nucleotide polymorphisms were tested by real-time PCR. Among them, notch4 rs2071286 T minor allele and TT genotype showed a higher frequency in Group B versus Group A (46% vs. 29%, P = 0.01, and 17% vs. 2%, P = 0.006, respectively). CONCLUSIONS Hematological or genetic analyses could be used to foresee the CV clinical response after DAA therapy and could be valuable to assess a rational flowchart to manage CV during follow-up.
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Affiliation(s)
- Laura Gragnani
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Serena Lorini
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Silvia Marri
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Umberto Basile
- Area Diagnostica di LaboratorioFondazione Policlinico Universitario “A. Gemelli”, I.R.C.C.S. RomeRomeItaly
| | - Veronica Santarlasci
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly,Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Monica Monti
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Francesco Madia
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Luisa Petraccia
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Cristina Stasi
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Niccolò Marello
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
| | - Cecilia Napodano
- Dipartimento di scienze Mediche e ChirurgicheUOC Gastroenterologia Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S.RomeItaly
| | - Francesco Annunziato
- Flow Cytometry Diagnostic Center and Immunotherapy (CDCI)Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Anna Linda Zignego
- MaSVE Interdepartmental Hepatology CenterDepartment of Experimental and clinical MedicineUniversity of FlorenceCenter for Research and Innovation CRIA‐MaSVEAOU CareggiFlorenceItaly
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15
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Napodano C, Gulli F, Rapaccini GL, Marino M, Basile U. Cryoglobulins: Identification, classification, and novel biomarkers of mysterious proteins. Adv Clin Chem 2021; 104:299-340. [PMID: 34462057 PMCID: PMC7604189 DOI: 10.1016/bs.acc.2020.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Cryoglobulins consist of serum immunoglobulins that precipitate below 37°C and resolubilize upon warming. The clinical triad of cryoglobulinemia usually includes purpura, weakness, and arthralgia. Cryoglobulinemic syndrome, clinically defined as a systemic vasculitis, is associated with chronic infection with hepatitis C virus (HCV) and autoimmune disorders and can evolve into B-cell malignancies. While the current literature about HCV-associated cryoglobulinemia is not very limited, little is known about the immunologic and serologic profiles of affected patients. Therefore, comprehension of the pathogenetic mechanisms underlying cryoprecipitation could be very helpful. Due to the persistence of viral antigenic stimulation, biomarkers to use after the worsening progression of HCV infection to lymphoproliferative and/or autoimmune diseases are widely needed. Laboratory methods used to detect and characterize low concentrations of cryoprecipitates and immunotyping patterns could improve patient management. The most critical factor affecting cryoglobulin testing is that the pre-analytical phase is not fully completed at 37°C.
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Affiliation(s)
- Cecilia Napodano
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Dipartimento Di Medicina E Chirurgia Traslazionale, Istituto di Patologia Generale, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S., Università Cattolica del Sacro Cuore, Rome, Italy.
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16
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Pocino K, Napodano C, Gragnani L, Ciasca G, Colantuono S, Marri S, Vantaggio L, Gulli F, Lorini S, Barini A, Stefanile A, Miele L, Casato M, Zignego AL, Rapaccini GL, Marino M, Visentini M, Basile U. Solving the mystery of HBV-related mixed cryoglobulinemia: potential biomarkers of disease progression. Rheumatology (Oxford) 2021; 60:4418-4427. [PMID: 33590837 PMCID: PMC7928620 DOI: 10.1093/rheumatology/keab157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/04/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The biomarkers of an immunological dysregulation due to a chronic HBV infection are indeed understudied. If untreated, this condition may evolve into liver impairment co-occurring with extrahepatic involvements. Here, we aim to identify a new panel of biomarkers [including immunoglobulin G (IgG) subclasses, RF, and Free Light Chains (FLCs)] that may be useful and reliable for clinical evaluation of HBV-related cryoglobulinemia. METHODS We retrospectively analysed clinical data from 44 HBV-positive patients. The patients were stratified (according to the presence/absence of mixed cryoglobulinemia) into two groups: 22 with cryoglobulins (CGs) and 22 without CGs. Samples from 20 healthy blood donors (HDs) were used as negative controls. Serum samples were tested for IgG subclasses, RF (-IgM, -IgG, and -IgA type), and FLCs. RESULTS We detected a strikingly different distribution of serum IgG subclasses between HDs and HBV-positive patients, together with different RF isotypes; in addition, FLCs were significantly increased in HBV-positive patients compared with HDs, while no significant difference was shown between HBV-positive patients with/without mixed cryoglobulinemia. CONCLUSION The immune-inflammatory response triggered by HBV may be monitored by a peculiar profile of biomarkers. Our results open a new perspective in the precision medicine era; in these challenging times, they could also be employed to monitor the clinical course of those COVID-19 patients who are at high risk of HBV reactivation due to liver impairment and/or immunosuppressive therapies.
