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Colombo C, Capsoni N, Russo F, Iannaccone M, Adamo M, Viola G, Bossi IE, Villanova L, Tognola C, Curci C, Morelli F, Guerrieri R, Occhi L, Chizzola G, Rampoldi A, Musca F, De Nittis G, Galli M, Boccuzzi G, Savio D, Bernasconi D, D’Angelo L, Garascia A, Chieffo A, Montorfano M, Oliva F, Sacco A. Ultrasound-Assisted, Catheter-Directed Thrombolysis for Acute Intermediate/High-Risk Pulmonary Embolism: Design of the Multicenter USAT IH-PE Registry and Preliminary Results. J Clin Med 2024; 13:619. [PMID: 38276125 PMCID: PMC10816433 DOI: 10.3390/jcm13020619] [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: 12/19/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/27/2024] Open
Abstract
Catheter-based revascularization procedures were developed as an alternative to systemic thrombolysis for patients with intermediate-high- and high-risk pulmonary embolisms. USAT IH-PE is a retrospective and prospective multicenter registry of such patients treated with ultrasound-facilitated, catheter-directed thrombolysis, whose preliminary results are presented in this study. The primary endpoint was the incidence of pulmonary hypertension (PH) at follow-up. Secondary endpoints were short- and mid-term changes in the echocardiographic parameters of right ventricle (RV) function, in-hospital and all-cause mortality, and procedure-related bleeding events. Between March 2018 and July 2023, 102 patients were included. The majority were at intermediate-high-risk PE (86%), were mostly female (57%), and had a mean age of 63.7 ± 14.5 years, and 28.4% had active cancer. Echocardiographic follow-up was available for 70 patients, and in only one, the diagnosis of PH was confirmed by right heart catheterization, resulting in an incidence of 1.43% (CI 95%, 0.036-7.7). RV echocardiographic parameters improved both at 24 h and at follow-up. In-hospital mortality was 3.9% (CI 95%, 1.08-9.74), while all-cause mortality was 11% (CI 95%, 5.4-19.2). Only 12% had bleeding complications, of whom 4.9% were BARC ≥ 3. Preliminary results from the USAT IH-PE registry showed a low incidence of PH, improvement in RV function, and a safe profile.
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Affiliation(s)
- Claudia Colombo
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.C.); (G.V.); (L.V.); (F.O.)
| | - Nicolò Capsoni
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (N.C.); (I.E.B.); (C.C.); (R.G.)
| | - Filippo Russo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (F.R.); (A.C.); (M.M.)
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, 10154 Turin, Italy; (M.I.); (G.B.)
| | - Marianna Adamo
- Institute of Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, 25123 Brescia, Italy;
| | - Giovanna Viola
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.C.); (G.V.); (L.V.); (F.O.)
| | - Ilaria Emanuela Bossi
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (N.C.); (I.E.B.); (C.C.); (R.G.)
| | - Luca Villanova
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.C.); (G.V.); (L.V.); (F.O.)
| | - Chiara Tognola
- 4th Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.T.); (L.O.); (F.M.)
| | - Camilla Curci
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (N.C.); (I.E.B.); (C.C.); (R.G.)
| | - Francesco Morelli
- Department of Interventional Radiology, Niguarda Cà Granda Hospital, 20142 Milan, Italy; (F.M.); (A.R.)
| | - Rossella Guerrieri
- Department of Emergency Medicine, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (N.C.); (I.E.B.); (C.C.); (R.G.)
| | - Lucia Occhi
- 4th Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.T.); (L.O.); (F.M.)
| | - Giuliano Chizzola
- Cardiac Catheterization Laboratory and Cardiology, ASST Spedali Civili di Brescia, 25121 Brescia, Italy;
| | - Antonio Rampoldi
- Department of Interventional Radiology, Niguarda Cà Granda Hospital, 20142 Milan, Italy; (F.M.); (A.R.)
| | - Francesco Musca
- 4th Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.T.); (L.O.); (F.M.)
| | - Giuseppe De Nittis
- Cardiovascular Interventional Unit, Cardiology Department, S. Anna Hospital, 10126 Como, Italy; (G.D.N.); (M.G.)
| | - Mario Galli
- Cardiovascular Interventional Unit, Cardiology Department, S. Anna Hospital, 10126 Como, Italy; (G.D.N.); (M.G.)
