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Marazuela M, Martínez-Hernandez R, Marques-Pamies M, Biagetti B, Araujo-Castro M, Puig-Domingo M. Predictors of biochemical response to somatostatin receptor ligands in acromegaly. Best Pract Res Clin Endocrinol Metab 2024:101893. [PMID: 38575404 DOI: 10.1016/j.beem.2024.101893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Although predictors of response to first-generation somatostatin receptor ligands (fg-SRLs), and to a lesser extent to pasireotide, have been studied in acromegaly for many years, their use is still not recommended in clinical guidelines. Is there insufficient evidence to use them? Numerous biomarkers including various clinical, functional, radiological and molecular markers have been identified. The first ones are applicable pre-surgery, while the molecular predictors are utilized for patients not cured after surgery. In this regard, factors predicting a good response to fg-SRLs are specifically: low basal GH, a low GH nadir in the acute octreotide test, T2 MRI hypointensity, a densely granulated pattern, high immunohistochemistry staining for somatostatin receptor 2 (SSTR2), and E-cadherin. However, there is still a lack of consensus regarding which of these biomarkers is more useful or how to integrate them into clinical practice. With classical statistical methods, it is complex to define reliable and generalizable cut-off values for a single biomarker. The potential solution to the limitations of traditional methods involves combining systems biology with artificial intelligence, which is currently providing answers to such long-standing questions that may eventually be finally included into the clinical guidelines and make personalized medicine a reality. The aim of this review is to describe the current knowledge of the main fg-SRLs and pasireotide response predictors, discuss their current usefulness, and point to future directions in the research of this field.
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Affiliation(s)
- Mónica Marazuela
- Department of Endocrinology and Nutrition Hospital Universitario La Princesa, Universidad Autónoma de Madrid,Instituto de Investigación Princesa, and Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER GCV14/ER/12), Madrid, Spain.
| | | | | | - Betina Biagetti
- Endocrinology & Nutrition Service, Vall d'Hebron University Hospital and Vall d'Hebron Research Institute (VHIR), Department of Medicine, Autonomous University of Barcelona, Reference Networks (ERN), 08035 Barcelona, Spain
| | - Marta Araujo-Castro
- Endocrinology & Nutrition Department. Hospital Universitario Ramón y Cajal, Spain & Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain
| | - Manel Puig-Domingo
- Department of Endocrinology and Nutrition, Department of Medicine, Germans Trias i Pujol Research Institute and Hospital, Universitat Autònoma de Barcelona, Spain and Centro de Investigación Biomédica en Red de Enfermedades Raras CIBERER G747, Badalona, Spain
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2
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Treppiedi D, Marra G, Di Muro G, Esposito E, Barbieri AM, Catalano R, Mangili F, Bravi F, Locatelli M, Lania AG, Ferrante E, Indirli R, Nozza E, Arlati F, Spada A, Arosio M, Mantovani G, Peverelli E. P720R USP8 Mutation Is Associated with a Better Responsiveness to Pasireotide in ACTH-Secreting PitNETs. Cancers (Basel) 2022; 14:cancers14102455. [PMID: 35626057 PMCID: PMC9139692 DOI: 10.3390/cancers14102455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 02/04/2023] Open
Abstract
Somatic mutations in the ubiquitin specific peptidase 8 (USP8) gene have been associated with higher levels of somatostatin (SS) receptor subtype 5 (SSTR5) in adrenocorticotroph hormone (ACTH)-secreting pituitary neuroendocrine tumors (PitNETs). However, a correlation between the USP8 mutational status and favourable responses to pasireotide, the somatostatin multi-receptor ligand acting especially on SSTR5, has not been investigated yet. Here, we studied the impact of USP8 mutations on pasireotide responsiveness in human and murine corticotroph tumor cells. SSTR5 upregulation was observed in USP8 wild-type primary tumor cells transfected with S718del USP8 mutant. However, cell transfection with S718del USP8 and C40-USP8 mutants in in vitro sensitive cultures from USP8 wild-type tumors abolished their ability to respond to pasireotide and did not confer pasireotide responsiveness to the in vitro resistant culture. Pasireotide failed to reduce ACTH secretion in primary cells from one S718P USP8-mutated tumor but exerted a strong antisecretory effect in primary cells from one P720R USP8-mutated tumor. In agreement, AtT-20 cells transfection with USP8 mutants led to SSTR5 expression increase but pasireotide could reduce ACTH production and cyclin E expression in P720R USP8 overexpressing cells, only. In situ Proximity Ligation Assay and immunoflurescence experiments revealed that P720R USP8 mutant is still able to bind 14-3-3 proteins in AtT-20 cells, without affecting SSTR5 localization. In conclusion, P720R USP8 mutation might be considered as a molecular predictor of favourable response to pasireotide in corticotroph tumor cells.
