1
|
Geroldi A, Ponti C, Mammi A, Patrone S, Gotta F, Trevisan L, Sanguineri F, Origone P, Gaudio A, La Barbera A, Cataldi M, Gemelli C, Massucco S, Schenone A, Lanteri P, Fiorillo C, Grandis M, Mandich P, Bellone E. Early Onset Inherited Peripheral Neuropathies: The Experience of a Specialized Referral Center for Genetic Diagnosis Achievement. Pediatr Neurol 2024; 154:4-8. [PMID: 38428336 DOI: 10.1016/j.pediatrneurol.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 01/26/2024] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Charcot-Marie-Tooth disease (CMT) is a heterogeneous group of inherited peripheral neuropathies. Although the typical disease onset is reported in the second decade, earlier onsets are not uncommon. To date, few studies on pediatric populations have been conducted and the achievement of molecular diagnosis remains challenging. METHODS During the last 24 years we recruited 223 patients with early-onset hereditary peripheral neuropathies (EOHPN), negative for PMP22 duplication, 72 of them referred by a specialized pediatric hospital. Genetic testing for CMT-associated genes has been carried out with a range of different techniques. RESULTS Of the 223 EOHPN cases, 43% were classified as CMT1 (demyelinating), 49% as CMT2 (axonal), and 8% as CMTi (intermediate). Genetic diagnosis was reached in 51% of patients, but the diagnostic yield increased to 67% when focusing only on cases from the specialized pediatric neuromuscular centers. Excluding PMP22 rearrangements, no significant difference in diagnostic rate between demyelinating and axonal forms was identified. De novo mutations account for 38% of cases. CONCLUSIONS This study describes an exhaustive picture of EOHPN in an Italian referral genetic center and analyzes the molecular diagnostic rate of a heterogeneous cohort compared with one referred by a specialized pediatric center. Our data identify MPZ, MFN2, GDAP1, and SH3TC2 genes as the most frequent players in EOHPN. Our study underlines the relevance of a specific neurological pediatric expertise to address the genetic testing and highlights its importance to clarify possible unexpected results when neuropathy is only a secondary clinical sign of a more complex phenotype.
Collapse
Affiliation(s)
- Alessandro Geroldi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy.
| | - Clarissa Ponti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Alessia Mammi
- IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Serena Patrone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Fabio Gotta
- IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Lucia Trevisan
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Francesca Sanguineri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Paola Origone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Andrea Gaudio
- IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Andrea La Barbera
- IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Matteo Cataldi
- Pediatric Neuropsychiatric Unit, IRCCS Institute "G. Gaslini", Genoa, Italy
| | - Chiara Gemelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Clinica Neurologica, Genoa, Italy
| | - Sara Massucco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Clinica Neurologica, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Clinica Neurologica, Genoa, Italy
| | - Paola Lanteri
- Pediatric Neuropsychiatric Unit, IRCCS Institute "G. Gaslini", Genoa, Italy
| | - Chiara Fiorillo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; Unit of Paediatric Neurology and Neuromuscular Disorders, IRCCS Institute "G. Gaslini", Genoa, Italy
| | - Marina Grandis
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Clinica Neurologica, Genoa, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| | - Emilia Bellone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy; IRCCS Ospedale Policlinico San Martino, UOC Genetica Medica, Genoa, Italy
| |
Collapse
|
2
|
Trevisan L, Gaudio A, Monfrini E, Avanzino L, Di Fonzo A, Mandich P. Genetics in Parkinson's disease, state-of-the-art and future perspectives. Br Med Bull 2024; 149:60-71. [PMID: 38282031 PMCID: PMC10938543 DOI: 10.1093/bmb/ldad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/30/2023] [Accepted: 12/12/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder and is clinically characterized by the presence of motor (bradykinesia, rigidity, rest tremor and postural instability) and non-motor symptoms (cognitive impairment, autonomic dysfunction, sleep disorders, depression and hyposmia). The aetiology of PD is unknown except for a small but significant contribution of monogenic forms. SOURCES OF DATA No new data were generated or analyzed in support of this review. AREAS OF AGREEMENT Up to 15% of PD patients carry pathogenic variants in PD-associated genes. Some of these genes are associated with mendelian inheritance, while others act as risk factors. Genetic background influences age of onset, disease course, prognosis and therapeutic response. AREAS OF CONTROVERSY Genetic testing is not routinely offered in the clinical setting, but it may have relevant implications, especially in terms of prognosis, response to therapies and inclusion in clinical trials. Widely adopted clinical guidelines on genetic testing are still lacking and open to debate. Some new genetic associations are still awaiting confirmation, and selecting the appropriate genes to be included in diagnostic panels represents a difficult task. Finally, it is still under study whether (and to which degree) specific genetic forms may influence the outcome of PD therapies. GROWING POINTS Polygenic Risk Scores (PRS) may represent a useful tool to genetically stratify the population in terms of disease risk, prognosis and therapeutic outcomes. AREAS TIMELY FOR DEVELOPING RESEARCH The application of PRS and integrated multi-omics in PD promises to improve the personalized care of patients.
Collapse
Affiliation(s)
- L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, Genova, 16132, Italy
- IRCCS Ospedale Policlinico San Martino – SS Centro Tumori Ereditari, Largo R. Benzi 10, Genova, 16132, Italy
| | - A Gaudio
- IRCCS Ospedale Policlinico San Martino- UOC Genetica Medica, Largo R. Benzi 10, Genova, 16132, Italy
| | - E Monfrini
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milan, 20122, Italy
- Neurology Unit, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via Festa del Perdono 7, Milan, 20122, Italy
| | - L Avanzino
- Department of Experimental Medicine, Section of Human Physiology, University of Genoa, Viale Benedetto XV/3, Genova, 16132, Italy
- IRCCS Ospedale Policlinico San Martino, Largo Rosanna Benzi 3, Genova, 16132, Italy
| | - A Di Fonzo
- Dino Ferrari Center, Neuroscience Section, Department of Pathophysiology and Transplantation, University of Milan, Via Francesco Sforza 35, Milan, 20122, Italy
- Neurology Unit, Foundation IRCCS Ca’Granda Ospedale Maggiore Policlinico, Via Festa del Perdono 7, Milan, 20122, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, Genova, 16132, Italy
- IRCCS Ospedale Policlinico San Martino- UOC Genetica Medica, Largo R. Benzi 10, Genova, 16132, Italy
| |
Collapse
|
3
|
Di Fonzo A, Percetti M, Monfrini E, Palmieri I, Albanese A, Avenali M, Bartoletti-Stella A, Blandini F, Brescia G, Calandra-Buonaura G, Campopiano R, Capellari S, Colangelo I, Comi GP, Cuconato G, Ferese R, Galandra C, Gambardella S, Garavaglia B, Gaudio A, Giardina E, Invernizzi F, Mandich P, Mineri R, Panteghini C, Reale C, Trevisan L, Zampatti S, Cortelli P, Valente EM. Harmonizing Genetic Testing for Parkinson's Disease: Results of the PARKNET Multicentric Study. Mov Disord 2023; 38:2241-2248. [PMID: 37750340 DOI: 10.1002/mds.29617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 08/30/2023] [Accepted: 09/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Early-onset Parkinson's disease (EOPD) commonly recognizes a genetic basis; thus, patients with EOPD are often addressed to diagnostic testing based on next-generation sequencing (NGS) of PD-associated multigene panels. However, NGS interpretation can be challenging in a diagnostic setting, and few studies have addressed this issue so far. METHODS We retrospectively collected data from 648 patients with PD with age at onset younger than 55 years who underwent NGS of a minimal shared panel of 15 PD-related genes, as well as PD-multiplex ligation-dependent probe amplification in eight Italian diagnostic laboratories. Data included a minimal clinical dataset, the complete list of variants included in the diagnostic report, and final interpretation (positive/negative/inconclusive). Patients were further stratified based on age at onset ≤40 years (very EOPD, n = 157). All variants were reclassified according to the latest American College of Medical Genetics and Genomics criteria. For classification purposes, PD-associated GBA1 variants were considered diagnostic. RESULTS In 186 of 648 (29%) patients, the diagnostic report listed at least one variant, and the outcome was considered diagnostic (positive) in 105 (16%). After reanalysis, diagnosis changed in 18 of 186 (10%) patients, with 5 shifting from inconclusive to positive and 13 former positive being reclassified as inconclusive. A definite diagnosis was eventually reached in 97 (15%) patients, of whom the majority carried GBA1 variants or, less frequently, biallelic PRKN variants. In 89 (14%) cases, the genetic report was inconclusive. CONCLUSIONS This study attempts to harmonize reporting of PD genetic testing across several diagnostic labs and highlights current difficulties in interpreting genetic variants emerging from NGS-multigene panels, with relevant implications for counseling. © 2023 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
Collapse
Affiliation(s)
- Alessio Di Fonzo
- Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Marco Percetti
- Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
- School of Medicine and Surgery, Milan Center for Neuroscience, University of Milan-Bicocca, Milan, Italy
- Foundation IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Edoardo Monfrini
- Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | | | | | - Micol Avenali
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavior Sciences, University of Pavia, Pavia, Italy
| | - Anna Bartoletti-Stella
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
- DIMEC, University of Bologna, Bologna, Italy
| | - Fabio Blandini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Gloria Brescia
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Sabina Capellari
- DIMEC, University of Bologna, Bologna, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Isabel Colangelo
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Giacomo Pietro Comi
- Neuroscience Section, Department of Pathophysiology and Transplantation, Dino Ferrari Center, University of Milan, Milan, Italy
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Neurology Unit, Milan, Italy
| | - Giada Cuconato
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | | | - Caterina Galandra
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| | - Stefano Gambardella
- Department of Biomolecular Sciences, University of Urbino "Carlo Bo", Urbino, Italy
| | - Barbara Garavaglia
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Andrea Gaudio
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emiliano Giardina
- Genomic Medicine Laboratory-UILDM, Santa Lucia Foundation IRCCS, Rome, Italy
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
| | - Federica Invernizzi
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Paola Mandich
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- DINOGMI, University of Genoa, Genoa, Italy
| | | | - Celeste Panteghini
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | - Chiara Reale
- Medical Genetics and Neurogenetics Unit, Fondazione IRCCS Istituto Neurologico C. Besta, Milan, Italy
| | | | - Stefania Zampatti
- Genomic Medicine Laboratory-UILDM, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Pietro Cortelli
- DIMEC, University of Bologna, Bologna, Italy
- DIBINEM, University of Bologna, Bologna, Italy
| | - Enza Maria Valente
- IRCCS Mondino Foundation, Pavia, Italy
- Department of Molecular Medicine, University of Pavia, Pavia, Italy
| |
Collapse
|
4
|
Geroldi A, Tozza S, Fiorillo C, Nolano M, Fossa P, Vitale F, Domi R, Gaudio A, Mammi A, Patrone S, Barbera AL, Origone P, Ponti C, Sanguineri F, Zara F, Cataldi M, Salpietro V, Venturi CB, Massucco S, Schenone A, Manganelli F, Mandich P, Bellone E, Gotta F. A novel de novo variant in POLR3B gene associated with a primary axonal involvement of the largest nerve fibers. J Peripher Nerv Syst 2023; 28:620-628. [PMID: 37897416 DOI: 10.1111/jns.12602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/24/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND AND AIMS POLR3B gene encodes a subunit of RNA polymerase III (Pol III). Biallelic mutations in POLR3B are associated with leukodystrophies, but recently de novo heterozygous mutations have been described in early onset peripheral demyelinating neuropathies with or without central involvement. Here, we report the first Italian case carrying a de novo variant in POLR3B with a pure neuropathy phenotype and primary axonal involvement of the largest nerve fibers. METHODS Nerve conduction studies, sympathetic skin response, dynamic sweat test, tactile and thermal quantitative sensory testing and brain magnetic resonance imaging were performed according to standard procedures. Histopathological examination was performed on skin and sural nerve biopsies. Molecular analysis of the proband and his relatives was performed with Next Generation Sequencing. The impact of the identified variant on the overall protein structure was evaluated through rotamers method. RESULTS Since his early adolescence, the patient presented with signs of polyneuropathy with severe distal weakness, atrophy, and reduced sensation. Neurophysiological studies showed a sensory-motor axonal polyneuropathy, with confirmed small fiber involvement. In addition, skin biopsy and sural nerve biopsy showed predominant large fibers involvement. A trio's whole exome sequencing revealed a novel de novo variant p.(Arg1046Cys) in POLR3B, which was classified as Probably Pathogenic. Molecular modeling data confirmed a deleterious effect of the variant on protein structure. INTERPRETATION Neurophysiological and morphological findings suggest a primary axonal involvement of the largest nerve fibers in POLR3B-related neuropathies. A partial loss of function mechanism is proposed for both neuropathy and leukodystrophy phenotypes.