| | - Giacomo Boccuzzi
- Division of Cardiology, San Giovanni Bosco Hospital, 10154 Turin, Italy; (M.I.); (G.B.)
| | - Daniele Savio
- Department of Interventional Radiology, San Giovanni Bosco Hospital, 10154 Turin, Italy;
| | - Davide Bernasconi
- Bicocca Bioinformatics Biostatistics and Bioimaging (B4) Center, School of Medicine and Surgery, University of Milano-Bicocca, 20126 Bicocca, Italy;
- Department of Clinical Research and Innovation, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy
| | - Luciana D’Angelo
- 2nd Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.D.); (A.G.)
| | - Andrea Garascia
- 2nd Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (L.D.); (A.G.)
| | - Alaide Chieffo
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (F.R.); (A.C.); (M.M.)
| | - Matteo Montorfano
- Interventional Cardiology Unit, IRCCS San Raffaele Hospital, 20132 Milan, Italy; (F.R.); (A.C.); (M.M.)
| | - Fabrizio Oliva
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.C.); (G.V.); (L.V.); (F.O.)
| | - Alice Sacco
- 1st Division of Cardiology, De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, 20162 Milan, Italy; (C.C.); (G.V.); (L.V.); (F.O.)
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Conticchio M, Inchingolo R, Delvecchio A, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Peri-operative score for elderly patients with resectable hepatocellular carcinoma. World J Hepatol 2023; 15:1307-1314. [PMID: 38223412 PMCID: PMC10784806 DOI: 10.4254/wjh.v15.i12.1307] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/25/2023] [Accepted: 12/04/2023] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Liver resection is the mainstay for a curative treatment for patients with resectable hepatocellular carcinoma (HCC), also in elderly population. Despite this, the evaluation of patient condition, liver function and extent of disease remains a demanding process with the aim to reduce postoperative morbidity and mortality. AIM To identify new perioperative risk factors that could be associated with higher 90- and 180-d mortality in elderly patients eligible for liver resection for HCC considering traditional perioperative risk scores and to develop a risk score. METHODS A multicentric, retrospective study was performed by reviewing the medical records of patients aged 70 years or older who electively underwent liver resection for HCC; several independent variables correlated with death from all causes at 90 and 180 d were studied. The coefficients of Cox regression proportional-hazards model for six-month mortality were rounded to the nearest integer to assign risk factors' weights and derive the scoring algorithm. RESULTS Multivariate analysis found variables (American Society of Anesthesiology score, high rate of comorbidities, Mayo end stage liver disease score and size of biggest lesion) that had independent correlations with increased 90- and 180-d mortality. A clinical risk score was developed with survival profiles. CONCLUSION This score can aid in stratifying this population in order to assess who can benefit from surgical treatment in terms of postoperative mortality.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" Regional General Hospital, Acquaviva Delle Fonti 70021, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, Department of Radiology, "F. Miulli" Regional General Hospital, Acquaviva Delle Fonti 75100, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" Regional General Hospital, Acquaviva Delle Fonti 70021, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCSS San Raffaele Scientific Institute, Milan 20132, Italy
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, Milan 20132, Italy
| | - Maximiliano Gelli
- Département de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Paris 94800, France
| | | | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Assistance Publique-Hôpitaux de Paris, Créteil 94000, France
| | | | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Emanuele Felli
- Department of Surgery, Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg 67000, France
| | - Taiga Wakabayashi
- Department of Surgery, Institut de Recherche Contre les Cancers de l'Appareil Digestif (IRCAD), Strasbourg 67000, France
| | - Patrick Pessaux
- Service de Chirurgie Viscérale et Digestive, Nouvel Hôpital Civil, Unité INSERM U1110, Strasbourg 67000, France
| | - Tullio Piardi
- Department of Surgery, Hôpital Robert Debré, Reims 51092, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Nicola de'Angelis
- Assistance Publique-Hôpitaux de Paris, Centre Hospitalier Universitaire Henri Mondor, Paris 94000, France
| | - Javier Briceño
- Unit of Hepatobiliary Surgery and Liver Transplantation, Hospital University Reina Sofía, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
| | - Renè Adam
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Paris 94000, France
| | - Daniel Cherqui
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Paris 94000, France
| | - Luca Antonio Aldrighetti
- Hepatobiliary Surgery Division, IRCSS San Raffaele Scientific Institute, Milan 20132, Italy
- Hepatobiliary Surgery Division, Vita-Salute San Raffaele University, Milan 20132, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" Regional General Hospital, Acquaviva Delle Fonti 70021, Italy.