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Affiliation(s)
- Krizia Pocino
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Cecilia Napodano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Laura Gragnani
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Gabriele Ciasca
- Istituto di Fisica, Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli I.R.C.C.S, Roma
| | - Stefania Colantuono
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Silvia Marri
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Lorenzo Vantaggio
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini
| | - Serena Lorini
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Antonella Barini
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
| | - Annunziata Stefanile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
| | - Luca Miele
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Milvia Casato
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Anna Linda Zignego
- Department of Experimental and Clinical Medicine, Interdepartmental Center for Systemic Manifestations of Hepatitis Viruses (MaSVE), University of Florence, Florence
| | - Gian Ludovico Rapaccini
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario ‘A. Gemelli’ I.R.C.C.S, Rome
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario ‘A. Gemelli’, I.R.C.C.S, Rome, Italy
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Hantavirus infection-induced B cell activation elevates free light chains levels in circulation. PLoS Pathog 2021; 17:e1009843. [PMID: 34379707 PMCID: PMC8382192 DOI: 10.1371/journal.ppat.1009843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/23/2021] [Accepted: 07/27/2021] [Indexed: 12/17/2022] Open
Abstract
In humans, orthohantaviruses can cause hemorrhagic fever with renal syndrome (HFRS) or hantavirus pulmonary syndrome (HPS). An earlier study reported that acute Andes virus HPS caused a massive and transient elevation in the number of circulating plasmablasts with specificity towards both viral and host antigens suggestive of polyclonal B cell activation. Immunoglobulins (Igs), produced by different B cell populations, comprise heavy and light chains; however, a certain amount of free light chains (FLCs) is constantly present in serum. Upregulation of FLCs, especially clonal species, associates with renal pathogenesis by fibril or deposit formations affecting the glomeruli, induction of epithelial cell disorders, or cast formation in the tubular network. We report that acute orthohantavirus infection increases the level of Ig FLCs in serum of both HFRS and HPS patients, and that the increase correlates with the severity of acute kidney injury in HFRS. The fact that the kappa to lambda FLC ratio in the sera of HFRS and HPS patients remained within the normal range suggests polyclonal B cell activation rather than proliferation of a single B cell clone. HFRS patients demonstrated increased urinary excretion of FLCs, and we found plasma cell infiltration in archival patient kidney biopsies that we speculate to contribute to the observed FLC excreta. Analysis of hospitalized HFRS patients’ peripheral blood mononuclear cells showed elevated plasmablast levels, a fraction of which stained positive for Puumala virus antigen. Furthermore, B cells isolated from healthy donors were susceptible to Puumala virus in vitro, and the virus infection induced increased production of Igs and FLCs. The findings propose that hantaviruses directly activate B cells, and that the ensuing intense production of polyclonal Igs and FLCs may contribute to acute hantavirus infection-associated pathological findings. Orthohantaviruses are globally spread zoonotic pathogens, which can cause hemorrhagic fever with renal syndrome (HFRS) and hantavirus pulmonary syndrome (HPS) with significant burden to human health. The pathogenesis mechanisms of orthohantavirus-caused diseases are not known in detail; however, excessive immune response towards the virus with concomitant pathological effects against host tissues appears to be a contributing factor. Here we report an increase of free immunoglobulin (Ig) light chains (FLCs), components required to make complete Ig molecules, in blood of acute HFRS and HPS. Samples collected during acute HFRS demonstrated increased FLCs levels in the urine and blood of patients hospitalized due the disease. Furthermore, the FLC levels positively correlated with markers of acute kidney injury. In addition, our results show that orthohantaviruses can infect and activate B cells to produce FLCs as well as whole Igs, which provides a mechanistic explanation of the increased FLC levels in patients. Taken together, our results suggest that aberrant antibody responses might play a role in the pathogenesis of orthohantavirus infections.
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18
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Gigante A, Pellicano C, Leodori G, Napodano C, Vantaggio L, Gulli F, Marino M, Visentini M, Rosato E, Basile U. Serum and urine free light chains measurements in patients with systemic sclerosis: novel biomarkers for disease activity. Clin Exp Immunol 2021; 205:135-141. [PMID: 33934349 DOI: 10.1111/cei.13611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 12/14/2022] Open
Abstract
Circulating free light chains (FLCs), considered biomarkers of B cell activity, are frequently elevated in patients affected by systemic inflammatory autoimmune diseases. As the systemic sclerosis (SSc) clinical course can be variable, this study is aimed at evaluating FLCs levels in affected individuals as biomarkers of disease activity. We assessed FLC levels in serum and urine of 72 SSc patients and 30 healthy controls (HC). Results were analyzed in comparison with overall clinical and laboratory findings, disease activity index (DAI) and disease severity scale (DSS). SSc patients displayed increased levels of κ and λ FLC in serum significantly higher than HC (p = 0.0001) alongside the mean values of free κ/λ ratio and κ + λ sum (p = 0.0001). SSc patients showed increased free κ in urine with a κ/λ higher than HC (p = 0.0001). SSc patients with increased κ + λ in serum showed that erythro-sedimentation rate (p = 0.034), C-reactive protein (p = 0.003), DAI (p = 0.024) and DSS (p = 0.015) were higher if compared to SSc patients with normal levels of FLC. A positive linear correlation was found between serum levels of free κ and DAI (r = 0.29, p = 0.014). In addition, SSc patients with increased free κ in urine had higher DAI (p = 0.048) than SSc patients with normal κ levels. Our results strengthen the role of serum FLC as useful biomarker in clinical practice to early diagnosis and monitor disease activity, showing for the first time that also urine FLC levels correlated with disease activity in SSc patients.