Collapse
Affiliation(s)
- Alessandro Geroldi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Stefano Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Chiara Fiorillo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- Child Neuropsychiatric Unit, IRCCS Institute G. Gaslini, Genoa, Italy
| | - Maria Nolano
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Fossa
- Department of Pharmacy, University of Genoa, Genoa, Italy
| | - Floriana Vitale
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Regi Domi
- Department of Pharmacy, University of Genoa, Genoa, Italy
| | - Andrea Gaudio
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Alessia Mammi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Serena Patrone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
| | - Andrea La Barbera
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Paola Origone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Clarissa Ponti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesca Sanguineri
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Federico Zara
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- Medical Genetic Unit, IRCCS Institute G. Gaslini, Genoa, Italy
| | - Matteo Cataldi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- Child Neuropsychiatric Unit, IRCCS Institute G. Gaslini, Genoa, Italy
| | - Vincenzo Salpietro
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- Medical Genetic Unit, IRCCS Institute G. Gaslini, Genoa, Italy
| | | | - Sara Massucco
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Angelo Schenone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Neurology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples Federico II, Naples, Italy
| | - Paola Mandich
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Emilia Bellone
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal and Infantile Sciences, University of Genoa, Genoa, Italy
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fabio Gotta
- OU Medical Genetics, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| |
Collapse
|
5
|
Gaudio A, Gotta F, Ponti C, Sanguineri F, Trevisan L, Geroldi A, Patrone S, Gemelli C, Cabona C, Astrea G, Fiorillo C, Gustincich S, Grandis M, Mandich P. Case report: Episodic ataxia without ataxia? Front Neurol 2023; 14:1224241. [PMID: 37965175 PMCID: PMC10640972 DOI: 10.3389/fneur.2023.1224241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/03/2023] [Indexed: 11/16/2023] Open
Abstract
Hereditary myopathies represent a clinically and genetically heterogeneous group of neuromuscular disorders, characterized by highly variable clinical presentations and frequently overlapping phenotypes with other neuromuscular disorders, likely influenced by genetic and environmental modifiers. Genetic testing is often challenging due to ambiguous clinical diagnosis. Here, we present the case of a family with clinical and Electromyography (EMG) features resembling a myotonia-like disorder in which Whole Exome Sequencing (WES) analysis revealed the co-segregation of two rare missense variants in UBR4 and HSPG2, genes previously associated with episodic ataxia 8 (EA8). A review of the literature highlighted a striking overlap between the clinical and the molecular features of our family and the previously described episodic ataxias (EAs), which raises concerns about the genotype-phenotype correlation, clinical variability, and the confounding overlap in these groups of disorders. This emphasizes the importance of thoroughly framing the patient's phenotype. The more clear-cut the diagnosis, the easier the identification of a genetic determinant, and the better the prognosis and the treatment of patients.
Collapse
Affiliation(s)
- Andrea Gaudio
- IRCCS Ospedale Policlinico San Martino—UOC Genetica Medica, Genova, Italy
| | - Fabio Gotta
- IRCCS Ospedale Policlinico San Martino—UOC Genetica Medica, Genova, Italy
| | - Clarissa Ponti
- IRCCS Ospedale Policlinico San Martino—UOC Genetica Medica, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
| | - Francesca Sanguineri
- IRCCS Ospedale Policlinico San Martino—UOC Genetica Medica, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
| | - Lucia Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Ospedale Policlinico San Martino—SS Centro Tumori Ereditari, Genova, Italy
| | - Alessandro Geroldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
| | - Serena Patrone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
| | - Chiara Gemelli
- IRCCS-Ospedale Policlinico San Martino—UOC Clinica Neurologica, Genova, Italy
| | - Corrado Cabona
- IRCCS-Ospedale Policlinico San Martino—UOC Neurofisiopatologia, Genova, Italy
| | | | - Chiara Fiorillo
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS Istituto Giannina Gaslini—UOC Neuropsichiatria Infantile, Genova, Italy
| | - Stefano Gustincich
- Department of Neuroscience and Brain Technologies, Istituto Italiano di Tecnologia, Genova, Italy
| | - Marina Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
- IRCCS-Ospedale Policlinico San Martino—UOC Clinica Neurologica, Genova, Italy
| | - Paola Mandich
- IRCCS Ospedale Policlinico San Martino—UOC Genetica Medica, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genova, Genova, Italy
| |
Collapse
|
6
|
Geroldi A, Trevisan L, Gaudio A, Gotta F, Patrone S, Origone P, Grandis M, Gemelli C, Schenone A, Accogli A, Zara F, Mandich P, Bellone E. A misleading presentation of Mohr-Tranebjaerg syndrome: What is hidden behind an axonal neuropathy? Parkinsonism Relat Disord 2022; 102:54-56. [PMID: 35947939 DOI: 10.1016/j.parkreldis.2022.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/21/2022] [Accepted: 07/24/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Alessandro Geroldi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy.
| | - Lucia Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Andrea Gaudio
- IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Fabio Gotta
- IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Serena Patrone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy.
| | - Paola Origone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Marina Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS-Ospedale Policlinico San Martino - UOC Clinica Neurologica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Chiara Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy.
| | - Angelo Schenone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS-Ospedale Policlinico San Martino - UOC Clinica Neurologica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Andrea Accogli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Federico Zara
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Istituto Giannina Gaslini - UOC Genetica Medica, Via Gerolamo Gaslini 5, 16147, Genova, Italy.
| | - Paola Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| | - Emilia Bellone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health, University of Genoa, Largo P. Daneo 3, 16132, Genova, Italy; IRCCS Ospedale Policlinico San Martino - UOC Genetica Medica, Largo R. Benzi 10, 16132, Genova, Italy.
| |
Collapse
|
7
|
Gaudio A, Rapisarda R, Xourafa A, Zanoli L, Manfrè V, Catalano A, Signorelli SS, Castellino P. Effects of competitive physical activity on serum irisin levels and bone turnover markers. J Endocrinol Invest 2021; 44:2235-2241. [PMID: 33675533 PMCID: PMC8421288 DOI: 10.1007/s40618-021-01529-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Irisin, a myokine, is a polypeptide derived from the cleavage of the extracellular domain of fibronectin domain-containing protein 5, a receptor that is present on different tissues (skeletal muscle, pericardium, myocardium, and brain), whose functions are not yet fully defined. PURPOSE The main aim of our study was to evaluate the effect of competitive physical activity on serum irisin levels and bone turnover markers. METHODS Fifteen male footballers and an equal number of subjects of the same age and gender, but with a predominantly sedentary lifestyle, had their serum levels of irisin and bone turnover markers measured. Bone mineral status was evaluated in both groups by quantitative bone ultrasound of the calcaneus. In addition, only in footballers, biochemical analyses were repeated after 3 months. RESULTS We did not observe significant differences in the serum levels of calcium, phosphorus, and parathyroid hormone between the two groups. The footballers had significantly higher quantitative bone ultrasound, 25-OH vitamin D, and creatinine values than the controls. There were also no significant differences in the bone alkaline phosphatase, carboxy-terminal telopeptide of type I collagen, osteoprotegerin, sclerostin or Dkk-1 values, while the irisin levels (+ 89%, p < 0.001) and RANKL were significantly higher in the footballers compared to those in the controls. CONCLUSION Our study shows that footballers have significantly higher serum irisin values than the general population. Irisin could be the "trait d'union" between bone health and physical activity.
