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D'Aiello A, Stiles B, Ohri N, Levy B, Cohen P, Halmos B. Perioperative Immunotherapy for Non-Small Cell Lung Cancer: Practical Application of Emerging Data and New Challenges. Clin Lung Cancer 2024:S1525-7304(24)00015-9. [PMID: 38462413 DOI: 10.1016/j.cllc.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/12/2024]
Abstract
Immune checkpoint inhibition, with or without chemotherapy, is an established standard of care for metastatic non-small cell lung cancer (NSCLC). For locally advanced NSCLC treated with chemoradiotherapy, consolidation immunotherapy has dramatically improved outcomes. Recently, immunotherapy has also been established as a valuable component of treatment for resectable NSCLC with pembrolizumab, atezolizumab, and nivolumab all approved for use in this setting. As more results read out from ongoing perioperative clinical trials, navigating treatment options will likely become increasingly complex for the practicing oncologist. In this paper, we distill key outcomes from major perioperative trials and highlight current knowledge gaps. In addition, we provide practical considerations for incorporating perioperative immunotherapy into the clinical management of operable NSCLC.
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Affiliation(s)
- Angelica D'Aiello
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY.
| | - Brendon Stiles
- Division of Thoracic Surgery and Surgical Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Nitin Ohri
- Department of Radiation Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Benjamin Levy
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Perry Cohen
- Division of Anatomic and Clinical Pathology, Department of Pathology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY
| | - Balazs Halmos
- Department of Oncology, Montefiore Einstein Comprehensive Cancer Center, Albert Einstein College of Medicine, Bronx, NY.
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Nassar AH, Kim SY, Aredo JV, Feng J, Shepherd F, Xu C, Kaldas D, Gray JE, Dilling TJ, Neal JW, Wakelee HA, Liu Y, Lin SH, Abuali T, Amini A, Nie Y, Patil T, Lobachov A, Bar J, Fitzgerald B, Fujiwara Y, Marron TU, Thummalapalli R, Yu H, Owen DH, Sharp J, Farid S, Rocha P, Arriola E, D'Aiello A, Cheng H, Whitaker R, Parikh K, Ashara Y, Chen L, Sankar K, Harris JP, Nagasaka M, Ayanambakkam A, Velazquez AI, Ragavan M, Lin JJ, Piotrowska Z, Wilgucki M, Reuss J, Luders H, Grohe C, Baena Espinar J, Feiner E, Punekar SR, Gupta S, Leal T, Kwiatkowski DJ, Mak RH, Adib E, Naqash AR, Goldberg SB. Consolidation Osimertinib Versus Durvalumab Versus Observation After Concurrent Chemoradiation in Unresectable EGFR-Mutant NSCLC: A Multicenter Retrospective Cohort Study. J Thorac Oncol 2024:S1556-0864(24)00032-7. [PMID: 38278303 DOI: 10.1016/j.jtho.2024.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 12/31/2023] [Accepted: 01/19/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION Durvalumab improves survival when used as consolidation therapy after chemoradiation (CRT) in patients with stage III NSCLC. The optimal consolidation therapy for patients with EGFR-mutant (EGFRmut) stage III NSCLC remains unknown. METHODS In this multi-institutional, international retrospective analysis across 24 institutions, we evaluated outcomes in patients with stage III EGFRmut NSCLC treated with concurrent CRT followed by consolidation therapy with osimertinib, durvalumab, or observation between 2015 and 2022. Kaplan-Meier method was used to estimate real-world progression-free survival (rwPFS, primary end point) and overall survival (secondary end point). Treatment-related adverse events (trAEs) during consolidation treatment were defined using Common Terminology Criteria for Adverse Events version 5.0. Multivariable Cox regression analysis was used. RESULTS Of 136 patients with stage III EGFRmut NSCLC treated with definitive concurrent CRT, 56 received consolidation durvalumab, 33 received consolidation osimertinib, and 47 was on observation alone. Baseline characteristics were similar across the three cohorts. With a median follow-up of 46 months for the entire cohort, the median duration of treatment was not reached (NR) for osimertinib (interquartile range: NR-NR) and was 5.5 (interquartile range: 2.4-10.8) months with durvalumab. After adjusting for nodal status, stage III A/B/C, and age, patients treated with consolidation osimertinib had significantly longer 24-month rwPFS compared to those treated with durvalumab or in the observation cohorts (osimertinib: 86%, durvalumab: 30%, observation: 27%, p < 0.001 for both comparisons). There was no difference in rwPFS between the durvalumab and the observation cohorts. No significant difference in overall survival across the three cohorts was detected, likely due to the limited follow-up. Any-grade trAE occurred in 52% (2 [6.1%] grade ≥3) and 48% (10 [18%] grade ≥3) of patients treated with osimertinib and durvalumab, respectively. Of 45 patients who progressed on consolidation durvalumab, 37 (82%) subsequently received EGFR tyrosine kinase inhibitors. Of these, 14 (38%) patients developed trAEs including five patients with pneumonitis (14%; 2 [5.4%] grade ≥3) and five patients with diarrhea (14%; 1 [2.7%] grade ≥3). CONCLUSIONS This study suggests that among patients with stage III unresectable NSCLC with a sensitizing EGFR mutation, consolidation osimertinib was associated with a significantly longer rwPFS compared to durvalumab or observation. No unanticipated safety signals were observed with consolidation osimertinib.