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Affiliation(s)
- Antonietta Gigante
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Pellicano
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Giorgia Leodori
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Cecilia Napodano
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Lorenzo Vantaggio
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Gulli
- Laboratorio di Patologia Clinica, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Rome, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Edoardo Rosato
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario 'A. Gemelli', IRCCS, Rome, Italy
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19
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Sarto C, Intra J, Fania C, Brivio R, Brambilla P, Leoni V. Monoclonal free light chain detection and quantification: Performances and limits of available laboratory assays. Clin Biochem 2021; 95:28-33. [PMID: 33991536 DOI: 10.1016/j.clinbiochem.2021.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 04/25/2021] [Accepted: 05/10/2021] [Indexed: 11/19/2022]
Abstract
The detection and quantification of immunoglobulin free light chains in serum and urine is recommended for the diagnosis and monitoring of monoclonal gammopathies according to the guidelines of the International Myeloma Working Group (IMWG). Several tests are currently available in the clinical laboratory to detect and quantify free light chains but although quality, efficiency, and effectiveness have been improved, the results are still variable and poorly harmonized and standardized. The present review article wants to analyze these aspects, with a keen eye on techniques, such as mass spectrometry, that could replace in the practical clinical laboratory the current methods including Bence-Jones protein assay and free light chain immunoassays.
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Affiliation(s)
- C Sarto
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
| | - J Intra
- Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, (MB), Italy.
| | - C Fania
- Clinical Chemistry Unit, "Maggiore della Carità" University Hospital, 28100 Novara, Italy
| | - R Brivio
- Clinical Chemistry Laboratory, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale di Monza ASST-Monza, St Gerardo Hospital, via Pergolesi 33, 20900 Monza, (MB), Italy
| | - P Brambilla
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
| | - V Leoni
- Department of Laboratory Medicine, University of Milano-Bicocca, Azienda Socio Sanitaria Territoriale della Brianza ASST-Brianza, Desio Hospital, via Mazzini 1, 20833 Desio, (MB), Italy
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20
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Napodano C, Callà C, Fiorita A, Marino M, Taddei E, Di Cesare T, Passali GC, Di Santo R, Stefanile A, Fantoni M, Urbani A, Paludetti G, Rapaccini GL, Ciasca G, Basile U. Salivary Biomarkers in COVID-19 Patients: Towards a Wide-Scale Test for Monitoring Disease Activity. J Pers Med 2021; 11:jpm11050385. [PMID: 34066701 PMCID: PMC8151878 DOI: 10.3390/jpm11050385] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/28/2021] [Accepted: 05/04/2021] [Indexed: 01/08/2023] Open
Abstract
The ongoing outbreak of coronavirus disease 2019 (COVID-19), which impairs the functionality of several organs, represents a major threat to human health. One of the hardest challenges in the fight against COVID-19 is the development of wide-scale, effective, and rapid laboratory tests to control disease severity, progression, and possible sudden worsening. Monitoring patients in real-time is highly demanded in this pandemic era when physicians need reliable and quantitative tools to prioritize patients’ access to intensive care departments. In this regard, salivary biomarkers are extremely promising, as they allow for the fast and non-invasive collection of specimens and can be repeated multiple times. Methods: We compare salivary levels of immunoglobulin A subclasses (IgA1 and IgA2) and free light chains (kFLC and λFLC) in a cohort of 29 SARS-CoV-2 patients and 21 healthy subjects. Results: We found that each biomarker differs significantly between the two groups, with p-values ranging from 10−8 to 10−4. A Receiving Operator Curve analysis shows that λFLC level is the best-suited candidate to discriminate the two groups (AUC = 0.96), with an accuracy of 0.94 (0.87–1.00 95% CI), a precision of 0.91 (0.81–1.00 95% CI), a sensitivity of 1.00 (0.96–1.00 95% CI), and a specificity of 0.86 (0.70–1.00 95% CI). Conclusion: These results suggest λFLC as an ideal indicator of patient conditions. This hypothesis is strengthened by the consideration that the λFLC half-life (approximately 6 h) is significantly shorter than the IgA one (21 days), thus confirming the potential of λFLC for effectively monitoring patients’ fluctuation in real-time.
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Affiliation(s)
- Cecilia Napodano
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.N.); (G.L.R.)
| | - Cinzia Callà
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Antonella Fiorita
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Mariapaola Marino
- Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
| | - Eleonora Taddei
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.T.); (M.F.)
| | - Tiziana Di Cesare
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Giulio Cesare Passali
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Riccardo Di Santo
- Dipartimento di Neuroscienze, Sezione di Fisica, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Annunziata Stefanile
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Massimo Fantoni
- Dipartimento di Sicurezza e Bioetica, Sezione di Malattie Infettive, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (E.T.); (M.F.)
| | - Andrea Urbani
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
| | - Gaetano Paludetti
- Dipartimento di Scienze dell’Invecchiamento, Neurologiche, Ortopediche e della Testa e del Collo, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (A.F.); (T.D.C.); (G.C.P.); (G.P.)
| | - Gian Ludovico Rapaccini
- Dipartimento di Scienze Mediche e Chirurgiche, UOC Gastroenterologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.N.); (G.L.R.)
| | - Gabriele Ciasca
- Dipartimento di Neuroscienze, Sezione di Fisica, Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Umberto Basile
- Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.C.); (A.S.); (A.U.)