Collapse
Affiliation(s)
- A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, AOU Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123, Catania, Italy.
| | - R Rapisarda
- AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - A Xourafa
- AOU Policlinico "G. Rodolico - San Marco", Catania, Italy
| | - L Zanoli
- Department of Clinical and Experimental Medicine, University of Catania, AOU Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123, Catania, Italy
| | - V Manfrè
- Clinica del Mediterraneo, Ragusa, Italy
| | - A Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - S S Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, AOU Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123, Catania, Italy
| | - P Castellino
- Department of Clinical and Experimental Medicine, University of Catania, AOU Policlinico "G. Rodolico - San Marco", Via S. Sofia 78, 95123, Catania, Italy
| |
Collapse
|
8
|
Bellone F, Morabito N, Gaudio A, Sottile A, Loddo S, Corica F, Catalano A. POS1119 A SINGLE DOSE OF ZOLEDRONATE INDUCES MODIFICATIONS OF SERUM VEGF IN OSTEOPOROTIC POSTMENOPAUSAL WOMEN. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.4312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Zoledronate (Zol) is an aminobisphosphonate commonly used to treat osteoporosis and other benign and malignant skeletal diseases. Exposure to bisphosphonates has been previously associated with the risk of osteonecrosis of the jaw (BRONJ), a rare but serious side effect. In cancer patients, the Vascular Endothelial Growth Factor (VEGF) has been advocated to take part to BRONJ pathogenesis via interfering with angiogenesis. No information is currently available on the VEGF concentrations after Zol administration for osteoporosis.Objectives:To explore change of VEGF concentrations after Zol administration in postmenopausal women with osteoporosis.Methods:A total of twenty-eight postmenopausal women with osteopenia or osteoporosis and at least one prevalent vertebral fracture were recruited and randomized in two groups. Eighteen women received a single i.v. dose of Zol 5 mg, while the other ten served as controls. Serum samples were collected at baseline, after 3 and 30 days, for repeated measurements of VEGF, and measurement of bone turn over markers and 25-hydroxyvitamin D (25(OH)D).Results:VEGF levels increased significantly after 3 days in women receiving Zol; then levels decreased after 30 days compared with VEGF concentrations at both day-3 and baseline (-18% at day-30 vs. baseline, p=0.01). 25(OH)D level, a surrogate of vitamin D status, was associated with VEGF change at the end of the study (r=0.29, p=0.028), and this association was maintained also after correcting for age, BMI, time since menopause, femoral neck BMD, osteocalcin, C-terminal telopeptide of collagen type 1 and baseline levels of VEGF (β=1.7, SE=0.71, p=0.03).Conclusion:Zol administration induced a reduction of circulating VEGF in postmenopausal women treated for osteoporosis, and vitamin D status has been showed to modulate this change. Further studies in this setting of women are needed to define whether VEGF modifications may predict the risk of BRONJ.Disclosure of Interests:None declared.
Collapse
|
9
|
Catalano A, Bellone F, Gaudio A, Sottile MC, Stoian SA, Lo Piano F, Maisano S, Corica F, Morabito N. AB0890 VITAMIN D PROMOTES BONE MINERAL DENSITY ACCRUAL AFTER DISCONTINUATION OF ALENDRONATE. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Vitamin D repletion is known to maximize the response to bisphosphonates (BPs) in terms of both bone mineral density (BMD) changes and anti-fracture efficacy. The contribute of vitamin to BMD after discontinuation of BPs has been poorly investigated.Objectives:To explore whether change of vitamin D status may contribute to the tail effect of alendronate (ALE) on BMD.Methods:Participants in this retrospective study were postmenopausal osteoporotic women exposed to ALE. Either cholecalciferol or calcifediol have been administered, as vitamin D supplementation in accordance to good clinical practice, during ALE treatment and after ALE discontinuation. BMD was evaluated by Dual-energy X-ray absorptiometry (DXA) at lumbar spine and femoral site. Vitamin D status has been checked by measuring 25(OH)D serum levels through HPLC. Surrogate bone formation and resorption markers (i.e. C-terminal telopeptide of type I collagen (CTX) and alkaline phosphatase (ALP), respectively) were also evaluated. The Fracture Risk Assessment Tool (FRAX) served to estimate the participants’ 10-year fracture risk for major osteoporotic and hip fracture.Results:88 postmenopausal osteoporotic women (age 61.14 ± 6.96 yr.) were included in the final analysis. The 10-year probability of major and hip fractures was 18.31±11.51 and 8.60 ± 10.55 %, respectively. Participants were exposed to ALE treatment for 31.27 ± 20.69 months; then they stopped treatment for 33.33 ± 18.97 months. Change of BMD was inversely related to drug holiday (r=-0.27, p=0.005). Modification of 25(OH)D was inversely associated with change of ALP (r=-0.22, p=0.018) and CTX levels (r=-0.3, p=0.06). By distributing participants in tertiles according to variation of 25(OH)D levels over time, women allocated in the tertile with the higher increase of 25(OH)D showed a 5.7% BMD gain that was two times larger in comparison with participants with lower increase of 25(OH)D. At a multiple regression analysis, after correcting for ALE treatment duration, bone turn-over marker modifications, BMI and age at menopause, BMD change at lumbar spine was significantly associated with time since menopause (ß=2.28, SE 0.44, p<0.0001), FRAX score (ß=-0.65, SE 0.29, p=0.03), drug holiday duration (ß=-2.17, SE 0.27, p<0.0001) and change of 25(OH)D levels (ß=0.15 SE 0.03, p=0.0007).Conclusion:After ALE discontinuation, modification of BMD are strictly associated with change of vitamin D status.Disclosure of Interests:None declared
Collapse
|
10
|
Eller-Vainicher C, Cairoli E, Grassi G, Grassi F, Catalano A, Merlotti D, Falchetti A, Gaudio A, Chiodini I, Gennari L. Pathophysiology and Management of Type 2 Diabetes Mellitus Bone Fragility. J Diabetes Res 2020; 2020:7608964. [PMID: 32566682 PMCID: PMC7262667 DOI: 10.1155/2020/7608964] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/14/2022] Open
Abstract
Individuals with type 2 diabetes mellitus (T2DM) have an increased risk of bone fragility fractures compared to nondiabetic subjects. This increased fracture risk may occur despite normal or even increased values of bone mineral density (BMD), and poor bone quality is suggested to contribute to skeletal fragility in this population. These concepts explain why the only evaluation of BMD could not be considered an adequate tool for evaluating the risk of fracture in the individual T2DM patient. Unfortunately, nowadays, the bone quality could not be reliably evaluated in the routine clinical practice. On the other hand, getting further insight on the pathogenesis of T2DM-related bone fragility could consent to ameliorate both the detection of the patients at risk for fracture and their appropriate treatment. The pathophysiological mechanisms underlying the increased risk of fragility fractures in a T2DM population are complex. Indeed, in T2DM, bone health is negatively affected by several factors, such as inflammatory cytokines, muscle-derived hormones, incretins, hydrogen sulfide (H2S) production and cortisol secretion, peripheral activation, and sensitivity. All these factors may alter bone formation and resorption, collagen formation, and bone marrow adiposity, ultimately leading to reduced bone strength. Additional factors such as hypoglycemia and the consequent increased propensity for falls and the direct effects on bone and mineral metabolism of certain antidiabetic medications may contribute to the increased fracture risk in this population. The purpose of this review is to summarize the literature evidence that faces the pathophysiological mechanisms underlying bone fragility in T2DM patients.
Collapse
Affiliation(s)
- C. Eller-Vainicher
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - E. Cairoli
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Italy
- Dept. of Clinical Sciences & Community Health, University of Milan, Milan, Italy
| | - G. Grassi
- Unit of Endocrinology, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Dept. of Clinical Sciences & Community Health, University of Milan, Milan, Italy
| | - F. Grassi
- Ramses Lab, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - A. Catalano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - D. Merlotti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| | - A. Falchetti
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Italy
| | - A. Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital ‘G. Rodolico', Catania, Italy
| | - I. Chiodini
- Istituto Auxologico Italiano, IRCCS, Unit for Bone Metabolism Diseases and Diabetes & Lab of Endocrine and Metabolic Research, Italy
- Dept. of Clinical Sciences & Community Health, University of Milan, Milan, Italy
| | - L. Gennari
- Department of Medicine, Surgery and Neurosciences, University of Siena, Italy
| |
Collapse
|
11
|
Catalano A, Gaudio A, Agostino RM, Morabito N, Bellone F, Lasco A. Trabecular bone score and quantitative ultrasound measurements in the assessment of bone health in breast cancer survivors assuming aromatase inhibitors. J Endocrinol Invest 2019; 42:1337-1343. [PMID: 31127591 DOI: 10.1007/s40618-019-01063-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/10/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE Aromatase inhibitors (AIs) represent the first-line adjuvant therapy for hormone receptor-positive breast cancer (BC) women. AIs have been associated with an increased rate of fractures. The aim of our study was to investigate trabecular bone score (TBS) and bone quantitative ultrasound (QUS) measurements as bone quality surrogates in AIs users. METHODS Sixty postmenopausal BC women starting AIs and forty-two controls (mean age 61.64 ± 8.33 years) were considered. Bone mineral density (BMD) at lumbar spine and femoral neck and TBS were measured by DXA; QUS-derived Amplitude-Dependent Speed of Sound (AD-SoS), Bone Transmission Time (BTT), and Ultrasound Bone Profile Index (UBPI) were assessed at phalangeal site; morphometric vertebral fractures (Vfx) by X-ray, serum bone-specific alkaline phosphatase (BSAP), and C-telopeptide of type 1 collagen (CTX) were also evaluated. RESULTS After 18 months, changes of TBS vs baseline were significantly different between AIs group and controls [Δ TBS - 2.2% vs - 0.4%, respectively, p = 0.001]. AD-SoS, BTT and UBPI values decreased only in AIs' group (- 3.7%, - 6.45%, -8.5%, vs baseline, respectively, pall < 0.001). 3 Vfx occurred in AIs users and were associated with the greater TBS and AD-SoS modifications. In the AIs' group, ΔTBS was associated with ΔAD-SoS (r = 0.58, p < 0.001) and ΔUBPI (r = 0.415, p = 0.001), but not with ΔBMD. Moreover, ΔTBS was independently predicted by ΔAD-SoS, after correcting for BMD, CTX and BSAP level changes (β = 0.37, SE = 2.44, p < 0.001). CONCLUSIONS TBS and phalangeal QUS provide useful information related to bone quality in AI-treated BC survivors and could be considered for fracture risk evaluation.