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Affiliation(s)
- Amin H Nassar
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - So Yeon Kim
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Jacqueline V Aredo
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Jamie Feng
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Frances Shepherd
- Department of Medical Oncology and Hematology, University Health Network, Princess Margaret Cancer Centre, Toronto, Canada
| | - Chao Xu
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David Kaldas
- Department of Internal Medicine, University of South Florida, Tampa, Florida; Department of Clinical Oncology, Cairo University, Cairo, Egypt
| | - Jhanelle E Gray
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Thomas J Dilling
- Thoracic Oncology Program, Moffitt Cancer Center, Tampa, Florida
| | - Joel W Neal
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Heather A Wakelee
- Division of Oncology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Yufei Liu
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven H Lin
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Tariq Abuali
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Arya Amini
- Department of Radiation Oncology, City of Hope National Cancer Center, Duarte, California
| | - Yunan Nie
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut
| | - Tejas Patil
- Department of Medicine, University of Colorado Cancer Center, Aurora, Colorado
| | - Anastasiya Lobachov
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jair Bar
- Institute of Oncology, Chaim Sheba Medical Center, Ramat Gan, Israel; School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Bailey Fitzgerald
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Yu Fujiwara
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Thomas U Marron
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Rohit Thummalapalli
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Helena Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Dwight H Owen
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - John Sharp
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Saira Farid
- The Ohio State University Comprehensive Cancer Center, Columbus, Ohio
| | - Pedro Rocha
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Edurne Arriola
- Medical Oncology Department, Hospital del Mar, Barcelona, Spain
| | - Angelica D'Aiello
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Haiying Cheng
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Ryan Whitaker
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Luxi Chen
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Kamya Sankar
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Jeremy P Harris
- Department of Radiation Oncology, University of California Irvine Medical Center, Orange, California
| | - Misako Nagasaka
- Division of Hematology and Oncology, Department of Medicine, University of California Irvine Medical Center, Orange, California
| | | | - Ana I Velazquez
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Meera Ragavan
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California
| | - Jessica J Lin
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Zofia Piotrowska
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Molly Wilgucki
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Joshua Reuss
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC
| | - Heike Luders
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | - Christian Grohe
- Klinik für Pneumologie-Evangelische Lungenklinik Berlin Buch, Berlin, Germany
| | | | - Ella Feiner
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Salman R Punekar
- Perlmutter Cancer Center, New York University Langone Health, New York, New York
| | - Shruti Gupta
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | - Ticiana Leal
- Department of Hematology and Medical Oncology, Thoracic Medical Oncology Program, Winship Cancer Institute, Emory University School of Medicine, Atlanta, Georgia
| | | | - Raymond H Mak
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Elio Adib
- Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sarah B Goldberg
- Department of Medicine (Medical Oncology), Yale School of Medicine, New Haven, Connecticut.
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D'Aiello A, Rahman N, Patrik Brodin N, Dave M, Jasra S, Kaubisch A, Kabarriti R, Chuy J. Hepatocellular Carcinoma in HIV-Infected Patients: Clinical Presentation and Outcomes in a Racially Diverse Urban Population. J Gastrointest Cancer 2023; 54:536-544. [PMID: 35534673 DOI: 10.1007/s12029-022-00833-z] [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] [Accepted: 04/27/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE As life expectancy for HIV patients improve, hepatocellular carcinoma (HCC) has become a non-AIDS defining illness with a high impact on morbidity and mortality of HIV-infected individuals. We sought to compare outcomes in HIV- versus non-HIV-infected patients treated for HCC at a multiethnic academic medical health system. METHODS A retrospective chart review of patients diagnosed with HCC from 1/1/2005 to 12/31/2016 was performed. Differences in characteristics among HIV and non-HIV subjects were assessed. Associations between HIV status, viral load, CD4 count, and overall survival (OS) were also assessed. RESULTS We identified 915 subjects (842 non-HIV and 73 with HIV). HIV-infected subjects were younger, predominantly male non-Hispanic Blacks, and more likely to have HBV and HCV co-infection, and alcohol use at diagnosis compared to non-HIV counterparts. Stage, MELD score, Child-Pugh, and ECOG performance status were similar. HIV-positive patients received systemic therapy at significantly higher rates and liver transplantation for HCC at significantly lower rates than those without HIV. The actuarial 3- and 5-year overall survival (OS) for all patients was 48.3% and 39.4%. For HIV-infected subjects, 3- and 5-year OS was significantly worse at 36.8% and 28.3% compared to 49.3% and 40.4%, respectively, for non-HIV subjects (log rank p = 0.033). CONCLUSIONS HIV-infected HCC patients have lower survival rates compared to those without HIV. Despite younger age and similar stage, MELD, and ECOG at diagnosis, HIV portends worse outcomes in patients with HCC.