- Correspondence:
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21
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Immune dyscrasia in adult growth hormone deficiency: Evaluation of hemolytic complement activity (CH50) and IgG subclasses. Biomed Pharmacother 2020; 131:110757. [PMID: 33152922 DOI: 10.1016/j.biopha.2020.110757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/06/2020] [Accepted: 09/11/2020] [Indexed: 11/23/2022] Open
Abstract
CH50 is a screening assay for the activation of the classical complement pathway, the immunoglobulins-mediated one, activated in several inflammatory diseases. Adult growth hormone deficiency (aGHD) is recognized as a chronic inflammatory condition, although poorly evaluated under the profile of inflammatory biomarkers. The aim of this case-control observational study is to analyze CH50 and immunoglobulins G (IgG) subclasses production in aGHD, comparing this condition to healthy controls. 38 subjects were included and divided as follows: aGHD (n = 18, 6 females and 12 males); healthy controls (n = 20, 10 females and 10 males). GHD was diagnosed with dynamic test using Growth Hormone-Releasing Hormone (GHRH 50 μg i.v. + arginine 0,5 g/Kg), with a peak GH response < 9 μg/L when BMI was <30 kg/m2 or < 4 μg/L when BMI was >30 kg/m2. The two groups were evaluated for hormonal and metabolic parameters, CH50 and IgG subtypes. IgG1 and IgG2 were significantly higher in controls than in aGHD, while IgG3 and IgG4 showed a trend to higher levels in controls, although not significant. Furthermore, CH50 levels were significantly higher in aGHD. These data substantiate the hypothesis of a dyscrasia in IgG subclasses production in aGHD. As IgG levels decrease, CH50 levels do not.
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22
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Basile U, Gulli F, Napodano C, Pocino K, Basile V, Marrapodi R, Colantuono S, Todi L, Marino M, Rapaccini GL, Visentini M. Biomarkers of minimal residual disease in rituximab-treated patients with mixed cryoglobulinemia. Biotechnol Appl Biochem 2020; 68:319-329. [PMID: 32333692 DOI: 10.1002/bab.1929] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 04/12/2020] [Indexed: 12/13/2022]
Abstract
Hepatitis C virus (HCV) represents the major risk factor for mixed cryoglobulinemia (MC), a small-vessel vasculitis that may evolve into an overt B-cell non-Hodgkin's lymphoma. Here, we aimed to identify a biomarker signature for the early diagnosis of minimal residual disease (MRD). We assessed free light chains (FLCs), IgM k,and IgM λ heavy/light chain (HLC) pairs, and vascular endothelial growth factor (VEGF) in sera from 34 patients with MC vasculitis (32 HCV- and 2 HBV-related), treated with low-dose rituximab (RTX). FLCs and IgM HLCs were measured by turbidimetric assay; VEGF by an enzyme-linked immunosorbent assay. After RTX, the positive (complete + partial) clinical and laboratory responses were of 85.29% and 50%, respectively; in contrast, the mean levels of FLCs, IgM HLCs, and VEGF were substantially unaffected in most patients and still above the normal range. In those achieving a reduction of FLCs and IgM k and λ chains values within the range of normality, we found that post-treatment free λ chains and IgM k values correlated with clinical and laboratory response. Our results suggest that high levels of FLCs, IgM HLCs, and VEGF could represent the signature of "dormant" B cell clones' activity that could be very useful to identify MRD indicative of possible relapse or worsening outcome.
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Affiliation(s)
- Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Rome, Italy
| | - Francesca Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Cecilia Napodano
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Basile
- Dipartimento di Medicina di Laboratorio, Università di Tor Vergata, Rome, Italy
| | - Ramona Marrapodi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Stefania Colantuono
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Laura Todi
- Istituto di Patologia generale, Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariapaola Marino
- Istituto di Patologia generale, Dipartimento di Medicina e Chirurgia Traslazionale, Fondazione Policlinico Universitario "A. Gemelli" I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gian Ludovico Rapaccini
- Dipartimento di Medicina Interna e Gastroenterologia, Fondazione Policlinico Universitario "A. Gemelli" - I.R.C.C.S, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marcella Visentini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
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23
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Sentinel biomarkers in HCV positive patients with mixed cryoglobulinemia. J Immunol Methods 2020; 476:112687. [DOI: 10.1016/j.jim.2019.112687] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/23/2019] [Accepted: 10/21/2019] [Indexed: 12/20/2022]
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24
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Gulli F, Napodano C, Marino M, Ciasca G, Pocino K, Basile V, Visentini M, Stefanile A, Todi L, De Spirito M, Rapaccini GL, Basile U. Serum immunoglobulin free light chain levels in systemic autoimmune rheumatic diseases. Clin Exp Immunol 2019; 199:163-171. [PMID: 31618438 DOI: 10.1111/cei.13385] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/19/2022] Open
Abstract
Several reports have highlighted the abnormal increments of serum immunoglobulin free light chains (FLCs) in the course of systemic autoimmune rheumatic diseases (SARD), but a comparative analysis among different conditions is still lacking. A strong association between elevated FLC and hepatitis C virus (HCV)-related mixed cryoglobulinaemia (HCVMC) has been well established. Here, we aimed to analyse serum FLC levels in patients with four different SARD in comparison with HCVMC. Using a turbidimetric assay, free κ and λ chains were quantified in sera from 198 SARD patients (37 rheumatoid arthritis, RA; 47 systemic lupus erythematosus, SLE; 52 anti-phospholipid syndrome, APS; 62 primary Sjogren's syndrome, pSS), 62 HCVMC and 50 healthy blood donors (HD). All patient groups showed increased κ levels when compared to HD: 33·5 ± 2·6 mg/l in HCVMC, 26·7 ± 2·3 mg/l in RA, 29·7 ± 1·9 mg/l in SLE, 23·8 ± 1·1 mg/l in APS, 24·2 ± 1·1 mg/l in pSS; 10·1 ± 0·6 mg/l in HD. Free λ levels displayed a significant increase only for HCVMC (20·4 ± 1·4 mg/l) and SLE (18·4 ± 1·0 mg/l) compared to HD (13·6 ± 0·9 mg/l). The increase of κ compared to λ takes into account a κ /λ ratio of 1·6 for all groups. Our results substantially analyse and strengthen the association between FLC and SARD focusing the questions regarding their role in the pathogenesis and diagnosis of human diseases. Unfortunately, the biochemical differences distinguishing normal from pathological FLC have not been identified. Production of different isotypes is probably connected to still-unknown pathways.