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Hwang H, Rampoldi A, Forghani P, Li D, Fite J, Boland G, Maher K, Xu C. Space microgravity increases expression of genes associated with proliferation and differentiation in human cardiac spheres. NPJ Microgravity 2023; 9:88. [PMID: 38071377 PMCID: PMC10710480 DOI: 10.1038/s41526-023-00336-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/21/2023] [Indexed: 04/12/2024] Open
Abstract
Efficient generation of cardiomyocytes from human-induced pluripotent stem cells (hiPSCs) is important for their application in basic and translational studies. Space microgravity can significantly change cell activities and function. Previously, we reported upregulation of genes associated with cardiac proliferation in cardiac progenitors derived from hiPSCs that were exposed to space microgravity for 3 days. Here we investigated the effect of long-term exposure of hiPSC-cardiac progenitors to space microgravity on global gene expression. Cryopreserved 3D hiPSC-cardiac progenitors were sent to the International Space Station (ISS) and cultured for 3 weeks under ISS microgravity and ISS 1 G conditions. RNA-sequencing analyses revealed upregulation of genes associated with cardiac differentiation, proliferation, and cardiac structure/function and downregulation of genes associated with extracellular matrix regulation in the ISS microgravity cultures compared with the ISS 1 G cultures. Gene ontology analysis and Kyoto Encyclopedia of Genes and Genomes mapping identified the upregulation of biological processes, molecular function, cellular components, and pathways associated with cell cycle, cardiac differentiation, and cardiac function. Taking together, these results suggest that space microgravity has a beneficial effect on the differentiation and growth of cardiac progenitors.
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Affiliation(s)
- Hyun Hwang
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Parvin Forghani
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Kevin Maher
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Li D, Armand LC, Sun F, Hwang H, Wolfson D, Rampoldi A, Liu R, Forghani P, Hu X, Yu WM, Qu CK, Jones DP, Wu R, Cho HC, Maxwell JT, Xu C. AMPK activator-treated human cardiac spheres enhance maturation and enable pathological modeling. Stem Cell Res Ther 2023; 14:322. [PMID: 37941041 PMCID: PMC10633979 DOI: 10.1186/s13287-023-03554-7] [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: 02/21/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Cardiac pathological outcome of metabolic remodeling is difficult to model using cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) due to low metabolic maturation. METHODS hiPSC-CM spheres were treated with AMP-activated protein kinase (AMPK) activators and examined for hiPSC-CM maturation features, molecular changes and the response to pathological stimuli. RESULTS Treatment of hiPSC-CMs with AMPK activators increased ATP content, mitochondrial membrane potential and content, mitochondrial DNA, mitochondrial function and fatty acid uptake, indicating increased metabolic maturation. Conversely, the knockdown of AMPK inhibited mitochondrial maturation of hiPSC-CMs. In addition, AMPK activator-treated hiPSC-CMs had improved structural development and functional features-including enhanced Ca2+ transient kinetics and increased contraction. Transcriptomic, proteomic and metabolomic profiling identified differential levels of expression of genes, proteins and metabolites associated with a molecular signature of mature cardiomyocytes in AMPK activator-treated hiPSC-CMs. In response to pathological stimuli, AMPK activator-treated hiPSC-CMs had increased glycolysis, and other pathological outcomes compared to untreated cells. CONCLUSION AMPK activator-treated cardiac spheres could serve as a valuable model to gain novel insights into cardiac diseases.
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Affiliation(s)
- Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lawrence C Armand
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Fangxu Sun
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Hyun Hwang
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - David Wolfson
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rui Liu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Parvin Forghani
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Xin Hu
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Wen-Mei Yu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Cheng-Kui Qu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dean P Jones
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Ronghu Wu
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Hee Cheol Cho
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Joshua T Maxwell
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Conticchio M, Inchingolo R, Delvecchio A, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali GC, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de’Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Impact of body mass index in elderly patients treated with laparoscopic liver resection for hepatocellular carcinoma. World J Gastrointest Surg 2023; 15:72-81. [PMID: 36741066 PMCID: PMC9896489 DOI: 10.4240/wjgs.v15.i1.72] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/14/2022] [Accepted: 12/07/2022] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The impact of obesity on surgical outcomes in elderly patients candidate for liver surgery is still debated.