Collapse
Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy.
| | - A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - R M Agostino
- Medical Oncology Unit, Grand Metropolitan Hospital "Bianchi Melacrino Morelli", Reggio Calabria, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
| | - F Bellone
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
| | - A Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, Via C. Valeria, 98125, Messina, Italy
| |
Collapse
|
12
|
Catalano A, Gaudio A, Morabito N, Basile G, Agostino RM, Xourafa A, Atteritano M, Morini E, Natale G, Lasco A. Quantitative ultrasound and DXA measurements in aromatase inhibitor-treated breast cancer women receiving denosumab. J Endocrinol Invest 2017; 40:851-857. [PMID: 28332172 DOI: 10.1007/s40618-016-0606-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2016] [Accepted: 12/27/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Denosumab has been proven to reduce fracture risk in breast cancer (BC) women under aromatase inhibitors (AIs). Quantitative ultrasound (QUS) provides information on the structure and elastic properties of bone. Our aim was to assess bone health by phalangeal QUS and by dual-energy X-ray absorptiometry (DXA), and to evaluate bone turnover in AIs-treated BC women receiving denosumab. METHODS 35 Postmenopausal BC women on AIs were recruited (mean age 61.2 ± 4.5 years) and treated with denosumab 60 mg administered subcutaneously every 6 months. Phalangeal QUS parameters [Amplitude Dependent Speed of Sound (AD-SoS), Ultrasound Bone Profile Index (UBPI), Bone Transmission Time (BTT)] and DXA at lumbar spine and femoral neck were performed. Serum C-telopeptide of type 1 collagen (CTX) and bone-specific alkaline phosphatase (BSAP) were also measured. The main outcomes were compared with a control group not receiving denosumab (n = 39). RESULTS In patients treated with denosumab, differently from controls, QUS and DXA measurements improved after 24 months, and a reduction of CTX and BSAP was detected at 12 and 24 months in comparison to baseline (P < 0.05). The percent changes (Δ) of QUS measurements were significantly associated with ΔBMD at femoral neck, and ΔCTX and ΔBSAP were associated with ΔBMD at lumbar spine (r = -0.39, P = 0.02; r = -0.49, P = 0.01, respectively). CONCLUSIONS Denosumab preserves bone health as assessed by phalangeal QUS and DXA. Since inexpensive and radiation-free, phalangeal QUS may be considered in the follow-up of AIs-treated BC women receiving denosumab.
Collapse
Affiliation(s)
- A Catalano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy.
| | - A Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - N Morabito
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Basile
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - R M Agostino
- Department of Human Pathology, University of Messina, Messina, Italy
| | - A Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - M Atteritano
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - E Morini
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| | - G Natale
- Mineral Metabolism and Nephrology Clinic of Vibo Valentia Hospital, Vibo Valentia, Italy
| | - A Lasco
- Department of Clinical and Experimental Medicine, University Hospital of Messina, University Hospital "G. Martino", Via C. Valeria, 98125, Messina, Italy
| |
Collapse
|
13
|
Santo L, Semeraro A, Zuccaro C, Anelli M, Bucci R, Carlino G, Marsico A, Quarta L, Cantatore F, Gaudio A, Casilli O, Cacciapaglia F, Falappone P, Iannone F. SAT0401 Two-Years Survival of Golimumab in 400 Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Axial Spondyloarthritis in Real-Life World. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.2475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
14
|
Zhukouskaya VV, Eller-Vainicher C, Gaudio A, Privitera F, Cairoli E, Ulivieri FM, Palmieri S, Morelli V, Grancini V, Orsi E, Masserini B, Spada AM, Fiore CE, Chiodini I. The utility of lumbar spine trabecular bone score and femoral neck bone mineral density for identifying asymptomatic vertebral fractures in well-compensated type 2 diabetic patients. Osteoporos Int 2016; 27:49-56. [PMID: 26138582 DOI: 10.1007/s00198-015-3212-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 06/12/2015] [Indexed: 11/28/2022]
Abstract
UNLABELLED The objective of the study was to evaluate the usefulness of trabecular bone score (TBS) and bone mineral density (BMD) for identifying vertebral fractures (VFx) in well-compensated type 2 diabetic (T2D) patients. TBS and femoral neck BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients. INTRODUCTION In T2D, the prevalence of VFx is increased, especially in poorly compensated and complicated diabetic patients. The possibility of predicting the fracture risk in T2D patients by measuring BMD and TBS, an indirect parameter of bone quality, is under debate. Therefore, the objective was to evaluate the usefulness of TBS and BMD for identifying VFx in well-compensated T2D patients. METHODS Ninety-nine T2D postmenopausal women in good metabolic control (glycosylated haemoglobin 6.8 ± 0.7 %) and 107 control subjects without T2D were evaluated. In all subjects, we evaluated the following: the BMD at the lumbar spine (LS) and the femoral neck (FN); the TBS by dual X-ray absorptiometry; and VFx by radiography. In T2D subjects, the presence of diabetic retinopathy, neuropathy, and nephropathy was evaluated. RESULTS T2D subjects had increased VFx prevalence (34.3 %) as compared to controls (18.7 %) (p = 0.01). T2D subjects presented higher BMD (LS -0.8 ± 1.44, FN -1.06 ± 1.08), as compared to controls (LS -1.39 ± 1.28, p = 0.002; FN -1.45 ± 0.91, p = 0.006, respectively). TBS was not different between diabetics and controls. In fractured T2D patients, LS-BMD, FN-BMD, and TBS were reduced (-1.2 ± 1.44; -1.44 ± 1.04; 1.072 ± 0.15) and the prevalence of retinopathy (15.4 %) was increased than in nonfractured T2D subjects (-0.59 ± 1.4, p = 0.035; -0.87 ± 1.05, p = 0.005; 1.159 ± 0.15, p = 0.006; 1.8 %, p = 0.04, respectively). The combination of TBS ≤1.130 and FN-BMD less than -1.0 had the best diagnostic accuracy for detecting T2D fractured patients (SP 73.8 %, SN 63.6 %, NPV 78.9 %, PPV 56.8 %). CONCLUSIONS TBS and FN-BMD below certain cutoffs may be useful for identifying VFx in well-compensated T2D patients.
Collapse
Affiliation(s)
- V V Zhukouskaya
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy.
| | - C Eller-Vainicher
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A Gaudio
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - F Privitera
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - E Cairoli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - F M Ulivieri
- Units of Nuclear Medicine, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - S Palmieri
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Morelli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Grancini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - E Orsi
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - B Masserini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A M Spada
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - C E Fiore
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - I Chiodini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| |
Collapse
|
15
|
Zhukouskaya VV, Eller-Vainicher C, Gaudio A, Privitera F, Cairoli E, Ulivieri FM, Palmieri S, Morelli V, Grancini V, Orsi E, Masserini B, Spada AM, Fiore CE, Chiodini I. Erratum to: The utility of lumbar spine trabecular bone score and femoral neck bone mineral density for identifying asymptomatic vertebral fractures in well-compensated type 2 diabetic patients. Osteoporos Int 2016; 27:421. [PMID: 26194494 DOI: 10.1007/s00198-015-3248-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V V Zhukouskaya
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy.
| | - C Eller-Vainicher
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - A Gaudio
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - F Privitera
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - E Cairoli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - F M Ulivieri
- Units of Nuclear Medicine, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - S Palmieri
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Morelli
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - V Grancini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - E Orsi
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - B Masserini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - A M Spada
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| | - C E Fiore
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - I Chiodini
- Units of Endocrinology and Metabolic Diseases, Fondazione IRCCS Cá Granda-Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Padiglione Granelli, Francesco Sforza Street 35, 20122, Milan, Italy
| |
Collapse
|
16
|
Gaudio A, Muratore F, Fiore V, Rapisarda R, Signorelli SS, Fiore CE. Decreased bone cortical density at the forearm in subjects with subclinical peripheral arterial disease. Osteoporos Int 2015; 26:1747-53. [PMID: 25672808 DOI: 10.1007/s00198-015-3057-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/28/2015] [Indexed: 12/14/2022]
Abstract
UNLABELLED The association between peripheral arterial disease (PAD) and low bone mass is controversial. In our study, peripheral quantitative computed tomography shows a reduction of cortical but not trabecular, bone mineral density (BMD) at the forearm, in patients with subclinical PAD. INTRODUCTION Some controversy exists regarding the association between peripheral arterial disease (PAD) and low bone mass. Previous studies have evaluated bone mineral density (BMD) in patients with subclinical PAD, with mixed results. Inconsistency of data may depend on the fact that most studies measured areal bone mineral density (aBMD) by Dual-energy-x ray absorptiometry (DXA). Because DXA cannot distinguish between cortical and trabecular compartments, we reasoned that a study aimed to establish whether these compartments were differentially affected by PAD status could give more information on the nature of this association. METHODS In this cross-sectional study, we used peripheral quantitative computed tomography (pQCT) to examine volumetric cortical and trabecular mineral density at the radius (vBMD) in a cohort of subjects with subclinical PAD as defined by ABI ≤0.90 and compared them with healthy subjects with no evidence of PAD. RESULTS Patients with subclinical PAD had significantly reduced cortical density (1101.0 ± 45.4 vs 1156.2 ± 51.3 mg/cm(3), p < 0.001) and cortical area (75.0 ± 20.9 vs 99.9 ± 18.2 mm(2), p < 0.001) than healthy subjects. Trabecular density (178.1 ± 47.9 vs 165.8 ± 29.6 mg/cm(3)) was not significantly different in the two groups. CONCLUSION Subclinical PAD induces a selective bone loss at the radius compartment, not identified by standard DXA, which seems to occur primarily at the cortical level.