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Affiliation(s)
- F Gulli
- Dipartimento di Medicina di Laboratorio, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - C Napodano
- Istituto di Medicina Interna, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Gastroenterologia e Oncologia medica, Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy
| | - M Marino
- Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy
| | - G Ciasca
- Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy.,Istituto di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - K Pocino
- Istituto di Medicina Interna, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Gastroenterologia e Oncologia medica, Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy
| | - V Basile
- Dipartimento di Medicina di Laboratorio, Università di Tor Vergata, Rome, Italy
| | - M Visentini
- Dipartimento di Medicina Traslazionale e di Precisione, Università di Roma La Sapienza, Rome, Italy
| | - A Stefanile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario 'A. Gemelli', IRCCS, Rome, Italy
| | - L Todi
- Istituto di Patologia Generale, Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy
| | - M De Spirito
- Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy.,Istituto di Fisica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - G L Rapaccini
- Istituto di Medicina Interna, Università Cattolica del Sacro Cuore, Rome, Italy.,Area di Gastroenterologia e Oncologia medica, Fondazione Policlinico Universitario 'A. Gemelli' - I.R.C.C.S, Rome, Italy
| | - U Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario 'A. Gemelli', IRCCS, Rome, Italy
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25
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Mancini A, Brunetti A, Bruno C, Vergani E, Pocino K, Napodano C, Gulli F, Santini SA, Basile U. Plasmatic free light chains in polycystic ovary syndrome. Gynecol Endocrinol 2019; 35:710-713. [PMID: 30835572 DOI: 10.1080/09513590.2019.1581759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Polycystic ovary syndrome (PCOS), as systemic disease, is accompanied by different indexes of inflammation. Free light chains of immunoglobulins (FLCs), produced by plasmacells, are released in slight excess for the immune requests, with still poorly defined physiological role but surely they represent a marker of inflammation. In order to evaluate their levels and correlate them with hyperandrogenism, we have studied a group of PCOS patients, age range 18-37 yrs, mean ± SEM body mass index (BMI) 24.1 ± 0.9 kg/m2), compared with age- and BMI-matched controls, with assay of k and λ FLCs, by turbidimetric method, and their ratio in blood plasma. PCOs exhibited higher levels vs. controls: (mean ± SEM λ: 10.0 ± 0.85 mg/L vs. 8.41 ± 0.45 mg/L; k: 12.45 ± 0.72 mg/L vs. 6.41 ± 0.34 mg/L; k/λ: 1.31 ± 0.07 vs. 0.78 ± 0.04). A significant direct correlation was observed between λ-FLCs and testosterone levels, no correlation was indeed found with HOMA-IR index. These data confirm high levels of FLCs in PCOS, suggesting systemic inflammatory state and a possible role in the pathophysiology of such complex syndrome.