AIM To evaluate the impact of high body mass index (BMI) on perioperative and oncological outcome in elderly patients (> 70 years old) treated with laparoscopic liver resection for hepatocellular carcinoma (HCC).
METHODS Retrospective multicenter study including 224 elderly patients (> 70 years old) operated by laparoscopy for HCC (196 with a BMI < 30 and 28 with BMI ≥ 30), observed from January 2009 to January 2019.
RESULTS After propensity score matching, patients in two groups presented comparable results, in terms of operative time (median range: 200 min vs 205 min, P = 0.7 respectively in non-obese and obese patients), complications rate (22% vs 26%, P = 1.0), length of hospital stay (median range: 4.5 d vs 6.0 d, P = 0.1). There are no significant differences in terms of short- and long-term postoperative results.
CONCLUSION The present study showed that BMI did not impact perioperative and oncologic outcomes in elderly patients treated by laparoscopic resection for HCC.
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Affiliation(s)
- Maria Conticchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Francesca Ratti
- Unit of Hepatobiliary Surgery, San Raffaele Hospital, Milano 20132, Italy
| | - Maximiliano Gelli
- Departement de Chirurgie Viscérale, Gustave Roussy Cancer Campus Grand Paris, Paris 94800, France
| | | | - Alexis Laurent
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Universitaire Henri Mondor, Créteil, Paris 94000, France
| | | | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Emanuele Felli
- Institut de Recherche Contre les Cancers de l’Appareil Digestif (IRCAD), Strasbourg 67000, France
| | - Taiga Wakabayashi
- Institut de Recherche Contre les Cancers de l’Appareil Digestif (IRCAD), Strasbourg 67000, France
| | - Patrick Pessaux
- Service de Chirurgie Viscérale et Digestive, Nouvel Hôpital Civil, Strasbourg 67000, France
| | - Tullio Piardi
- Department of Surgery, Hôpital Robert Debré, Reims 51092, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41121, Italy
| | - Nicola de’Angelis
- Assistance Publique-Hôpitaux de Paris, Department of Digestive and Hepatobiliary Surgery, Centre Hospitalier Universitaire Henri Mondor, Créteil, Paris 94000, France
| | - Javier Briceño
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
| | - Renè Adam
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Paris 94000, France
| | - Daniel Cherqui
- Department of Surgery, Centre Hepatobiliaire, Hopital Paul Brousse, Paris 94000, France
| | | | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
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Biffi A, Porcu G, Castellini G, Napoletano A, Coclite D, D’Angelo D, Fauci AJ, Iacorossi L, Latina R, Salomone K, Iannone P, Gianola S, Chiara O, Medici A, Mazzola A, Coniglio C, De Blasio E, Flego G, Geraci M, Maccauro G, Rampoldi A, Santolini F, Tacconi C, Tugnoli G, Stocchetti N, Fabbri A, Ruggeri MP, Seta MD, Pizzarelli S, Cammarano RR. Systemic hemostatic agents initiated in trauma patients in the pre-hospital setting: a systematic review. Eur J Trauma Emerg Surg 2022; 49:1259-1270. [DOI: 10.1007/s00068-022-02185-6] [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] [Received: 07/05/2022] [Accepted: 11/24/2022] [Indexed: 12/23/2022]
Abstract
Abstract
Purpose
The effect of systemic hemostatic agents initiated during pre-hospital care of severely injured patients with ongoing bleeding or traumatic brain injury (TBI) remains controversial. A systematic review and meta-analysis was therefore conducted to assess the effectiveness and safety of systemic hemostatic agents as an adjunctive therapy in people with major trauma and hemorrhage or TBI in the context of developing the Italian National Institute of Health guidelines on major trauma integrated management.
Methods
PubMed, Embase, and Cochrane Library databases were searched up to October 2021 for studies that investigated pre-hospital initiated treatment with systemic hemostatic agents. The certainty of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation approach, and the quality of each study was determined with the Cochrane risk-of-bias tool. The primary outcome was overall mortality, and secondary outcomes included cause-specific mortality, health-related quality of life, any adverse effects and blood product use, hemorrhage expansion, and patient-reported outcomes.