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Affiliation(s)
- Angelica D'Aiello
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Numa Rahman
- Department of Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - N Patrik Brodin
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Manish Dave
- Department of Medicine (Hematology & Oncology), Saint Barnabas Medical Center, Livingston, NY, 07039, USA
| | - Sakshi Jasra
- Division of Hematology & Medical Oncology, University of Vermont, Larner College of Medicine, Burlington, VT, 05405, USA
| | - Andreas Kaubisch
- Department of Medicine (Hematology & Oncology), Saint Barnabas Medical Center, Livingston, NY, 07039, USA
| | - Rafi Kabarriti
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Jennifer Chuy
- Division of Hematology & Medical Oncology, NYU Langone Health, New York, NY, 10016, USA.
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D'Aiello A, Halmos B. Tissue-agnostic RET inhibition: can you trust your target? Lancet Oncol 2022; 23:1235-1237. [DOI: 10.1016/s1470-2045(22)00556-3] [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] [Received: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/26/2022]
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Cribari F, Conte C, Ruggio A, Narducci ML, D'Aiello A, Pedicino D, Biasucci LM, Liuzzo G. Levosimendan for acute right heart failure in COVID-19: another arrow in our quiver? Eur Rev Med Pharmacol Sci 2022; 26:5596-5600. [PMID: 35993658 DOI: 10.26355/eurrev_202208_29432] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE SARS-CoV-2 infection is associated with a higher risk of acute right heart failure (RHF) due to primary right ventricle (RV) dilation and systemic inflammatory response, which in turn lead to microvascular and cardiomyocytes dysfunction, local hypoxia and multi-organ failure. In this clinical setting, levosimendan could be a viable therapy thanks to its right-heart tropism and its additional pleiotropic properties. CASE REPORT We present the case of a 72 years-old man with positive nasopharyngeal swab for SARS-CoV-2 infection, mild pulmonary involvement and clinical signs of new-onset RHF. We started a 12-hour levosimendan cycle to improve RV performance and reduce cardiac filling pressures. RESULTS We obtained a net clinical benefit in terms of acute RHF-related signs and symptoms, progressive renal and liver function improvement and concomitant reduction of high-sensitivity C-Reactive Protein and Interleukin-6 (IL-6) levels. CONCLUSIONS Acute RHF during SARS-CoV-2 infection could be related to a convergent widespread systemic inflammatory response. Thanks to its anti-inflammatory and anti-remodeling properties, levosimendan might represent a viable therapy in this clinical setting, contributing to the dampening of the inflammatory response.
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Affiliation(s)
- F Cribari
- Catholic University of the Sacred Heart, Rome, Italy.