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Affiliation(s)
- Donatella Treppiedi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Giusy Marra
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Genesio Di Muro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- PhD Program in Endocrinological Sciences, University Sapienza of Rome, 00185 Rome, Italy
| | - Emanuela Esposito
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- PhD Program in Experimental Medicine, University of Milan, 20054 Milan, Italy
| | - Anna Maria Barbieri
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Rosa Catalano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Federica Mangili
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Francesca Bravi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Marco Locatelli
- Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
| | - Andrea Gerardo Lania
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, 20089 Rozzano, Italy;
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Rita Indirli
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Emma Nozza
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Federico Arlati
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Correspondence: ; Tel.: +39-02-55033512
| | - Erika Peverelli
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (G.M.); (G.D.M.); (E.E.); (A.M.B.); (R.C.); (F.M.); (F.B.); (R.I.); (E.N.); (F.A.); (A.S.); (M.A.); (E.P.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
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Peverelli E, Treppiedi D, Mantovani G. Molecular mechanisms involved in somatostatin receptor regulation in corticotroph tumors: the role of cytoskeleton and USP8 mutations. ENDOCRINE ONCOLOGY (BRISTOL, ENGLAND) 2022; 2:R24-R30. [PMID: 37435448 PMCID: PMC10259348 DOI: 10.1530/eo-22-0042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/23/2022] [Indexed: 07/13/2023]
Abstract
Adrenocorticotropic hormone (ACTH)-secreting pituitary tumors mainly express somatostatin receptor 5 (SSTR5) since SSTR2 is downregulated by the elevated levels of glucocorticoids that characterize patients with Cushing's disease (CD). SSTR5 is the molecular target of pasireotide, the only approved pituitary tumor-targeted drug for the treatment of CD. However, the molecular mechanisms that regulate SSTR5 are still poorly investigated. This review summarizes the experimental evidence supporting the role of the cytoskeleton actin-binding protein filamin A (FLNA) in the regulation of SSTR5 expression and signal transduction in corticotroph tumors. Moreover, the correlations between the presence of somatic USP8 mutations and the expression of SSTR5 will be reviewed. An involvement of glucocorticoid-mediated β-arrestins modulation in regulating SSTRs expression and function in ACTH-secreting tumors will also be discussed.