Collapse
Affiliation(s)
- A Gaudio
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - F Muratore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - V Fiore
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - R Rapisarda
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy
| | - S S Signorelli
- Department of Clinical and Experimental Medicine, Section of Vascular Medicine, Medical Angiology Unit, University of Catania, Garibaldi Hospital, Piazza S. Maria di Gesù 5, 95123, Catania, Italy
| | - C E Fiore
- Department of Clinical and Experimental Medicine, Section of Metabolic Bone Disease, University of Catania, Clinica Medica OVE, Via Plebiscito 628, 95124, Catania, Italy.
| |
Collapse
|
17
|
Balsorano P, Gaudio A, Romagnoli S, Krishnan I. Urinary strong ion difference and acute kidney injury: an early marker of renal dysfunction? Crit Care 2015. [PMCID: PMC4471496 DOI: 10.1186/cc14441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
18
|
Balsorano P, Romagnoli S, Gaudio A. Potential role of jugular vein echographic assessment for central venous pressure estimation. Crit Care 2015. [PMCID: PMC4472714 DOI: 10.1186/cc14251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
19
|
Gaudio A, Privitera F, Pulvirenti I, Canzonieri E, Rapisarda R, Fiore CE. Relationships between osteoprotegerin, receptor activator of the nuclear factor kB ligand serum levels and carotid intima-media thickness in patients with type 2 diabetes mellitus. Panminerva Med 2014; 56:221-225. [PMID: 25056244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of this paper was to investigate the association of circulating osteoprotegerin (OPG) and receptor activator of the nuclear factor kB ligand (RANKL) levels with carotid intima-media thickness (CIMT) in type 2 diabetes mellitus (T2DM). METHODS We performed a cross-sectional community-based study including 40 T2DM postmenopausal women and 40 healthy controls. CIMT was measured by B-mode ultrasound. Serum OPG and RANKL were measured by solid-phase enzyme-linked immunosorbent assay (ELISA). RESULTS Serum OPG levels were higher in T2DM than in controls (median 2.9 vs 2.0 pmol/liter; P<0.001), significantly associated with CIMT in T2DM (P<0.001). RANKL levels were lower in T2DM than in controls (median 0.45 vs 0.60 pmol/liter; P<0.0001), however no association was found with CIMT. Serum OPG levels were associated with cross-sectional measure of CIMT in T2DM. CONCLUSION The data would support the role of an increased OPG/RANKL ratio as a possible marker of progression of vascular dysfunction in diabetes.
Collapse
Affiliation(s)
- A Gaudio
- Department of Medical and Pediatric Sciences University of Catania, Catania, Italy -
| | | | | | | | | | | |
Collapse
|
20
|
Gaudio A, Corrado A, Santoro N, Maruotti N, Cantatore FP. Melkersson-Rosenthal syndrome in a patient with psoriatic arthritis receiving etanercept. Int J Immunopathol Pharmacol 2013; 26:229-33. [PMID: 23527726 DOI: 10.1177/039463201302600123] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Melkersson-Rosenthal syndrome is a rare granulomatous neuro-mucocutaneous systemic disease that is characterized by relapsing peripheral facial paralysis, orofacial edema and fissured tongue. The disease etiology is still not well known, but it has been hypothesized that a possible role is played by various causal agents such as infectious diseases, genetic causes, allergic conditions, benign lymphogranulomatosis, various associations with other pathological conditions, particularly with immune-mediated diseases and food contact allergies. In this report we describe the case of a woman, 42 years old, with psoriatic arthritis who developed neurological episodes related to MRS after treatment with anti-TNF therapy. This finding further supports the hypothesis that TNF-alpha blockade, and particularly the use of the TNF-alpha receptor, could trigger the development of granulomatous lesions in predisposed patients. The case we report further sustains the importance for the clinician to take into account this potential adverse event in patients receiving anti-TNF-alpha therapies.
Collapse
|
21
|
Lasco A, Catalano A, Morabito N, Gaudio A, Basile G, Trifiletti A, Atteritano M. Adrenal effects of teriparatide in the treatment of severe postmenopausal osteoporosis. Osteoporos Int 2011; 22:299-303. [PMID: 20309523 DOI: 10.1007/s00198-010-1222-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 02/19/2010] [Indexed: 11/27/2022]
Abstract
UNLABELLED The aim of our study was to investigate the effects of teriparatide on the hypophysis-adrenal axis in postmenopausal women. Treatment with teriparatide increased plasmatic and urinary levels of cortisol after 6 and 12 months. Our paper demonstrates a possible direct secretagogue effect of teriparatide on adrenals in osteoporotic postmenopausal women. INTRODUCTION Teriparatide, recombinant human parathyroid hormone (1-34) (rhPTH [1-34]), is approved for the treatment of osteoporosis in men and postmenopausal women at high risk for fracture. In literature, data regarding the secretagogue effect of PTH on adrenocortical cells are present on in vitro, but not on in vivo, studies. The aim of our study was to investigate the effects of teriparatide on the hypophysis-adrenal axis in postmenopausal women. METHODS Twenty postmenopausal women with severe osteoporosis were treated with teriparatide in a regimen of 20 μg daily, self-administered injections at bedtime for 12 months and a calcium and vitamin D supplementation. At the same time, 20 osteopenic women matched for age and body mass index with the patients were enrolled and treated only with calcium and vitamin D. In all subjects, calcium, adrenocorticotropic hormone (ACTH), and plasmatic and urinary cortisol were evaluated at baseline and after 6 and 12 months. RESULTS Treatment with teriparatide increased plasmatic and urinary levels of cortisol after 6 and 12 months, reaching statistical significance only after 1 year. Plasmatic levels of ACTH did not change significantly. CONCLUSIONS Our paper, for the first time, demonstrates a possible direct secretagogue effect of teriparatide on adrenals in osteoporotic postmenopausal women.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina, A.O.U. Policlinico G. Martino Via C. Valeria, 98125, Messina, Italy
| | | | | | | | | | | | | |
Collapse
|
22
|
Pennisi P, Russo E, Gaudio A, Veca R, D’Amico F, Mangiafico R, Laspina M, Tringali G, Signorelli S, Fiore C. The association between carotid or femoral atherosclerosis and low bone mass in postmenopausal women referred for osteoporosis screening. Does osteoprotegerin play a role? Maturitas 2010; 67:358-62. [DOI: 10.1016/j.maturitas.2010.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Revised: 07/21/2010] [Accepted: 07/24/2010] [Indexed: 11/25/2022]
|
23
|
Corrado A, Neve A, Maruotti N, Gaudio A, Marucci A, Cantatore FP. Dose-dependent metabolic effect of zoledronate on primary human osteoblastic cell cultures. Clin Exp Rheumatol 2010; 28:873-879. [PMID: 21205463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 09/13/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVES To evaluate the in vitro effect of the bisphosponate zoledronate on metabolic activity, proliferation and viability of human osteoblasts. METHODS Primary human osteoblasts cultures were obtained from cancellous bone of healthy subjects undergoing bone marrow biopsy. Cell cultures were treated with crescent concentrations of zoledronate (10⁻¹⁰to 10⁻³), with and without 1,25(OH)2 vitamin D3. In these experimental conditions we evaluated cells viability and proliferation using the MMT colorimetric test, cell apoptosis by measurement of Caspase 3 activity and metabolic cell activity through alkaline phosphatase activity and osteocalcin production. RESULTS Osteocalcin and alkaline phosphatase synthesis was significantly enhanced by 10⁻¹⁰ M to 10⁻⁵ M zoledronate concentrations, whereas was dramatically decreased by higher drug concentrations. Vitamin D3 enhanced the positive metabolic effect of zoledronate. The effect of zoledronate on cell proliferation was variable and dose-dependent. While no effect was observed with lower drug concentrations (10⁻¹⁰ M to 10⁻⁸ M), zoledronate 10⁻⁷ M increased cell proliferation. Conversely, concentrations higher than 10⁻⁷ M significantly reduced cell proliferation, in a dose-dependent manner. Osteoblast apoptosis was enhanced after treatment with the highest zoledronate concentrations. The maximum positive effect on osteoblasts metabolic activity and proliferation was observed with the zoledronate concentrations corresponding to those theoretically reached in bone microenvironment when zoledronate is used in clinical practice for post-menopausal osteoporosis treatment. CONCLUSIONS The results of this study confirm that bisphosphonates exert different cellular biochemical effects depending on dosage and support the hypothesis that their positive effect on bone mineral density could be partially due to an anabolic action on bone forming cells.
Collapse
Affiliation(s)
- A Corrado
- Rheumatology Clinic, Department of Medical and Occupational Sciences, University of Foggia, Ospedale Col. D'Avanzo, Foggia, Italy
| | | | | | | | | | | |
Collapse
|
24
|
Maruotti N, Corrado A, Gaudio A, Cantatore FP. Membranous nephropathy in rheumatoid arthritis: a case report. Clin Exp Rheumatol 2009; 27:840-842. [PMID: 19917171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Rheumatoid arthritis is a chronic disease characterized by inflammation, abnormal cellular and humoral immune responses, synovial hyperplasia and rarely by renal involvement, characterized principally by secondary amyloidosis and nephrotoxic effects related to drugs, while renal lesions directly due to the disease itself are infrequent. In this report we describe a patient with rheumatoid arthritis who developed membranous nephropathy associated with nephrotic syndrome while receiving adalimumab, an anti-tumour necrosis factor-alpha drug.
Collapse
Affiliation(s)
- N Maruotti
- Department of Rheumatology, University of Foggia Medical School, Italy
| | | | | | | |
Collapse
|
25
|
Trifiletti A, Scamardi R, Bagnato GF, Gaudio A. Hemostatic changes in vasculitides. Thromb Res 2009; 124:252-5. [PMID: 19525001 DOI: 10.1016/j.thromres.2009.05.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 05/16/2009] [Accepted: 05/19/2009] [Indexed: 02/01/2023]
Abstract
The systemic vasculitides are an heterogeneous group of rare diseases characterized by inflammation and fibrinoid necrosis of blood vessel walls. Today it is well known that the inflammatory process characterizing vasculitides activates coagulation factors, inhibits anticoagulant factors, inhibits fibrinolytic processes, increases platelet activity and production and determines endothelial dysfunction. So far the mortality in vasculitides, even if falling, remains substantially high. Patients with vasculitic syndrome are at increased risk of developing atherosclerosis and in these patients prevalence of cardiovascular disease and cardiovascular events is higher than in the general population. Vasculitides can be associated with antiphospholipid syndrome. It is important to establish a strategy of antithrombotic therapy management in vasculitic patients, but this has not yet been clearly achieved.