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Thakkar A, Cui Z, Peeke SZ, Shah N, Pradhan K, Lombardo A, Khatun F, Mustafa J, De Castro A, Gillick K, Joseph F, Naik A, Rahman S, D'Aiello A, Elkind R, Sakalian S, Fehn K, Wright K, Abreu M, Townsend-Nugent L, Chambers N, Mathew R, Binakaj D, Nelson R, Palesi C, Paroder M, Uehlinger J, Wang Y, Shi Y, Zang X, Wang H, Nishimura C, Ren X, Steidl UG, Gritsman K, Janakiram M, Kornblum N, Derman O, Mantzaris I, Shastri A, Bartash R, Puius Y, McCort M, Goldfinger M, Bachier-Rodriguez L, Verma A, Braunschweig I, Sica RA. Patterns of leukocyte recovery predict infectious complications after CD19 CAR-T cell therapy in a real-world setting. Stem Cell Investig 2021; 8:18. [PMID: 34631871 DOI: 10.21037/sci-2021-008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/03/2021] [Indexed: 01/31/2023]
Abstract
Background Adoptive immunotherapy using CD19-targeted Chimeric antigen receptor T cells (CAR-T) has revolutionized the treatment of relapsed/refractory diffuse large B-cell lymphoma (DLBCL). Data is limited on the propensity of infections and lymphohematopoietic reconstitution after Day 30 (D30) following CAR-T cell therapy. In this study, we evaluated the prevalence and nature of infectious complications in an expanded cohort of DLBCL patients treated with CD19 CAR-T therapy and its association with the dynamics of leukocyte subpopulation reconstitution post-CAR-T cell therapy. Methods We conducted a retrospective study including 19 patients who received axicabtagene ciloleucel and investigated associations between cytopenia and infectious complications after D30. Results Nineteen patients were included, consisting of 42% Hispanic, 32% Caucasian, 21% African-American, and 5% Asian subjects. Post-D30 of CAR-T infusion, 47% patients (n=9) developed an infection and 53% (n=10) remained infection-free. The most common infection type observed was viral (7 patients) followed by bacterial (5 patients) and fungal (3 patients). Of 25 total infectious events, 56% were grade 1 or 2 and 44% were grade 3 with 10 being viral in etiology. To determine the kinetics of lymphohematopoietic reconstitution and its association with infection risk, we evaluated the relationship between cytopenias and rates of infection after D30. Notably, compared to non-infection group, infection group had a higher median absolute lymphocyte count (ALC) (1,000/µL vs. 600/µL, P<0.05), a lower median absolute neutrophil count (ANC)/ALC ratio (1.6 vs. 3.1, P<0.05) and a lower median AMC/ALC at D30 (0.37 vs. 1.67, P<0.05). In addition, we observed that only 22% of patients had recovered ANC >1,500/µL in the infection group as opposed to 70% in the non-infection group at D90 (P<0.05). Fifty-eight percent of the patients (11/19) with relapsed refractory DLBCL achieved a complete response with a median follow-up of 233 days (7.7 months). Conclusions Although CAR-T cell therapy is highly effective, infectious complications remain an important cause of morbidity and mortality. Low ANC/ALC and AMC/ALC ratios at D30 are potential novel predictors of infection and can be considered in future prophylactic strategies.
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Affiliation(s)
- Astha Thakkar
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Zhu Cui
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Nishi Shah
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kith Pradhan
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amanda Lombardo
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fariha Khatun
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jennat Mustafa
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Alyssa De Castro
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Kailyn Gillick
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Felisha Joseph
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Anjali Naik
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Shafia Rahman
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Angelica D'Aiello
- Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard Elkind
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Susan Sakalian
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen Fehn
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Karen Wright
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michelly Abreu
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Latoya Townsend-Nugent
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Nicole Chambers
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rosmi Mathew
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Donika Binakaj
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Randin Nelson
- Department of Transfusion Medicine, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | - Carlo Palesi
- Department of Transfusion Medicine, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | - Monika Paroder
- Department of Transfusion Medicine, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | - Joan Uehlinger
- Department of Transfusion Medicine, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | - Yang Shi
- Department of Pathology, Montefiore Medical Center/Albert Einstein College of Medicine Bronx, NY, USA
| | | | - Hao Wang
- Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Xiaoxin Ren
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich G Steidl
- Department of Medicine, Albert Einstein College of Medicine Bronx, NY, USA
| | - Kira Gritsman
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Murali Janakiram
- Department of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA
| | - Noah Kornblum
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Ioannis Mantzaris
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Aditi Shastri
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Rachel Bartash
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yoram Puius
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Margaret McCort
- Division of Infectious Diseases, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mendel Goldfinger
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Amit Verma
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ira Braunschweig
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - R Alejandro Sica
- Division of Oncology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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7
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Bonanni A, Pedicino D, Vinci R, D'Aiello A, Ponzo M, Ciampi P, Pisano E, Canonico F, Di Sario M, Conte C, Cribari F, Grimaldi MC, Severino A, Crea F, Liuzzo G. Takotsubo syndrome: a way to reach a straightforward diagnosis. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1392] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background/Introduction
Acute stress-induced cardiomyopathy, also known as Takotsubo Syndrome (TTS), was originally classified as a benign disease. Nowadays, this assumption has changed, especially in its long-term outcome, due to TTS clinical presentation, that often mirrors the acute myocardial infarction (MI) phenotype. Current knowledge already delineate clinical features distinctive of TTS and MI patients, however, diagnosis requires multiple, expansive, and invasive medical examinations. Moreover, concerning the biological panorama, very slight is known and the lack of a tailored therapy is resented. Therefore, a biological profile for this clinical category could provide easier and less invasive diagnostic tools, leading edge towards novel therapeutic pathways.
Purpose
The aim of the study is to perform a biological profile of the TTS group compared to the ST Segment Elevation Myocardial Infarction (STEMI) in order to explore the molecular peculiarities attendant the pathophysiologic mechanisms.