Results
Five trials of tranexamic acid (TXA) met the inclusion criteria for this meta-analysis. With a high certainty of evidence, when compared to placebo TXA reduced mortality at 24 h (relative risk = 0.83, 95% confidence interval = 0.73–0.94) and at 1 month among trauma patients (0.91, 0.85–0.97). These results depend on the subgroup of patients with significant hemorrhage because in the subgroup of TBI there are no difference between TXA and placebo. TXA also reduced bleeding death and multiple organ failure whereas no difference in health-related quality of life.
Conclusion
Balancing benefits and harms, TXA initiated in the pre-hospital setting can be used for patients experiencing major trauma with significant hemorrhage since it reduces the risk of mortality at 24 h and one month with no difference in terms of adverse effects when compared to placebo. Considering the subgroup of severe TBI, no difference in mortality rate was found at 24 h and one month. These results highlight the need to conduct future studies to investigate the role of other systemic hemostatic agents in the pre-hospital settings.
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Secco S, Brambillasca P, Morelli M, Sampogna G, Alfonsi A, Morelli F, Solcia M, Dell’Oglio P, Olivero A, Palagonia E, Spinelli M, Bocciardi A, Rampoldi A, Galfano A. Efficacy of prostate artery embolization in patients with indwelling bladder catheter. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)01155-7] [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: 11/05/2022] Open
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8
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Rampoldi A, Forghani P, Li D, Hwang H, Armand LC, Fite J, Boland G, Maxwell J, Maher K, Xu C. Space microgravity improves proliferation of human iPSC-derived cardiomyocytes. Stem Cell Reports 2022; 17:2272-2285. [PMID: 36084640 PMCID: PMC9561632 DOI: 10.1016/j.stemcr.2022.08.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [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] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/30/2022] Open
Abstract
In microgravity, cells undergo profound changes in their properties. However, how human cardiac progenitors respond to space microgravity is unknown. In this study, we evaluated the effect of space microgravity on differentiation of human induced pluripotent stem cell (hiPSC)-derived cardiac progenitors compared with 1G cultures on the International Space Station (ISS). Cryopreserved 3D cardiac progenitors were cultured for 3 weeks on the ISS. Compared with 1G cultures, the microgravity cultures had 3-fold larger sphere sizes, 20-fold higher counts of nuclei, and increased expression of proliferation markers. Highly enriched cardiomyocytes generated in space microgravity showed improved Ca2+ handling and increased expression of contraction-associated genes. Short-term exposure (3 days) of cardiac progenitors to space microgravity upregulated genes involved in cell proliferation, survival, cardiac differentiation, and contraction, consistent with improved microgravity cultures at the late stage. These results indicate that space microgravity increased proliferation of hiPSC-cardiomyocytes, which had appropriate structure and function. Cryopreserved 3D hiPSC-cardiac progenitors differentiated efficiently in space Microgravity cultures had increased sphere sizes and cellular proliferation Beating cardiomyocytes in microgravity cultures had improved Ca2+ handling Microgravity cultures had upregulated genes in cardiac contraction
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Affiliation(s)
- Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Parvin Forghani
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Hyun Hwang
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lawrence Christian Armand
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Joshua Maxwell
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Kevin Maher
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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9
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Sacco A, Serafini L, Occhi L, Morici N, Rampoldi A. Intermediate-high-risk pulmonary embolism treated with local ultrasound-facilitated thrombolysis: a single-center experience. J Cardiovasc Med (Hagerstown) 2022; 23:347-349. [PMID: 35013051 DOI: 10.2459/jcm.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alice Sacco
- Intensive Cardiac Care Unit, 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Lisa Serafini
- Medical School, Universita degli Studi Milano-Bicocca
| | - Lucia Occhi
- Cardiologia 4, 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
| | - Nuccia Morici
- Intensive Cardiac Care Unit, 'De Gasperis' Cardio Center, ASST Grande Ospedale Metropolitano Niguarda
- Department of Clinical Sciences and Community Health, Universita degli Studi di Milano
| | - Antonio Rampoldi
- Diagnostic Radiology and General Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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10