Collapse
Affiliation(s)
- A Trifiletti
- Department of Internal Medicine, University of Messina, Italy
| | | | | | | |
Collapse
|
26
|
Russo GT, Di Benedetto A, Alessi E, Giandalia A, Gaudio A, Ientile R, Horvath KV, Asztalos B, Raimondo G, Cucinotta D. Menopause modulates homocysteine levels in diabetic and non-diabetic women. J Endocrinol Invest 2008; 31:546-51. [PMID: 18591889 DOI: 10.1007/bf03346406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
High total homocysteine (tHcy) plasma levels may contribute to the increased cardiovascular risk of Type 2 diabetic women. However, to date, data on factors modulating tHcy concentration in this population are scarce. Fasting tHcy, vitamin B12, folate plasma levels, and the methylene tetrahydrofolate reductase (MTHFR) C677T genotype as well as clinical, biochemical, and lifestyle variables were compared in 91 Type 2 diabetic and 91 matched non-diabetic women (40 pre- and 51 post-menopausal, in each group). Fasting tHcy concentration did not differ between diabetic and control women, even after multivariable adjustment. In both groups, tHcy levels increased after menopause, but the differences were weakened after multivariable adjustment. The MTHFR genotype distribution was in accordance with the Hardy-Weinberg equilibrium, with a similar TT frequency in diabetic (22.2 %) and control women (19.8%). Overall, tHcy plasma concentration was higher in TT homozygous compared to other genotypes. We found a menopause-genotype interaction on tHcy levels (p=0.068 for menopause*genotype interaction); overall, the increase of tHcy concentration in TT subjects was limited to pre-menopause (p<0.0001; adjusted p=0.024), and this was confirmed after considering diabetic and control women separately (p=0.001 and p=0.01, respectively). At multivariate analysis, menopause was an independent correlate of tHcy concentration, together with creatinine, folate and MTHFR genotype. Our data show that menopause has a strong influence on tHcy concentration even in Type 2 diabetic women and demonstrate, for the first time, that it may modulate the association between tHcy and the common MTHFR polymorphism both in diabetic and non-diabetic women.
Collapse
Affiliation(s)
- G T Russo
- Department of Internal Medicine, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Gaudio A, Morabito N, Xourafa A, Macrì I, Meo A, Morgante S, Trifiletti A, Lasco A, Frisina N. Bisphosphonates in the treatment of thalassemia-associated osteoporosis. J Endocrinol Invest 2008; 31:181-4. [PMID: 18362512 DOI: 10.1007/bf03345587] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Thalassemia major is a common cause of skeletal morbidity, as shown by the increased fracture risk in thalassemic patients. The etiology of this bone disease is multifactorial and culminates in a state of increased bone turnover with excessive bone resorption and remodeling. Despite hormonal replacement therapy, calcium and vitamin D administration, effective iron chelation, and normalization of hemoglobin levels, patients with thalassemia major continue to lose bone mass. The increased bone turnover rate observed in thalassemic patients justifies the use of powerful anti-resorption drugs, such as bisphosphonates. To date, alendronate, pamidronate, and zoledronate seem to be effective in increasing bone mineral density and normalizing bone turnover, but more trials are necessary to evaluate their efficacy in reducing fracture risks in larger thalassemic populations.
Collapse
Affiliation(s)
- A Gaudio
- Department of Internal Medicine, University Polyclinic, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Gaudio A, Lasco A, Morabito N, Atteritano M, Vergara C, Catalano A, Fries W, Trifiletti A, Frisina N. Hepatic osteodystrophy: does the osteoprotegerin/receptor activator of nuclear factor-kB ligand system play a role? J Endocrinol Invest 2005; 28:677-82. [PMID: 16277162 DOI: 10.1007/bf03347549] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Multiple factors can contribute to the development of osteodystrophy in patients with chronic liver disease (CLD). Recently, two new cytokines, osteoprotegerin (OPG) and the receptor activator of nuclear factor-kB ligand (RANKL), have been implicated in the pathogenesis of postmenopausal osteoporosis and other metabolic bone diseases. Therefore, the aim of our study was to evaluate bone metabolism, bone mineral density (BMD) and OPG/RANKL system in 65 male patients with CLD and in 65 healthy controls. Our patients showed lower BMD values than controls both at lumbar and femoral levels. Moreover, they had an unbalanced bone turnover with an increased resorption phase, as shown by high levels of urinary deoxypyridinoline and a decreased formation phase, as shown by the slightly, but significant, low levels of bone-alkaline phosphatase. Patients showed lower plasma levels of free-testosterone than controls and higher - although not significantly so - plasma levels of 17 beta-estradiol. Furthermore, patients with CLD had higher levels of sex hormone-binding globulin and OPG, and lower levels of 25-hydroxyvitamin D (25-HOD) and IGF-I than the control group, while RANKL levels were similar in the two groups. In conclusion, our data do not confirm the hypothesis that the OPG/RANKL system could exert a key role in the pathogenesis of hepatic osteodystrophy, but rather that the observed increase in OPG levels may represent either the result of the inflammatory process per se or a compensation for the observed enhanced bone resorption.
Collapse
Affiliation(s)
- A Gaudio
- Department of Internal Medicine, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Trifiletti A, Scamardi R, Gaudio A, Lasco A, Frisina N. Hemostatic effects of diets containing olive or soy oil in hypertensive patients. J Thromb Haemost 2005; 3:179-80. [PMID: 15634286 DOI: 10.1111/j.1538-7836.2004.01095.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
30
|
Lasco A, Gaudio A, Morabito N, Previti M, Mileto A, Frisina N, Cucinotta D. Effects of a long-term treatment with raloxifene on insulin sensitivity in postmenopausal women. Diabetologia 2004; 47:571-574. [PMID: 14762655 DOI: 10.1007/s00125-004-1328-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2003] [Revised: 11/10/2003] [Indexed: 10/26/2022]
Abstract
AIMS/HYPOTHESIS Our aim was to investigate the effect of long-term administration of raloxifene, a selective estrogen receptor modulator, on insulin sensitivity, glucose tolerance and plasma lipid concentrations in a group of postmenopausal women. METHODS A total of 24 women with postmenopausal osteoporosis were consecutively enrolled and randomly assigned to take raloxifene, 60 mg/day for 12 months or placebo. At baseline and after 6 and 12 months, in each subject insulin sensitivity (M-index) was assessed by means of an euglycaemic hyperinsulinaemic clamp. Plasma concentrations of total cholesterol, triglycerides and HDL-cholesterol were also measured and glucose tolerance was evaluated. RESULTS In the raloxifene-treated group, the M index decreased after 6 and 12 months with respect to the placebo group (-21%, p=0.042 and -23%, p=0.018, respectively). Neither fasting plasma glucose nor glucose tolerance changed in the raloxifene-treated group, compared to the placebo group. Low density lipoprotein cholesterol concentrations decreased at 12 months (-13%, p=0.047). CONCLUSION/INTERPRETATION A long-term treatment with raloxifene in osteoporotic, otherwise healthy post-menopausal women can reduce insulin sensitivity without affecting glucose tolerance.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy.
| | - A Gaudio
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| | - N Morabito
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| | - M Previti
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| | - A Mileto
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| | - N Frisina
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| | - D Cucinotta
- Department of Internal Medicine, University of Messina School of Medicine, 98100, Messina, Italy
| |
Collapse
|
31
|
Trifiletti A, Lasco A, Scamardi R, Pizzoleo MA, Gaudio A, La Rocca R, Morini E, Frisina N. Long-Term Hemostatic Effects of Cholesterol-Lowering Therapy with Atorvastatin. Pathophysiol Haemos Thromb 2003; 33:84-7. [PMID: 14624049 DOI: 10.1159/000073851] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2003] [Accepted: 06/17/2003] [Indexed: 11/19/2022]
Abstract
This study assessed hemostatic effects of an HMC-CoA reductase inhibitor, atorvastatin, on different parameters in 32 hypercholesterolemic patients of both sexes. In the patients and in 25 control subjects, plasma levels of tissue-type plasminogen activator, plasminogen activator inhibitor (PAI-1), D-dimer, prothrombin fragment 1 + 2 (F1 + 2), total cholesterol, triglycerides and fibrinogen had been measured. All these parameters were evaluated in patients after 6 and 12 months of treatment with atorvastatin at a dosage of 20 mg/day. This treatment significantly lowered the total cholesterol level in all patients. Moreover, after 6 months of atorvastatin treatment, PAI-1 and F1 + 2, which were both increased at baseline, were significantly reduced. This reduction continued after 12 months. The present results show that a reduction of hemostatic abnormalities, which exist in hypercholesterolemia, may be another important effect of the atorvastatin therapy.
Collapse
Affiliation(s)
- A Trifiletti
- Department of Internal Medicine, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Morabito N, Gaudio A, Lasco A, Vergara C, Tallarida F, Crisafulli G, Trifiletti A, Cincotta M, Pizzoleo MA, Frisina N. Three-year effectiveness of intravenous pamidronate versus pamidronate plus slow-release sodium fluoride for postmenopausal osteoporosis. Osteoporos Int 2003; 14:500-6. [PMID: 12750879 DOI: 10.1007/s00198-003-1397-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2002] [Accepted: 01/23/2003] [Indexed: 11/30/2022]
Abstract
All currently available and approved therapies for osteoporosis inhibit bone resorption. But, despite their great value, antiresorptive agents are generally not associated with dramatic increases in bone mass. In light of these data, the aim of our prospective, placebo-controlled, randomized clinical trial, with a 3-year follow up, was to examine the effects of cyclic intravenous pamidronate and fluoride in combination, versus pamidronate alone, on bone mineral density (BMD) at vertebral and femoral levels, biochemical markers of bone turnover, IGF-1 serum levels, and safety and tolerability in 40 postmenopausal women with osteoporosis. During the treatment period, pamidronate alone reduced both markers of bone formation and bone resorption, resulting in an increase of BMD, after 3 years, of 7.07% at the lumbar level and of 6.76% at the femoral level. In the group treated with pamidronate and fluoride, markers of bone turnover had a different trend: after 3 years, there was a lower reduction of bone resorption and an increase of bone formation markers, with a concomitant increase in IGF-1 levels. This resulted, after 3 years of treatment, in a marked variation of BMD at the lumbar level (+12.74%) and a reduced, but still significant, increase at the femoral level (3.89%). Spine radiography and clinical evaluation did not reveal any vertebral fractures in either treatment group. In conclusion, the combined use of pamidronate and fluoride produced somewhat larger, continuous increases in BMD, at the lumbar level, than pamidronate alone.