Methods
We performed a gene expression array on two groups of pooled cDNA from peripheral blood mononuclear cells, from TTS (n=11) and STEMI (n=19) patients. We conducted gene expression validations for each enrolled patient through qPCR.
Results
Our preliminary data displayed several differences in gene expression levels of a grand number of cell adhesion signaling molecule between the two groups. As shown in figure 1, three gene were more expressed in TTS group: Nitric Oxide Synthase 3, also known as endothelial NOS (NOS3; p=0.002), Superoxide dismutase 1 (SOD1; p=0.03) and transferrin receptor (TFRC; p=0.005). Meanwhile, five gene displayed a higher expression in STEMI patients compared to TTS: phospholipase A2 Group 7 (PLA2G7; p=0.04), Galectin 8 (LGALS8; p=0.02), Intercellular Adhesion Molecule 1 (ICAM1; p=0.002), Hyaluronidase 2 (HYAL2; p=0.01) and Hyaluronan Receptor (CD44; p=0.0002).
Conclusions
The earliest results of this study led us to focus on fewer genes related to endothelial and oxidative stress pathways. TTS is habitually triggered by intense emotional or physical stress. Indeed, our results showed how TTS patients present higher expression of NOS3, SOD1 and TFRC, all components involved in the oxidative stress pathways. In STEMI patients, top expressed genes, such as HYAL2, CD44 and ICAM1, are all associated with extracellular matrix turnover, likely due to the presence of a stenotic plaque and the consequent endothelial derangement. The uncovering of diagnostic biomarkers in TTS might improve the early, non-invasive, stratification of this group of patients, thus facilitating novel and personalized therapeutics design.
Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The present study was supported by the Italian National Project Grant PRIN 2017.
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Affiliation(s)
- A Bonanni
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Pedicino
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R Vinci
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A D'Aiello
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Ponzo
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Ciampi
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - E Pisano
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Canonico
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Di Sario
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Conte
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Cribari
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M C Grimaldi
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Severino
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Liuzzo
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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8
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Vinci R, Pedicino D, Andreotti F, Russo G, D'Aiello A, De Cristofaro R, Crea F, Liuzzo G. From angiotensin-converting enzyme 2 disruption to thromboinflammatory microvascular disease: A paradigm drawn from COVID-19. Int J Cardiol 2021; 326:243-247. [PMID: 33181158 PMCID: PMC7654294 DOI: 10.1016/j.ijcard.2020.11.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/28/2020] [Accepted: 11/04/2020] [Indexed: 02/06/2023]
Abstract
We concisely review clinical, autopsy, experimental and molecular data of 2019 coronavirus disease (COVID-19). Angiotensin-converting enzyme 2 disruption and thromboinflammatory microangiopathy emerge as distinctive features. Briefly, entry of the virus into microvessels can profoundly disrupt the local renin-angiotensin system, cause endothelial injury, activate the complement cascade and induce powerful thromboinflammatory reactions, involving, in particular, von Willebrand factor, that, if widespread, may lead to microvascular plugging, ischemia and, ultimately, organ failure. We believe the current COVID-19 data consolidate a widely unrecognised paradigm of potentially fatal thromboinflammatory microvascular disease.
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Affiliation(s)
- R Vinci
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - D Pedicino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Andreotti
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - G Russo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - A D'Aiello
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - R De Cristofaro
- Haemorrhagic and Thrombotic Diseases, Fondazione Policlinico Universitario "A. Gemelli", IRCCS, Rome, Italy; Institute of Internal Medicine and Geriatrics, Catholic University School of Medicine, Rome, Italy
| | - F Crea
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Liuzzo
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy; Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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9
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D'Aiello A, Lin J, Gucalp R, Tabatabaie V, Cheng H, Bloomgarden N, Tomer Y, Halmos B. P09.03 Thyroid Dysfunction in Lung Cancer Patients Treated With Immune Checkpoint Inhibitors (ICI): Outcomes in a Multiethnic Urban Cohort. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.01.431] [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: 11/16/2022]
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10
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Russo G, Pedicino D, Burzotta F, Lodi Rizzini M, Genuardi L, Vinci R, Bologna M, D'Aiello A, Gallo D, Chiastra C, Aurigemma C, Bonanni A, Trani C, Liuzzo G, Crea F. Fluid-dynamics and biological features of unstable plaques: different shear stress for different plaques. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The use of Optical Coherence Tomography (OCT) in acute coronary syndromes (ACS) allows recognizing ruptured fibrous cap (RFC) and intact fibrous cap (IFC) culprit lesions. The biological differences between them, as recently pointed out in translation studies, highlight different mechanisms for a similar clinical manifestation that might deserve different therapeutic approaches. The relationship between endothelial wall shear stress (WSS) and ACS has been demonstrated, however the differences in WSS features between RFC and IFC have not been elucidated.