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Affiliation(s)
- Erika Peverelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Donatella Treppiedi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy
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4
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Treppiedi D, Marra G, Di Muro G, Catalano R, Mangili F, Esposito E, Calebiro D, Arosio M, Peverelli E, Mantovani G. Dimerization of GPCRs: Novel insight into the role of FLNA and SSAs regulating SST 2 and SST 5 homo- and hetero-dimer formation. Front Endocrinol (Lausanne) 2022; 13:892668. [PMID: 35992099 PMCID: PMC9389162 DOI: 10.3389/fendo.2022.892668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
The process of GPCR dimerization can have profound effects on GPCR activation, signaling, and intracellular trafficking. Somatostatin receptors (SSTs) are class A GPCRs abundantly expressed in pituitary tumors where they represent the main pharmacological targets of somatostatin analogs (SSAs), thanks to their antisecretory and antiproliferative actions. The cytoskeletal protein filamin A (FLNA) directly interacts with both somatostatin receptor type 2 (SST2) and 5 (SST5) and regulates their expression and signaling in pituitary tumoral cells. So far, the existence and physiological relevance of SSTs homo- and hetero-dimerization in the pituitary have not been explored. Moreover, whether octreotide or pasireotide may play modulatory effects and whether FLNA may participate to this level of receptor organization have remained elusive. Here, we used a proximity ligation assay (PLA)-based approach for the in situ visualization and quantification of SST2/SST5 dimerization in rat GH3 as well as in human melanoma cells either expressing (A7) or lacking (M2) FLNA. First, we observed the formation of endogenous SST5 homo-dimers in GH3, A7, and M2 cells. Using the PLA approach combined with epitope tagging, we detected homo-dimers of human SST2 in GH3, A7, and M2 cells transiently co-expressing HA- and SNAP-tagged SST2. SST2 and SST5 can also form endogenous hetero-dimers in these cells. Interestingly, FLNA absence reduced the basal number of hetero-dimers (-36.8 ± 6.3% reduction of PLA events in M2, P < 0.05 vs. A7), and octreotide but not pasireotide promoted hetero-dimerization in both A7 and M2 (+20.0 ± 11.8% and +44.1 ± 16.3% increase of PLA events in A7 and M2, respectively, P < 0.05 vs. basal). Finally, immunofluorescence data showed that SST2 and SST5 recruitment at the plasma membrane and internalization are similarly induced by octreotide and pasireotide in GH3 and A7 cells. On the contrary, in M2 cells, octreotide failed to internalize both receptors whereas pasireotide promoted robust receptor internalization at shorter times than in A7 cells. In conclusion, we demonstrated that in GH3 cells SST2 and SST5 can form both homo- and hetero-dimers and that FLNA plays a role in the formation of SST2/SST5 hetero-dimers. Moreover, we showed that FLNA regulates SST2 and SST5 intracellular trafficking induced by octreotide and pasireotide.
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Affiliation(s)
- Donatella Treppiedi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giusy Marra
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Genesio Di Muro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- University Sapienza of Rome, Rome, Italy
| | - Rosa Catalano
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Federica Mangili
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuela Esposito
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Davide Calebiro
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, United Kingdom
- Centre of Membrane Proteins and Receptors, Universities of Birmingham and Nottingham, Birmingham, United Kingdom
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Erika Peverelli
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- *Correspondence: Erika Peverelli,
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Endocrinology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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5
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Treppiedi D, Barbieri AM, Di Muro G, Marra G, Mangili F, Catalano R, Esposito E, Ferrante E, Serban AL, Locatelli M, Lania AG, Spada A, Arosio M, Peverelli E, Mantovani G. Genetic Profiling of a Cohort of Italian Patients with ACTH-Secreting Pituitary Tumors and Characterization of a Novel USP8 Gene Variant. Cancers (Basel) 2021; 13:cancers13164022. [PMID: 34439178 PMCID: PMC8392476 DOI: 10.3390/cancers13164022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/17/2021] [Accepted: 08/07/2021] [Indexed: 12/18/2022] Open
Abstract