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Affiliation(s)
- Antonio Mancini
- a Operative Unit of Endocrinology , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Alessandro Brunetti
- a Operative Unit of Endocrinology , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Carmine Bruno
- a Operative Unit of Endocrinology , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Edoardo Vergani
- a Operative Unit of Endocrinology , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Krizia Pocino
- b Department of Internal Medicine , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Cecilia Napodano
- b Department of Internal Medicine , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | | | - Stefano Angelo Santini
- d Institute of Biochemistry and Clinical Biochemistry , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
| | - Umberto Basile
- e Area di Medicina di Laboratorio , Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore , Rome , Italy
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Grossi V, Gulli F, Infantino M, Stefanile A, Napodano C, Benucci M, Pocino K, Li Gobbi F, Damiani A, Di Pino A, Manfredi M, Marino M, Basile V, Rapaccini GL, Basile U. The Laboratory Role in anti-TNF Biological Therapy Era. Immunol Invest 2019; 49:317-332. [DOI: 10.1080/08820139.2019.1637434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Valentina Grossi
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Francesca Gulli
- Department of Laboratory Medicine, Madre Giuseppina Vannini Hospital, Rome, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Annunziata Stefanile
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Napodano
- Department of Internal Medicine and Gastroenterology - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Maurizio Benucci
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Krizia Pocino
- Department of Internal Medicine and Gastroenterology - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Arianna Damiani
- Rheumatology Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Antonella Di Pino
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory Unit, Azienda USL Toscana Centro, S. Giovanni di Dio Hospital, Florence, Italy
| | - Mariapaola Marino
- Istituto di Patologia Generale - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Valerio Basile
- Department of Experimental Medicine and Surgery, “Tor Vergata” University Hospital, Rome, Italy
| | - Gian Ludovico Rapaccini
- Laboratory Diagnostics Area - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Umberto Basile
- Istituto di Patologia Generale - Fondazione Policlinico Universitario Agostino Gemelli- IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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27
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Lo Sasso B, Agnello L, Bivona G, Bellia C, Ciaccio M. Cerebrospinal Fluid Analysis in Multiple Sclerosis Diagnosis: An Update. ACTA ACUST UNITED AC 2019; 55:medicina55060245. [PMID: 31167509 PMCID: PMC6630948 DOI: 10.3390/medicina55060245] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/10/2019] [Accepted: 05/30/2019] [Indexed: 01/11/2023]
Abstract
Multiple sclerosis (MS) is an immune-mediated demyelinating disease of the central nervous system (CNS) with brain neurodegeneration. MS patients present heterogeneous clinical manifestations in which both genetic and environmental factors are involved. The diagnosis is very complex due to the high heterogeneity of the pathophysiology of the disease. The diagnostic criteria have been modified several times over the years. Basically, they include clinical symptoms, presence of typical lesions detected by magnetic resonance imaging (MRI), and laboratory findings. The analysis of cerebrospinal fluid (CSF) allows an evaluation of inflammatory processes circumscribed to the CNS and reflects changes in the immunological pattern due to the progression of the pathology, being fundamental in the diagnosis and monitoring of MS. The detection of the oligoclonal bands (OCBs) in both CSF and serum is recognized as the “gold standard” for laboratory diagnosis of MS, though presents analytical limitations. Indeed, current protocols for OCBs assay are time-consuming and require an operator-dependent interpretation. In recent years, the quantification of free light chain (FLC) in CSF has emerged to assist clinicians in the diagnosis of MS. This article reviews the current knowledge on CSF biomarkers used in the diagnosis of MS, in particular on the validated assays and on the alternative biomarkers of intrathecal synthesis.
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Affiliation(s)
- Bruna Lo Sasso
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Luisa Agnello
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Giulia Bivona
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Chiara Bellia
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
| | - Marcello Ciaccio
- Institute of Clinical Biochemistry, Clinical Molecular Medicine and Laboratory Medicine, Department of Biomedicine, Neuroscience and Advanced Diagnostics, University of Palermo, 90100 Palermo, Italy.
- Department Laboratory Medicine, University-Hospital, 90100 Palermo, Italy.
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Martellosio JP, Leleu X, Roblot P, Martin M, Puyade M. Dosage des chaînes légères libres : indications et méthodes. Rev Med Interne 2019; 40:297-305. [DOI: 10.1016/j.revmed.2019.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 01/04/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
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Napodano C, Pocino K, Rigante D, Stefanile A, Gulli F, Marino M, Basile V, Rapaccini GL, Basile U. Free light chains and autoimmunity. Autoimmun Rev 2019; 18:484-492. [PMID: 30844547 DOI: 10.1016/j.autrev.2019.03.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The study of free light chains (FLCs) has grown as area of enormous interest for many clinicians with the aim of disclosing the exact biological role and potential use of FLCs in the clinical routine. Moreover, the attention given to immunological functions of FLCs has sparked a new light into their pathogenic contribution in different chronic autoimmune-based inflammatory diseases. The release of intracellular antigens following cell death or ineffective clearance of apoptotic debris, modification of self-antigens, and molecular mimicry may trigger the production of immunoglobulins after activation and polyclonal expansion of B cells, by which FLCs are released. The discovery of polyclonal FLCs as potential biomarkers started with the observation of their increased concentrations in a variety of biological fluids related to patients with autoimmune diseases. This review deals with the use of polyclonal FLCs for identifying severity and monitoring outcome after treatment in some autoimmune diseases, namely systemic lupus erythematosus, myasthenia gravis, systemic sclerosis, rheumatoid arthritis and Sjögren's syndrome, as supported by the fact that levels of FLCs correlate with both B cell activation markers and other specific markers of disease activity. In a near future, following the evidence shown, FLCs might probably work as early prognostic markers of severity and also as indicators of response to treatment or early assessment of relapse in selected autoimmune diseases.