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Sampogna G, Barbosa F, Brambillasca PM, Montanari E, Rampoldi A, Spinelli M. Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease intermittent catheterization in case of concomitant benign prostatic hyperplasia. Spinal Cord Ser Cases 2022; 8:34. [PMID: 35332117 PMCID: PMC8948271 DOI: 10.1038/s41394-022-00499-6] [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: 07/04/2021] [Revised: 02/18/2022] [Accepted: 02/20/2022] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Case series. OBJECTIVES To assess the safety and efficacy of prostatic artery embolization (PAE) to reduce prostate volume (PV) and facilitate intermittent catheterization (IC) in individuals with concurrent benign prostatic hyperplasia (BPH) and spinal cord injury (SCI). SETTING Italian tertiary referral center for people with SCI. METHODS We retrospectively collected all data of individuals undergoing PAE from 2015 to 2020 because of BPH-related problems during IC. PAE was performed under local anesthesia with superselective catheterization of the prostatic arteries. Technical success was defined as bilateral embolization. We determined pre- and post-procedural PV by magnetic resonance imaging. RESULTS We considered 10 cases with tetraplegia (n = 5) and paraplegia (n = 5). Nine (90%) procedures were technically successful, while we performed monolateral PAE in one case. The median pre-procedural PV was 61 mL. After 6 months, all patients experienced significant PV reduction (median: 19.6%), and 7/7 patients with indwelling urinary catheter started successfully IC. Neither intra- nor post-procedural complications occurred within a median follow-up of 33 months. CONCLUSIONS PAE proved to be a safe and effective treatment for BPH to facilitate IC in people with SCI. Considering the minimal morbidity of PAE, further multi-center studies are mandatory to draw definitive conclusions and warrant its widespread adoption in this population.
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Affiliation(s)
- Gianluca Sampogna
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Fabiane Barbosa
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | | | - Emanuele Montanari
- Unit of Urology, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Antonio Rampoldi
- Unit of Interventional Radiology, Niguarda Hospital, Milan, Italy
| | - Michele Spinelli
- Unit of Neuro-Urology - Unipolar Spinal Unit, Niguarda Hospital, Milan, Italy.
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11
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Ferrario L, Garagiola E, Gerardi C, Bellavia G, Colombo S, Ticca C, Rossetti C, Ciboldi M, Meroni M, Vanzulli A, Rampoldi A, Bignardi T, Arrigoni F, Porazzi E, Foglia E. Innovative and conventional "conservative" technologies for the treatment of uterine fibroids in Italy: a multidimensional assessment. Health Econ Rev 2022; 12:21. [PMID: 35303183 PMCID: PMC8932203 DOI: 10.1186/s13561-022-00367-x] [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] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND To evaluate the potential benefits of the Magnetic Resonance-guided high intensity Focused Ultrasound (MRgFUS) introduction in the clinical practice, for the treatment of uterine fibroids, in comparison with the standard "conservative" procedures, devoted to women who wish to preserve their uterus or enhance fertility: myomectomy and uterine artery embolization (UAE). METHODS A Health Technology Assessment was conducted, assuming the payer's perspective (Italian National Healthcare Service). The nine EUnetHTA Core Model dimensions were deeply investigated, by means of i) a literature review; ii) the implementation of health economics tools (useful for uterine fibroids patients' clinical pathway economic evaluation, and budget impact analysis), to define MRgFUS economic and organizational sustainability, and iii) administration of specific questionnaires filled by uterine fibroids' experts, to gather their perceptions on the three possible conservative approaches (MRgFUS, UAE and myomectomy). RESULTS Literature revealed that MRgFUS would generate several benefits, from a safety and an efficacy profile, with significant improvement in symptoms relief. Advantages emerged concerning the patients' perspective, thus leading to a decrease both in the length of hospital stay (p-value< 0.001), and in patients' productivity loss (p-value = 0.024). From an economic point of view, the Italian NHS would present an economic saving of - 6.42%. A positive organizational and equity impact emerged regarding the capability to treat a larger number of women, thus performing, on average, 131.852 additional DRGs. CONCLUSIONS Results suggest that MRgFUS could be considered an advantageous technological alternative to adopt within the target population affected by uterine fibroids, demonstrating its economic and organisational feasibility and sustainability, with consequent social benefits.