Purpose
The aim of this study is to provide a fluid-dynamic and biological description of unstable and stable (SA) plaques, according to OCT analysis.
Methods
We enrolled 10 SA and 20 Non-ST Elevation Myocardial Infarction (NSTEMI)-ACS patients, with IFC (n=10) and RFC (n=10) culprit lesions according to OCT analysis. We performed Real-time PCR primer array on pooled Peripheral Blood Mononuclear Cell (PBMC) for 30 different molecules whose expression is strictly dependent on WSS. High-fidelity 3D-coronary artery models were created for 3 patients per group, applying previously validated methodologies.
Results
Among the groups we found a broad difference in molecular expression (Fig. 1A), with RFC displaying higher levels of molecules involved in vasoconstriction/dilatation (EDN1, NOS3), cellular adhesion (ICAM1), and peptidase inhibition (PI16). A significantly higher WSS was observed in RFC group (p<0.001, Fig 1B and C), with larger variability and larger areas exposed to both low and high WSS (Fig. 1D). Interestingly, the molecules overexpressed in RFC are known to be upregulated by high WSS.
Conclusions
Our data demonstrated that IFC and RFC unstable plaques are associated with different WSS conditions, alongside with the expression of different molecular patterns specifically related to altered WSS. In the era of precision medicine these findings may have relevant therapeutical implications.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- G Russo
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Pedicino
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Burzotta
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Lodi Rizzini
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Turin, Italy
| | - L Genuardi
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - R Vinci
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M Bologna
- Politecnico di Milano, Biosignals, Bioimaging and Bioinformatics Laboratory (B3-Lab), Department of Electronics, Informatio, Milan, Italy
| | - A D'Aiello
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - D Gallo
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Turin, Italy
| | - C Chiastra
- Politecnico di Torino, Department of Mechanical and Aerospace Engineering, Turin, Italy
| | - C Aurigemma
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Bonanni
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Trani
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Liuzzo
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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11
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Pisano E, Severino A, Bugli F, Pedicino D, Paroni Sterbini F, Martini C, Vinci R, Canonico F, Bonanni A, D'Aiello A, Ciampi P, Ponzo M, Sanguinetti M, Crea F, Liuzzo G. Plaque instability in acute coronary syndromes: a possible pathogenic role of gut microbial communities. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The imbalance between protective and harmful bacteria in the microbial communities leads to a non-physiological condition, known as “dysbiosis”. In the last decade, several studies have suggested that gut microbiota can contribute to the development and progression of various disease including cardiovascular disease through metabolism-mediated pathways. The production and the release of bacterial metabolites, including Trimethylamine N-oxide (TMAO), can affect host health acting to distant organs.
Purpose
The aim of the present study was to explore the gut microbiota and the levels of TMAO in patients with stable angina (SA) and acute coronary syndrome (ACS) with or without elevation of the ST segment, respectively STEMI and NSTEMI, and in control subjects.
Methods
Feces were obtained from ACS (n=31) and SA (n=23) patients and controls (n=24). Genomic DNA was isolated using the QIamp DNA Stool Mini Kit. Samples were subjected to 16S rRNA gene V3–V4 region sequencing by an Illumina MiSeq TM platform. A combination of software packages QIIME and VSEARCH was used to generate a biological observation matrix (BIOM) at different taxonomic levels (from phylum to genus). The BIOM was analysed using the Web-based program MicrobiomeAnalyst. β-diversity between groups was obtained by weighted UniFrac distance metric analysis. Serum TMAO levels were measured with a UPLC-MS/MS mass spectrometry in SA and ACS patients.
Results
β-diversity analysis showed a different bacterial composition in SA and ACS patients and controls ([PERMANOVA] F-value: 1.9706; R-squared: 0.050567; p-value <0.018) (Figure 1A). In particular, analysis between the three groups revealed a significant enrichment of Streptococcus genus in ACS patients (Kruskas Wallis test; p=0.0085) (Figure 1B). Controls and ACS revealed a similar gut microbial composition ([PERMANOVA] F-value: 0.7591; R-squared: 0.014388; p-value <0.61) (Figure 2A); in contrast, controls and SA showed separate clusters according to relative differences in taxonomic composition ([PERMANOVA] F-value: 3.0498; R-squared: 0.064821 p-value <0.006) (Figure 2B). Finally, β-diversity analysis in SA and ACS revealed different microbial communities in the two groups [PERMANOVA] F-value: 2.5103; R-squared: 0.046051; p-value <0.025) (Figure 2C) that could partially explain the severity progression of cardiovascular disease. Serum TMAO levels were higher in STEMI (n=14) as compared to SA and to NSTEMI (n=16) (respectively p=0.016 and p=0.028) (Figure 3).