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Affiliation(s)
- Cecilia Napodano
- Area Gastroenterologia e Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Krizia Pocino
- Area Gastroenterologia e Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Donato Rigante
- Institute of Pediatrics, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica Sacro Cuore, Rome, Italy.
| | - Annunziata Stefanile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Gulli
- Clinical Pathology Laboratory, Ospedale Madre Giuseppina Vannini, Rome, Italy
| | - Mariapaola Marino
- Institute of General Pathology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valerio Basile
- Department of Experimental Medicine and Surgery, (")Tor Vergata" University Hospital, Rome, Italy
| | - Gian Ludovico Rapaccini
- Area Gastroenterologia e Oncologia Medica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Umberto Basile
- Area Diagnostica di Laboratorio, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, Lipshultz SE, Liu PP, Matsumori A, Mazzanti A, McMurray J, Priori SG. Dilated cardiomyopathy. Nat Rev Dis Primers 2019; 5:32. [PMID: 31073128 PMCID: PMC7096917 DOI: 10.1038/s41572-019-0084-1] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Dilated cardiomyopathy (DCM) is a clinical diagnosis characterized by left ventricular or biventricular dilation and impaired contraction that is not explained by abnormal loading conditions (for example, hypertension and valvular heart disease) or coronary artery disease. Mutations in several genes can cause DCM, including genes encoding structural components of the sarcomere and desmosome. Nongenetic forms of DCM can result from different aetiologies, including inflammation of the myocardium due to an infection (mostly viral); exposure to drugs, toxins or allergens; and systemic endocrine or autoimmune diseases. The heterogeneous aetiology and clinical presentation of DCM make a correct and timely diagnosis challenging. Echocardiography and other imaging techniques are required to assess ventricular dysfunction and adverse myocardial remodelling, and immunological and histological analyses of an endomyocardial biopsy sample are indicated when inflammation or infection is suspected. As DCM eventually leads to impaired contractility, standard approaches to prevent or treat heart failure are the first-line treatment for patients with DCM. Cardiac resynchronization therapy and implantable cardioverter-defibrillators may be required to prevent life-threatening arrhythmias. In addition, identifying the probable cause of DCM helps tailor specific therapies to improve prognosis. An improved aetiology-driven personalized approach to clinical care will benefit patients with DCM, as will new diagnostic tools, such as serum biomarkers, that enable early diagnosis and treatment.
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Affiliation(s)
- Heinz-Peter Schultheiss
- Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany. .,Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany.
| | - DeLisa Fairweather
- Mayo Clinic, Department of Cardiovascular Medicine, Jacksonville, FL, USA.
| | - Alida L. P. Caforio
- 0000 0004 1757 3470grid.5608.bDivision of Cardiology, Department of Cardiological Thoracic and Vascular Sciences and Public Health, University of Padua, Padova, Italy
| | - Felicitas Escher
- grid.486773.9Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany ,0000 0001 2218 4662grid.6363.0Department of Cardiology, Charité–Universitaetsmedizin Berlin, Berlin, Germany ,0000 0004 5937 5237grid.452396.fDZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - Ray E. Hershberger
- 0000 0001 2285 7943grid.261331.4Divisions of Human Genetics and Cardiovascular Medicine in the Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH USA
| | - Steven E. Lipshultz
- 0000 0004 1936 9887grid.273335.3Department of Pediatrics, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY USA ,0000 0000 9958 7286grid.413993.5Oishei Children’s Hospital, Buffalo, NY USA ,Roswell Park Comprehensive Cancer Center, Buffalo, NY USA
| | - Peter P. Liu
- 0000 0001 2182 2255grid.28046.38University of Ottawa Heart Institute, Ottawa, Ontario Canada
| | - Akira Matsumori
- grid.410835.bClinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Andrea Mazzanti
- 0000 0004 1762 5736grid.8982.bDepartment of Molecular Medicine, University of Pavia, Pavia, Italy ,Department of Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy
| | - John McMurray
- 0000 0001 2193 314Xgrid.8756.cBritish Heart Foundation (BHF) Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Silvia G. Priori
- 0000 0004 1762 5736grid.8982.bDepartment of Molecular Medicine, University of Pavia, Pavia, Italy ,Department of Molecular Cardiology, IRCCS ICS Maugeri, Pavia, Italy
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Nazimek K, Askenase PW, Bryniarski K. Antibody Light Chains Dictate the Specificity of Contact Hypersensitivity Effector Cell Suppression Mediated by Exosomes. Int J Mol Sci 2018; 19:ijms19092656. [PMID: 30205452 PMCID: PMC6163184 DOI: 10.3390/ijms19092656] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 12/21/2022] Open
Abstract
Antibody light chains (LCs), formerly considered a waste product of immunoglobulin synthesis, are currently recognized as important players in the activation of the immune response. However, very little is known about the possible immune regulatory functions of LCs. Recently, we reported that hapten-specific LCs coat miRNA-150-carrying exosomes produced by CD8+ suppressor T cells downregulating the contact hypersensitivity (CHS) reaction in an antigen-specific manner, in mice tolerized by intravenous administration of a high dose of hapten-coupled syngeneic erythrocytes. Thus, the current studies aimed at investigating the role of hapten-specific LCs in antigen-specific, exosome-mediated suppression of CHS effector cells. Suppressor T cell-derived exosomes from tolerized B-cell-deficient µMT-/-, NKT-cell-deficient Jα18-/-, and immunoglobulin-deficient JH-/- mice were nonsuppressive, unless supplemented with LCs of specificity strictly respective to the hapten used for sensitization and CHS elicitation in mice. Thus, these observations demonstrate that B1-cell-derived LCs, coating exosomes in vivo and in vitro, actually ensure the specificity of CHS suppression. Our research findings substantially expand current understanding of the newly discovered, suppressor T cell-dependent tolerance mechanism by uncovering the function of antigen-specific LCs in exosome-mediated, cell⁻cell communication. This express great translational potential in designing nanocarriers for specific targeting of desired cells.