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Affiliation(s)
- L Ferrario
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy.
| | - E Garagiola
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
| | - C Gerardi
- IRCCS- Istituto di Ricerche Farmacologiche "Mario Negri", Milan, Italy
| | - G Bellavia
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - S Colombo
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Ticca
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - C Rossetti
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Ciboldi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - M Meroni
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Vanzulli
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - A Rampoldi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - T Bignardi
- ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - E Porazzi
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
| | - E Foglia
- Centre for Health Economics, Social and Health Care Management, LIUC- Università Cattaneo, Corso Matteotti, 22, 21053, Catellanza, VA, Italy
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12
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Centonze L, Vella I, Morelli F, Checchini G, De Carlis R, Rampoldi A, Lauterio A, Andorno E, De Carlis L. Portal Steal Syndrome From a Large Linton's Splenorenal Shunt after Liver Transplantation: Successful Endovascular Management Through Off-Label Application of a 30 mm Amplatzer Cardiac Plug. Vasc Endovascular Surg 2022; 56:308-311. [PMID: 34978227 DOI: 10.1177/15385744211068614] [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] [Indexed: 11/17/2022]
Abstract
A 34-year-old patient underwent liver transplantation for progressive hepatic failure in the setting of congenital hepatic fibrosis. In past medical history, the patient had undergone splenectomy with proximal Linton's splenorenal surgical shunt creation for symptomatic portal hypertension with hypersplenism. The patient developed an early allograft dysfunction, with radiologic evidence of a reduced portal flow associated to portal steal from the patent surgical shunt. The patient was successfully treated through endovascular placement of a 30 mm Amplatzer cardiac plug at the origin of the splenic vein.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Ivan Vella
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Morelli
- Department of Interventional Radiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Giuliana Checchini
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Rampoldi
- Department of Interventional Radiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Enzo Andorno
- Department of General Surgery, 9338IRCCS Azienda Ospedaliera Universitaria San Martino, Genoa, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.,School of Medicine, University of Milan-Bicocca, Milan, Italy
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13
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Delvecchio A, Inchingolo R, Laforgia R, Ratti F, Gelli M, Anelli MF, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Liver resection vs radiofrequency ablation in single hepatocellular carcinoma of posterosuperior segments in elderly patients. World J Gastrointest Surg 2021; 13:1696-1707. [PMID: 35070074 PMCID: PMC8727180 DOI: 10.4240/wjgs.v13.i12.1696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/30/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver resection and radiofrequency ablation are considered curative options for hepatocellular carcinoma. The choice between these techniques is still controversial especially in cases of hepatocellular carcinoma affecting posterosuperior segments in elderly patients.
AIM To compare post-operative outcomes between liver resection and radiofrequency ablation in elderly with single hepatocellular carcinoma located in posterosuperior segments.
METHODS A retrospective multicentric study was performed enrolling 77 patients age ≥ 70-years-old with single hepatocellular carcinoma (≤ 30 mm), located in posterosuperior segments (4a, 7, 8). Patients were divided into liver resection and radiofrequency ablation groups and preoperative, peri-operative and long-term outcomes were retrospectively analyzed and compared using a 1:1 propensity score matching.
RESULTS After propensity score matching, twenty-six patients were included in each group. Operative time and overall postoperative complications were higher in the resection group compared to the ablation group (165 min vs 20 min, P < 0.01; 54% vs 19% P = 0.02 respectively). A median hospital stay was significantly longer in the resection group than in the ablation group (7.5 d vs 3 d, P < 0.01). Ninety-day mortality was comparable between the two groups. There were no significant differences between resection and ablation group in terms of overall survival and disease free survival at 1, 3, and 5 years.
CONCLUSION Radiofrequency ablation in posterosuperior segments in elderly is safe and feasible and ensures a short hospital stay, better quality of life and does not modify the overall and disease-free survival.