Collapse
Affiliation(s)
- N Morabito
- Palazzo Forte Gonzaga, via Montepiselli 71, 98100 Messina, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Lasco A, Cannavò S, Gaudio A, Morabito N, Basile G, Nicita-Mauro V, Frisina N. Effects of long-lasting raloxifene treatment on serum prolactin and gonadotropin levels in postmenopausal women. Eur J Endocrinol 2002; 147:461-5. [PMID: 12370106 DOI: 10.1530/eje.0.1470461] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effects of a 6 month administration of raloxifene hydrochloride, a selective estrogen receptor modulator which was recently approved for the prevention of osteoporosis, on serum gonadotropin and prolactin (PRL) levels and on TRH-stimulated PRL responsiveness in postmenopausal women who have not undergone estrogen replacement therapy. DESIGN AND METHODS Sixteen healthy postmenopausal women were divided into two groups on the basis of their bone status, evaluated by dual energy X-ray absorptiometry at the lumbar level. Eight women (chronological age 52.4+/-4.1 (s.d.) years, menopausal age 42.4+/-3.9 years), in whom T-score L2-L4 was less than -2.5 s.d., were treated with raloxifene (60 mg p.o.) administered daily for 6 months (group 1), while the other eight women (chronological age 52.6+/-2.5 years, menopausal age 42.1+/-3.6 years), in whom the T-score L2-L4 ranged between -1 and -2.5 s.d., were used as a control group (group 2). Serum PRL, FSH, LH and 17beta-estradiol (E2) levels were evaluated at baseline and after 3 and 6 months of treatment. In all subjects, PRL responsiveness to TRH (200 microg i.v.) administration was evaluated at baseline and at the end of the study. RESULTS At baseline, mean PRL, LH and FSH levels were not significantly different in the two groups (PRL 133.6+/-21.7 vs 136.7+/-28.1 mIU/l (NS), LH 25.1+/-6.8 vs 24.4+/-6.7 mIU/ml (NS), FSH 74.4+/-25.0 vs 71.1+/-24.1 mIU/ml (NS), in group 1 and group 2 respectively). No significant variations in serum FSH and LH values, in either group, or in serum PRL levels in group 2, were observed at the 3 and 6 month examinations. On the contrary, serum PRL values decreased significantly in group 1 after 3 months (100.1+/-47.7 mIU/l, P<0.05) and 6 months (81.5+/-30.2 mIU/l, P<0.001). At baseline, no significant differences were observed in the TRH-stimulated serum PRL peak between the groups (1015.4+/-30.5 vs 1030.2+/-25.7 mIU/l in group 1 and in group 2 respectively), while it decreased significantly at the 6 month examination in group 1 (770.5+/-47.4 mIU/l, P<0.001) and it was significantly lower than in group 2 (1068.1+/-301.8 mIU/l, P=0.02). Serum E2 was not detected at baseline and at each examination, in all patients. CONCLUSIONS The decrease of PRL values induced by long-term raloxifene administration in postmenopausal women could be explained by a direct antiestrogenic effect of raloxifene on lactotrope cells or by the recently suggested increase of opiatergic tone on the hypothalamic-pituitary region.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, Section of Endocrinology, University of Messina, Messina, Italy.
| | | | | | | | | | | | | |
Collapse
|
34
|
Abstract
The aim of our randomized, placebo-controlled study was to investigate the effects of 2 years' daily oral administration of alendronate or intramuscular administration of clodronate every 10 days, on bone remodeling parameters and bone mineral density (BMD), safety and tolerability in a group of osteoporotic thalassemic patients. Twenty-five young patients (mean age 26.6 +/- 7.1 years) with beta-thalassemia major were randomly divided to receive placebo or 100 mg of clodronate intramuscularly every 10 days or 10 mg of alendronate per os daily. All patients took 500 mg of elemental calcium and 400 IU cholecalciferol in the evening at meal time. After 2 years, pyridinium crosslinks, which are bone resorption markers, did not differ significantly from baseline values in the placebo group, whereas they had decreased significantly in the clodronate and alendronate groups. Osteocalcin, a bone formation marker, did not change significantly in the placebo group, whereas it decreased slightly, but not significantly, in the clodronate and alendronate groups after 12 and 24 months. At the end of the study, the lumbar spine BMD had decreased significantly in the placebo group; it did not change significantly in the clodronate group; in the alendronate group it had increased but not significantly, whereas the increase was significant with respect to the placebo group. Femoral neck BMD decreased significantly in the placebo group; it did not change significantly in the clodronate group, but increased significantly in the alendronate group. No relevant side effects were recorded during our study. In conclusion, in patients with thalassemia-induced osteoporosis, the daily administration of alendronate significantly increases BMD, the most important predictor of the risk of fracture at several sites. Clodronate treatment at our dosage is ineffective in this pathology in spite of the good compliance of patients.
Collapse
Affiliation(s)
- N Morabito
- Department of Internal Medicine, University of Messina, Italy.
| | | | | | | | | | | | | |
Collapse
|
35
|
Trifiletti A, Lasco A, Scamardi R, Cincotta M, Gaudio A, Barbera N, Frisina N. Hemostasis and fibrinolysis factors in first-degree relatives of patients with Type 2 diabetes without hypertension. Pathophysiol Haemost Thromb 2002; 32:127-30. [PMID: 12372926 DOI: 10.1159/000065214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
First-degree relatives of type 2 diabetic patients with or without a family history of hypertension are at increased risk for cardiovascular diseases. The aim of this study was to verify some possible hemostatic alterations in first-degree relatives of type 2 diabetic, normotensive and hypertensive patients. In 78 non-diabetic, normotensive first-degree relatives of type 2 diabetic patients (47 without a family history of hypertension and 31 with a family history of hypertension) and in 36 normoglycemic, normotensive subjects with no family history of hypertension, we evaluated plasma levels of fasting glucose and insulin, tissue-type plasminogen activator (t-PA), plasminogen activator-inhibitor (PAI-1), D-dimer (DD) and prothrombin fragment 1 + 2 (F1+2). Insulin resistance, calculated by the HOMA model, and plasma levels of t-PA and PAI-1 were significantly higher in relatives of diabetics compared to controls. As far as the thrombin activation indexes are concerned, we detected a significant increase in DD and F1+2 in relatives of diabetics with hypertension compared to other study subjects. In conclusion, our data indicate that familial predisposition may influence the hemostatic system in first-degree relatives of diabetic and/or hypertensive patients.
Collapse
Affiliation(s)
- A Trifiletti
- Department of Internal Medicine, University of Messina, Italy.
| | | | | | | | | | | | | |
Collapse
|
36
|
Abstract
Patients with beta-thalassaemia major are susceptible to osteopenia due to several factors which interfere with bone remodeling. It is known that bone metabolism and skeletal consolidation result from a complex sequence of hormonal changes, where the concerted actions of GH, IGF-I and sex hormones and their receptors, are responsible for the timing and attainment of skeletal consolidation. IGF-I and the corresponding binding protein (IGFBP-III), markers of bone metabolism and lumbar and femoral neck BMD were measured in 28 adult patients, undergoing hormonal replacement and chelation therapy and a hypertransfusion program, with beta-thalassaemia major (12 males with mean age 22.5+/-3.1 and 16 females with mean age 27.5+/-8.2), and in 28 healthy volunteers matched for age, anthropometric features and sex to the patients. BMD values, both at lumbar and femoral neck level were significantly lower (p<0.001 and p<0.05) by 18.7 and 4.2% respectively, in patients than in the controls. Markers of bone resorption [pyridinoline (Pyr) 78.1+/-15.7 vs 47.5+/-11.2 pmol/pmol urinary creatinine, p<0.001 and deoxypyridinoline (D-Pyr) 21.9+/-3.5 vs 14.5+/-5.4 pmol/ micromol urinary creatinine, p<0.001] were higher in patients than in controls, whereas the marker of bone formation was slightly lower [osteocalcin (BGP) 3.8+/-0.6 vs 4.6+/-1.7 pmol/ml, p<0.05]. Plasma levels of IGF-I (21.07+/-5.12 vs 35.25+/-8.33 nmol/ml, p<0.001) and IGF binding protein III (IGFBP-III) (1.9+/-0.4 vs 2.5+/-0.1 mg/ml, p<0.001) were lower in patients than in controls and positively correlated with BMD L2-L4 (r=0.57, p<0.05 and r=0.47, p<0.05 respectively), BMD neck (r=0.40, p<0.05 and r=0.34, p<0.05 respectively) and BGP (r=0.52, p<0.05 and r=0.34, p<0.05 respectively). Our beta-thalassaemic patients, in spite of normalizing hemoglobin levels, adequate hormone replacement and chelation therapies, showed osteopenia and an unbalanced bone turnover with an increased resorptive phase and a decreased formation phase probably correlated to low levels of IGF-I and IGFBP-III observed in our study.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina, Italy.