Conclusion
These results, taken together, suggest that gut microbiota and its derived metabolites might play an essential role in the progression of atherosclerosis and in coronary plaque instability.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): Linea D1 Università Cattolica del Sacro Cuore
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Affiliation(s)
- E Pisano
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
| | - A Severino
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Bugli
- Catholic University of the Sacred Heart, Rome, Italy
| | - D Pedicino
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
| | - F Paroni Sterbini
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
| | - C Martini
- Catholic University of the Sacred Heart, Rome, Italy
| | - R Vinci
- Catholic University of the Sacred Heart, Rome, Italy
| | - F Canonico
- Catholic University of the Sacred Heart, Rome, Italy
| | - A Bonanni
- Catholic University of the Sacred Heart, Rome, Italy
| | - A D'Aiello
- Polyclinic Agostino Gemelli IRCCS, Rome, Italy
| | - P Ciampi
- Polyclinic Agostino Gemelli IRCCS, Rome, Italy
| | - M Ponzo
- Polyclinic Agostino Gemelli IRCCS, Rome, Italy
| | - M Sanguinetti
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
| | - G Liuzzo
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Departement of Cardiovascular Science, Rome, Italy
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12
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Canonico F, Vinci R, Pedicino D, Pisano E, Ciampi P, Bonanni A, Ponzo M, D'Aiello A, Di Sario M, Severino A, D'Amario D, Niccoli G, Biasucci L, Crea F, Liuzzo G. Meta-inflammation in monocytes of patients with Acute Coronary Syndrome. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Several studies suggest that an alteration of monocyte metabolism might be implicated in inflammatory diseases. Enhanced glycolysis might be a hallmark of pro-inflammatory monocyte subsets. Improved glycolysis enables the immune cells to generate sufficient ATP and biosynthetic intermediates to carry out its particular effector functions. For macrophages this includes phagocytosis and inflammatory cytokine production. Pyruvate Kinase isozyme M2 (PKM-2) catalyzes the final step of glycolysis producing pyruvate and ATP. Latest studies have shown that a member of Jumonji family (JMJD8) acts as a positive regulator in TNF-induced NF-kB signaling leading to pro-inflammatory pathways in macrophages and is involved in angiogenesis and cellular metabolism through interacting with PKM-2 in endothelial cells.
Purpose
The aims of the study are to assess the expression of the glycolytic key enzyme PKM-2 in CD14+ monocytes obtained from patients with non-ST-elevation myocardial infarction (NSTEMI) or with stable angina (SA). Furthermore, the expression of JMJD8 was evaluated.
Methods
30 patients with NSTEMI and 30 patients with SA were enrolled. Peripheral blood mononuclear cells were obtained from whole blood samples. For cytoplasmatic protein identification, cells were fixed and permeabilized and then incubated with fluorochrome-conjugated mAbs anti-CD14, anti-PKM-2 and anti-JMJD8. For analysis we used Two-tailed Mann-Whitney non parametric Comparison test.
Results
CD14+ monocytes from NSTEMI patients showed reduced expression of the key glycolytic enzyme PKM-2 as compared to CD14+ monocytes from SA patients (p=0.02) (Figure 1). JMJD8 expression in NSTEMI patients is increased compared with SA patients (p=0.02) (Figure 2).
Conclusion
This study introduces a role for immune-metabolism in the immunity dysregulation described in ACS patients and provides novel insights into the mechanisms responsible for coronary instability. Taking their potential interaction into account, our data suggest that in acute setting glycolysis key enzyme PKM2 expression is downregulated. Besides, JMJD8 protein levels increase in NSTEMI patients acting as potential limiting factor of PKM2 function. Moreover, our data propose the potential roles of immune-metabolism to detect novel therapeutic targets, associated with an accurate patient stratification based on immune-metabolic profiles, for prevention and treatment of atherosclerosis, in the perspective of a personalized medicine approach.
Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Fondazione Policlinico A. Gemelli
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Affiliation(s)
- F Canonico
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - R Vinci
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - D Pedicino
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - E Pisano
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - P Ciampi
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - A Bonanni
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Ponzo
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - A D'Aiello
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - M Di Sario
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - A Severino
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - D D'Amario
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G Niccoli
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - L.M Biasucci
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - F Crea
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
| | - G Liuzzo
- Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy
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13
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D'Aiello A, Gucalp RA, Tabatabaie V, Cheng H, Bloomgarden NA, Halmos B. Thyroid dysfunction in lung cancer patients treated with immune checkpoint inhibitors (ICI): Role of race, gender, and concurrent chemotherapy in a multiethnic urban cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.e21622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21622 Background: Immune-related adverse events (irAE) associated with ICI have been reported, but remain poorly understood. We sought to characterize patterns of thyroid dysfunction—one of the most common irAE—in a large cohort of ethnically-diverse lung cancer patients treated with ICI. Methods: A retrospective chart review of lung cancer patients receiving an anti-PD1 or PD-L1 agent from January 2016 to July 2019 was performed. Subjects included had normal baseline thyroid function. Thyrotoxicosis and hypothyroidism was defined as thyroid-stimulating hormone level less than 0.4 and greater than 4.6, respectively. Time to event analysis with inverted Kaplan Meier curves and log-rank tests were used to compare thyroid dysfunction among race, gender, and treatment subgroups. Results: We identified 256 subjects: 206 had normal baseline thyroid function and 76 went on to develop thyroid dysfunction. Rates of thyroid dysfunction by one year occurred at similar frequencies among all races. Thyrotoxicosis occurred at significantly higher rates in Black (25, 31.7%) than in White (8, 12.9%) and Hispanic (7, 16.7%) subjects. In contrast, hypothyroidism occurred more often in White (13, 21.0%) and Hispanic (18, 42.9%) than in Black (12, 15.2%) subjects. Gender and concurrent chemotherapy showed no significant association with thyroid dysfunction. Of subjects with thyrotoxicosis (N = 42), hypothyroidism followed in 33.3% (N = 14) with 1 subject receiving methimazole and 13 levothyroxine. In those subjects, median time to thyrotoxicosis and hypothyroidism was 4.0 and 7.2 weeks, respectively. Conclusions: Despite the higher prevalence of non-ICI-related thyroid disease among females and the anticipated immunosuppressive effect of chemotherapy, neither gender nor chemotherapy correlated with thyroid dysfunction; however, race did. Black subjects exhibited significantly higher rates of thyrotoxicosis. Our findings are consistent with prior research showing that thyrotoxicosis, including Graves’ disease, occurs more often in Blacks. While the pathogenesis of ICI-related thyroid dysfunction is unclear, the early onset of thyrotoxicosis demonstrated by our study calls for careful monitoring, especially for particular races. [Table: see text]
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Affiliation(s)
- Angelica D'Aiello
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Rasim A. Gucalp
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Vafa Tabatabaie
- Department of Endocrinology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Haiying Cheng
- Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Noah A. Bloomgarden
- Department of Endocrinology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
| | - Balazs Halmos
- Department of Medical Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY
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Abstract
The management of advanced non-small cell lung cancer (NSCLC) has been revolutionized in recent years with the introduction of biomarker-targeted molecular therapies and immune checkpoint inhibitors. In contrast, since adjuvant chemotherapy was first established twenty years ago as the standard of care, little has changed for resected early-stage (IB-IIIA) patients for whom the potential for cure is greatest. In this manuscript we will review recently presented data as well as ongoing/planned studies in this arena. So far, investigative efforts have yielded mixed results regarding the use of tyrosine kinase inhibitors (TKIs) in early-stage NSCLC, though a series of now better planned, biomarker-driven ongoing phase III trials may be more informative. Several innovative immunotherapy studies have already shown promising results principally in the neoadjuvant setting with a large number of pivotal neo-adjuvant and adjuvant trials now in progress. Given the more robust design and biomarker-focused approach of the new generation of studies, significant advances in the optimal curative treatment of early stage NSCLC are anticipated.
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Affiliation(s)
- Jason E Sandler
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Angelica D'Aiello
- Department of Medicine, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
| | - Balazs Halmos
- Department of Oncology, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA
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15
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Vinci R, Pedicino D, Pisano E, Flego D, Giglio AF, Trotta F, Lucci C, Ruggio A, Ponzo M, D'Aiello A, Canonico F, Severino A, Biasucci LM, Liuzzo G, Crea F. P1692Increased expression of CD31 on platelets from patients with Non-ST segment Elevation Myocardial Infarction and its role in platelets-monocytes interaction. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p1692] [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] [Indexed: 11/12/2022] Open
Affiliation(s)
- R Vinci
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - D Pedicino
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - E Pisano
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - D Flego
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A F Giglio
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - F Trotta
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - C Lucci
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Ruggio
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - M Ponzo
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A D'Aiello
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - F Canonico
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - A Severino
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - L M Biasucci
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - G Liuzzo
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
| | - F Crea
- Catholic University of the Sacred Heart, Department of Cardiovascular and Thoracic Sciences, Rome, Italy
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16
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D'Aiello A, Keshavan MS. Mohan Agashe, M.D. eminent psychiatrist and veteran actor. Asian J Psychiatr 2013; 6:272-4. [PMID: 23642994 DOI: 10.1016/j.ajp.2013.03.002] [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] [Indexed: 11/16/2022]
Affiliation(s)
- Angelica D'Aiello
- Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
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