Simple Summary Cushing’s Disease (CD) is a rare but severe endocrine disorder due to an adrenocorticotropic hormone (ACTH)-secreting pituitary tumor, and pathogenetics remained a puzzling issue for a long time. The recent identification of somatic mutations in the 14-3-3 protein binding motif of ubiquitin specific peptidase 8 gene (USP8), present in a consistent subgroup of ACTH-secreting pituitary tumors, have represented a major advance in the understanding of CD pathogenesis. In our cohort of 60 patients we found an incidence of 11.7% of USP8 recurrent somatic mutations whereas a novel USP8 variant (G664R) located upstream the canonical USP8 mutational hotspot was identified in one case. This alteration has never been reported by previous records. The present study provides USP8 G664R variant in vitro functional characterization in AtT-20 cells and demonstrates its possible implication in ACTH-secreting tumor pathogenesis, contributing to enlarge the genetic landscape of CD. Abstract Cushing’s Disease (CD) is a rare condition characterized by an overproduction of ACTH by an ACTH-secreting pituitary tumor, resulting in an excess of cortisol release by the adrenal glands. Somatic mutations in the deubiquitinases USP8 and USP48, and in BRAF genes, have been reported in a subset of patients affected by CD. The aim of this study was to characterize the genetic profile of a cohort of 60 patients with ACTH-secreting tumors, searching for somatic mutations in USP8, USP48, and BRAF hotspot regions. Seven patients were found to carry USP8 somatic mutations in the well-characterized 14-3-3 protein binding motif (n = 5 P720R, n = 1 P720Q, n = 1 S718del); 2 patients were mutated in USP48 (M415I); no mutation was identified in BRAF. In addition, a novel USP8 variant, G664R, located in exon 14, upstream of the 14-3-3 protein binding motif, was identified in 1 patient. Functional characterization of USP8 G664R variant was performed in murine corticotroph tumor AtT-20 cells. Transient transfection with the USP8 G664R variant resulted in a significant increase of ACTH release and cell proliferation (+114.5 ± 53.6% and +28.3 ± 2.6% vs. empty vector transfected cells, p < 0.05, respectively). Notably, USP8 proteolytic cleavage was enhanced in AtT-20 cells transfected with G664R USP8 (1.86 ± 0.58–fold increase of N-terminal USP8 fragment, vs. WT USP8, p < 0.05). Surprisingly, in situ Proximity Ligation Assay (PLA) experiments showed a significant reduction of PLA positive spots, indicating USP8/14-3-3 proteins colocalization, in G664R USP8 transfected cells with respect to WT USP8 transfected cells (−47.9 ± 6.6%, vs. WT USP8, p < 0.001). No significant difference in terms of ACTH secretion, cell proliferation and USP8 proteolytic cleavage, and 14-3-3 proteins interaction was observed between G664R USP8 and S718del USP8 transfected cells. Immunofluorescence experiments showed that, contrary to S718del USP8 but similarly to WT USP8 and other USP8 mutants, G664R USP8 displays an exclusive cytoplasmic localization. In conclusion, somatic mutations were found in USP8 (13.3% vs. 36.5% incidence of all published mutations) and USP48 (3.3% vs. 13.3% incidence) hotspot regions. A novel USP8 variant was identified in a CD patient, and in vitro functional studies in AtT-20 cells suggested that this somatic variant might be clinically relevant in ACTH-secreting tumor pathogenesis, expanding the characterization of USP8 functional domains.
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Affiliation(s)
- Donatella Treppiedi
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Anna Maria Barbieri
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Genesio Di Muro
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Giusy Marra
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Federica Mangili
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Rosa Catalano
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Emanuela Esposito
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Emanuele Ferrante
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.F.); (A.L.S.)
| | - Andreea Liliana Serban
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.F.); (A.L.S.)
| | - Marco Locatelli
- Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy;
- Neurosurgery Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Andrea Gerardo Lania
- Endocrinology, Diabetology and Medical Andrology Unit, Humanitas Clinical and Research Center, IRCCS, 20089 Rozzano, Italy;
- Department of Biomedical Sciences, Humanitas University, 20089 Rozzano, Italy
| | - Anna Spada
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
| | - Maura Arosio
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.F.); (A.L.S.)
| | - Erika Peverelli
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
- Correspondence: ; Tel.: +39-02-55033512
| | - Giovanna Mantovani
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy; (D.T.); (A.M.B.); (G.D.M.); (G.M.); (F.M.); (R.C.); (E.E.); (A.S.); (M.A.); (G.M.)
- Endocrinology Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (E.F.); (A.L.S.)
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