| | | | | | | | | | | | | |
Collapse
|
37
|
Lasco A, Cannavò S, Gaudio A, Morabito N, Trifiletti A, Di Cesare E, Basile G, Nicita-Mauro V, Frisina N. Raloxifene and pituitary secretion in post-menopausal women. J Endocrinol Invest 2002; 25:95-6. [PMID: 12508935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Lasco A, Frisina N, Morabito N, Gaudio A, Morini E, Trifiletti A, Basile G, Nicita-Mauro V, Cucinotta D. Metabolic effects of dehydroepiandrosterone replacement therapy in postmenopausal women. Eur J Endocrinol 2001; 145:457-61. [PMID: 11581005 DOI: 10.1530/eje.0.1450457] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To investigate whether long-term treatment with dehydroepiandrosterone (DHEA) in postmenopausal women can modify insulin sensitivity and plasma lipid profile. DESIGN AND METHODS Twenty healthy postmenopausal women with serum dehydroepiandrosterone sulfate (DHEA-S) concentrations <2.5 micromol/l were enrolled and randomly assigned to two different treatment groups: group 1 were treated with micronized DHEA, 25 mg/day at 0800 h for 12 months; group 2 were treated with an identical placebo tablet. At the beginning and at the end of the study, plasma lipid profile, glucose tolerance (oral glucose tolerance test) and insulin sensitivity (euglycemic hyperinsulinemic clamp: M index) were assessed. RESULTS After 12 months, the group treated with DHEA showed a considerable improvement of insulin sensitivity (M index +29.55%, P=0.01) and lipid pattern (high-density lipoprotein cholesterol +11.61%, P=0.03; low-density lipoprotein cholesterol -11.07%, P=0.04; triglycerides -19.60%, P=0.03), but glucose tolerance did not change. No modifications were observed in the placebo group. CONCLUSIONS Long-term treatment with DHEA ameliorates some metabolic parameters that are linked to increased cardiovascular risk and, consequently, this seems to be an interesting therapeutic tool in the management of the postmenopausal syndrome.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina, Messina, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Saitta A, Altavilla D, Cucinotta D, Morabito N, Frisina N, Corrado F, D'Anna R, Lasco A, Squadrito G, Gaudio A, Cancellieri F, Arcoraci V, Squadrito F. Randomized, double-blind, placebo-controlled study on effects of raloxifene and hormone replacement therapy on plasma no concentrations, endothelin-1 levels, and endothelium-dependent vasodilation in postmenopausal women. Arterioscler Thromb Vasc Biol 2001; 21:1512-9. [PMID: 11557681 DOI: 10.1161/hq0901.095565] [Citation(s) in RCA: 129] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The endothelium is thought to play an important role in the genesis of atherosclerosis, and several lines of evidence suggest that the effect of an intervention on endothelial function might predict its involvement in coronary disease progression and in the rate of cardiovascular events. Estrogen has direct effects on the blood vessel wall, indicating that vascular endothelium may play a key role in the cardiovascular protective effects of hormone replacement therapy (HRT). Raloxifene relaxes coronary arteries in vitro by an estrogen receptor-dependent and NO-dependent mechanism, thus suggesting that this selective estrogen receptor modulator could also have beneficial effects on endothelial function. This study compared the effects of HRT and raloxifene on NO products, endothelin-1 plasma levels, and endothelium-dependent vasodilatation in postmenopausal women. Healthy postmenopausal women (n=90) were enrolled in a double-blind, randomized, placebo-controlled, 6-month trial. Women were randomly assigned to receive continuous HRT (1 mg 17beta-estradiol combined with 0.5 mg norethisterone acetate), raloxifene (60 mg/d), or placebo for 6 months. Flow-mediated endothelium-dependent vasodilation of the brachial artery, plasma NO concentrations, and endothelin levels were measured at baseline and after 6 months of therapy. The mean baseline level of NO breakdown products was 26.5+/-10.7 micromol/L and increased to 36.3+/-11.4 micromol/L after 6 months of treatment with raloxifene. The mean baseline plasma endothelin level was 17.3+/-8.9 pg/mL and decreased to 11.5+/-2.1 pg/mL after 6 months of treatment with the selective estrogen receptor modulator. The mean baseline ratio of NO (breakdown products) to endothelin was also significantly increased at the end of treatment with raloxifene. Postmenopausal women treated with HRT had similar changes in plasma nitrites/nitrates and endothelin levels as well as in the ratio of NO to endothelin. In contrast, these markers of endothelial function did not change in the placebo-treated women. Flow-mediated endothelium-dependent vasodilation of the brachial artery was 8.3+/-2.1% at baseline and increased to 12.3+/-2.1% after 6 months of treatment with raloxifene. HRT also caused a significant and similar increase in flow-mediated endothelium-dependent vasodilation. No change in flow-mediated vasodilation was observed in the participants treated with placebo. We conclude that raloxifene therapy and HRT influence endothelial function and improve flow-mediated endothelium-dependent vasodilation to a comparable extent in healthy postmenopausal women at least after a 6-month treatment period. However, further investigation is warranted to enhance our understanding of the mechanisms of the effect of raloxifene on vascular function and to determine whether its effect on endothelial function may contribute to the reduction in cardiovascular-related morbidity and mortality.
Collapse
Affiliation(s)
- A Saitta
- Department of Internal Medicine, Section of Pharmacology, University of Messina, Messina, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Trifiletti A, Scamardi R, Cincotta M, Sottilotta G, Gaudio A, Romano C, Sottile L, Lasco A. Correlation between family history of hypertension and haemostatic disorders. Minerva Med 2001; 92:19-21. [PMID: 11317134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
BACKGROUND The aim of this study was to evaluate whether a family history of hypertension is associated with haemostatic disorders. METHODS In 38 normotensive subjects with a family history of hypertension (relatives) and in 46 sex, age and body mass index matched controls with no family history of hypertension, tissue-type plasminogen activator (t-PA), plasminogen activator-inhibitor (PAI-1), D-dimer (DD) and prothrombin fragment 1+2 (F1+2) were evaluated. RESULTS The t-PA and PAI-1 observed values were significantly higher than the values detected in the controls. CONCLUSIONS These data seem to suggest a correlation between family history of hypertension and haemostatic disorders.
Collapse
Affiliation(s)
- A Trifiletti
- Department of Internal Medicine, University of Messina, Via Monsignor D'Arrigo, 23-98121 Messina, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
41
|
Lasco A, Morabito N, Gaudio A, Buemi M, Wasniewska M, Frisina N. Effects of hormonal replacement therapy on bone metabolism in young adults with beta-thalassemia major. Osteoporos Int 2001; 12:570-5. [PMID: 11527055 DOI: 10.1007/s001980170079] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of our cross-sectional study was to evaluate the effects of hormonal replacement therapy (HRT) on a population of young thalassemics in order to understand better the role of hypogonadism in the balance of bone metabolism. Markers of bone turnover and bone mineral density (BMD) were measured in 40 young patients (mean age 19.8 +/- 4.5 years) with beta-thalassemia major: 20 subjects were biochemically eugonadal. since they were undergoing HRT (group A, treated patients), and 20 were hypogonadic, having suspended HRT (group B, untreated patients). We also examined 20 healthy control subjects (group C) matched for age, anthropometric features and sex to the study groups. Our study shows that young thalassemic patients exhibit a significant loss of cortical and trabecular bone [aBMD L2-L4: 0.886 +/- 0.052 g/cm2 (group A), 0.726 +/- 0.040 g/cm2 (group B), 1.083 +/- 0.090 g/cm (group C); aBMD femoral neck: 0.890 +/- 0.071 g/cm2 (group A), 0.700 +/- 0.065 g/cm2 (group B), 0.934 +/- 0.076 g/ cm2 (group C)]. Osteoporosis is only observed at the lumbar level in treated thalassemic patients, while in untreated patients it involves the femoral neck also. Bone turnover in thalassemic patients is higher in the resorptive phase, than in the neoformation phase and this is more marked in hypogonadic untreated patients. In conclusion, our data demonstrate the important role played by hypogonadism in the development and deterioration of osteopenia/osteoporosis in thalassemia major. Consequently, sex hormone replacement therapy represents an appropriate tool in the prevention and treatment of osteoporosis in thalassemics, probably together with bisphosphonates in cases with severely increased bone resorption.
Collapse
Affiliation(s)
- A Lasco
- Department of Internal Medicine, University of Messina, Italy.
| | | | | | | | | | | |
Collapse
|
42
|
|
43
|
Cavallini G, Rigo L, Brunori MP, Moi A, Gaudio A, Di Francesco V, Frulloni L, Vaona B, Filippini M, Bovo P. Ultrasonography-secretin test pattern after acute administration of octreotide in healthy persons and in patients with recurrent acute pancreatitis. J Clin Gastroenterol 1997; 24:231-4. [PMID: 9252847 DOI: 10.1097/00004836-199706000-00010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The intravenous administration of octreotide stimulates sphincter of Oddi activity and impairs pancreatic flow into the duodenum. Postsecretin ultrasonography (US-S test) has revealed an increase in the caliber of the main pancreatic duct, which disappears in healthy persons approximately 10 minutes later as a result of the opening of the sphincter of Oddi and passage of stimulated fluids into the duodenum. We have assessed US-S test patterns after octreotide in healthy persons and in patients with recurrent acute pancreatitis. The study sample consisted of 16 participants: alcohol-abstinent, nonsmoking, healthy volunteers (four men, three women; mean age: 28 +/- 2.5 years) and nine patients with recurrent acute pancreatitis (six men, three women; mean age: 32.1 +/- 7.1 years). All participants underwent measurement of the main pancreatic duct at 1-min intervals for 60 min after secretin stimulation (1 IU/kg intravenous bolus). On a different day the same persons had repeated US-S tests 1 hour after administration of 0.1 mg octreotide intramuscularly. In both controls and patients with recurrent acute pancreatitis, octreotide administration induced an appreciable dilatation of the main pancreatic duct before secretin stimulation, and the caliber remained significantly increased throughout the duration of the test. These results suggest that a single administration of octreotide at the dose used (a) does not inhibit pancreatic secretion of basal and secretin-stimulated fluid within the first 60 min and (b) probably exerts an inhibitory effect on sphincter of Oddi relaxation. These findings warrant more intensive study given their therapeutic implications for acute pancreatic disease.
Collapse
Affiliation(s)
- G Cavallini
- Medical Department, University of Verona, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|