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Affiliation(s)
- Katarzyna Nazimek
- Department of Immunology, Jagiellonian University Medical College, 31-121 Krakow, Poland.
- Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT 06520, USA.
| | - Philip W Askenase
- Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT 06520, USA.
| | - Krzysztof Bryniarski
- Department of Immunology, Jagiellonian University Medical College, 31-121 Krakow, Poland.
- Section of Rheumatology, Allergy and Clinical Immunology, Yale University School of Medicine, New Haven, CT 06520, USA.
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32
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Basile U, Bruno C, Napodano C, Vergani E, Pocino K, Brunetti A, Gulli F, Santini SA, Mancini A. Plasmatic free light chains as inflammatory marker in insulin resistance: comparison of metabolic syndrome with adult growth hormone deficiency. Biofactors 2018; 44:480-484. [PMID: 30175865 DOI: 10.1002/biof.1444] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022]
Abstract
Biological functions of immunoglobulin-free light chains (FLCs), other than in chronic inflammatory diseases, are still poorly defined; the field of insulin resistance (IR) has not been investigated, despite the strict relationships with oxidative stress (OS) and inflammation. Therefore, we evaluated FLCs levels and their relationships with metabolic parameters in adult growth hormone deficiency (GHD) and metabolic syndrome (MetS), both characterized by IR. One hundred subjects were enrolled: group A, patients with GHD [n =31, 24-69 years, mean ± SEM body mass index (BMI) 26.8 ± 1.5 kg/m2 ]; group B, patients with MetS (n = 29, 21-70 years, BMI 31.9 ± 1.3); group C, controls (N = 40, 21-62 years, BMI 21.6 ± 1.1). Groups were matched by age range and, for patients, by BMI. Morning blood sample was collected for metabolic parameters and FLCs, assessed by turbidimetric assay. GHD patients show levels of FLCs significantly higher than MetS and controls (mean ± SEM κ 37.21 ± 6.97, 15.27 ± 0.86, 12.34 ± 0.85 mg/l; λ 19.44 ± 2.61, 11.78 ± 0.72 and 11.67 ± 0.77 mg/l; κ/λ ratio 1.77 ± 0.13, 1.38 ± 0.09; and 1.10 ± 0.06, respectively); only κ were higher in MetS versus controls. Therefore, the ratio showed progressive declining values in GHD versus MetS versus controls. Our data show increased FLCs levels in GHD and MetS, with the highest values in the former. Both conditions show OS, but with different molecular patterns. FLCs may contribute to chronic inflammation, leading to OS, and cardiovascular complications of GHD. Prognostic and therapeutic implications require further investigation. © 2018 BioFactors, 44(5):480-484, 2018.
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Affiliation(s)
- Umberto Basile
- Department of Laboratory Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Carmine Bruno
- Operative Unit of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Cecilia Napodano
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Edoardo Vergani
- Operative Unit of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Krizia Pocino
- Department of Internal Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Brunetti
- Operative Unit of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Stefano Angelo Santini
- Institute of Biochemistry and Clinical Biochemistry, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
| | - Antonio Mancini
- Operative Unit of Endocrinology, Fondazione Policlinico Universitario A. Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome, Italy
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33
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Laputková G, Schwartzová V, Bánovčin J, Alexovič M, Sabo J. Salivary Protein Roles in Oral Health and as Predictors of Caries Risk. Open Life Sci 2018; 13:174-200. [PMID: 33817083 PMCID: PMC7874700 DOI: 10.1515/biol-2018-0023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 02/13/2018] [Indexed: 12/13/2022] Open
Abstract
This work describes the current state of research on the potential relationship between protein content in human saliva and dental caries, which remains among the most common oral diseases and causes irreversible damage in the oral cavity. An understanding the whole saliva proteome in the oral cavity could serve as a prerequisite to obtaining insight into the etiology of tooth decay at early stages. To date, however, there is no comprehensive evidence showing that salivary proteins could serve as potential indicators for the early diagnosis of the risk factors causing dental caries. Therefore, proteomics indicates the promising direction of future investigations of such factors, including diagnosis and thus prevention in dental therapy.
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Affiliation(s)
- Galina Laputková
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P. J. Šafárik in Košice, Trieda SNP 1, Košice, 040 11, Slovakia
| | - Vladimíra Schwartzová
- 1st Department of Stomatology, Faculty of Medicine, University of P. J. Šafárik in Košice, Trieda SNP 1, Košice, 040 11, Slovakia
| | - Juraj Bánovčin
- Department of Stomatology and Maxillofacial Surgery, Faculty of Medicine, University of P. J. Šafárik in Košice, Rastislavova 43, Košice, 041 90, Slovakia
| | - Michal Alexovič
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P. J. Šafárik in Košice, Trieda SNP 1, Košice, 040 11, Slovakia
| | - Ján Sabo
- Department of Medical and Clinical Biophysics, Faculty of Medicine, University of P. J. Šafárik in Košice, Trieda SNP 1, Košice, 040 11, Slovakia
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