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Affiliation(s)
- Antonella Delvecchio
- Unit of General Surgery, "A. Perrino" Hospital, Ceglie Messapica 70124, Bari, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 75100, Italy
| | - Rita Laforgia
- Unit of Laparoscopic Surgery, University of Bari, Bary 70124, Italy
| | - Francesca Ratti
- Unit of Hepato-Pancreatic-Biliary Surgery, University Vita Salute San Raffaele, Milan 20132, Italy
| | - Maximiliano Gelli
- Department of Surgical Oncology, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
| | | | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Henry Mondor University Hospital, Creteil 94000, France
| | - Giulio Vitali
- Division of Transplantation, Geneva University Hospital, Geneva 44041, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Emanuele Felli
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Taiga Wakabayashi
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Patrick Pessaux
- Department of Digestive Surgery, Strasbourg University Hospital, Strasbourg 67000, France
| | - Tullio Piardi
- Department of Digestive and Hepatobiliary Surgery, Robert Debrè University Hospital, Reims 51100, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 42121, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
| | - Javier Briceño
- Department of General Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20162, Italy
| | - Renè Adam
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | - Daniel Cherqui
- Department of Hepatobiliary Surgery, Paul Brousse University Hospital, Villejuif 94800, France
| | | | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70124, Italy
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14
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D'Amico G, Maruzzelli L, Airoldi A, Petridis I, Tosetti G, Rampoldi A, D'Amico M, Miraglia R, De Nicola S, La Mura V, Solcia M, Volpes R, Perricone G, Sgrazzutti C, Vanzulli A, Primignani M, Luca A, Malizia G, Federico A, Dallio M, Andriulli A, Iacobellis A, Addario L, Garcovich M, Gasbarrini A, Chessa L, Salerno F, Gobbo G, Merli M, Ridola L, Baroni GS, Tarantino G, Caporaso N, Morisco F, Pozzoni P, Colli A, Belli LS. Performance of the model for end-stage liver disease score for mortality prediction and the potential role of etiology. J Hepatol 2021; 75:1355-1366. [PMID: 34333100 DOI: 10.1016/j.jhep.2021.07.018] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 07/02/2021] [Accepted: 07/16/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Although the discriminative ability of the model for end-stage liver disease (MELD) score is generally considered acceptable, its calibration is still unclear. In a validation study, we assessed the discriminative performance and calibration of 3 versions of the model: original MELD-TIPS, used to predict survival after transjugular intrahepatic portosystemic shunt (TIPS); classic MELD-Mayo; and MELD-UNOS, used by the United Network for Organ Sharing (UNOS). We also explored recalibrating and updating the model. METHODS In total, 776 patients who underwent elective TIPS (TIPS cohort) and 445 unselected patients (non-TIPS cohort) were included. Three, 6 and 12-month mortality predictions were calculated by the 3 MELD versions: discrimination was assessed by c-statistics and calibration by comparing deciles of predicted and observed risks. Cox and Fine and Grey models were used for recalibration and prognostic analyses. RESULTS In the TIPS/non-TIPS cohorts, the etiology of liver disease was viral in 402/188, alcoholic in 185/130, and non-alcoholic steatohepatitis in 65/33; mean follow-up±SD was 25±9/19±21 months; and the number of deaths at 3-6-12 months was 57-102-142/31-47-99, respectively. C-statistics ranged from 0.66 to 0.72 in TIPS and 0.66 to 0.76 in non-TIPS cohorts across prediction times and scores. A post hoc analysis revealed worse c-statistics in non-viral cirrhosis with more pronounced and significant worsening in the non-TIPS cohort. Calibration was acceptable with MELD-TIPS but largely unsatisfactory with MELD-Mayo and -UNOS whose performance improved much after recalibration. A prognostic analysis showed that age, albumin, and TIPS indication might be used to update the MELD. CONCLUSIONS In this validation study, the performance of the MELD score was largely unsatisfactory, particularly in non-viral cirrhosis. MELD recalibration and candidate variables for an update to the MELD score are proposed. LAY SUMMARY While the discriminative performance of the model for end-stage liver disease (MELD) score is credited to be fair to good, its calibration, the correspondence of observed to predicted mortality, is still unsettled. We found that application of 3 different versions of the MELD in 2 independent cirrhosis cohorts yielded largely imprecise mortality predictions particularly in non-viral cirrhosis. Thus, we propose a recalibration and suggest candidate variables for an update to the model.
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Affiliation(s)
- Gennaro D'Amico
- Gatroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Gastroenterology Unit, Clinica La Maddalena, Palermo, Italy.
| | - Luigi Maruzzelli
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Aldo Airoldi
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Ioannis Petridis
- Hepatology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giulia Tosetti
- Gastroenterology and Hepatology Unit Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | | | - Mario D'Amico
- Radiology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy; Radiology Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Roberto Miraglia
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Stella De Nicola
- Hepatology and Gastroenterology Unit, ASST GOM Niguarda, Milan, Italy
| | - Vincenzo La Mura
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione Luigi Villa, Milan, Italy
| | - Marco Solcia
- Interventional Radiology Unit, ASST GOM Niguarda, Milan, Italy
| | - Riccardo Volpes
- Hepatology Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | | | - Cristiano Sgrazzutti
- University of Milan, Department of Oncology and Hemato-oncology and Radiology, Department ASST Niguarda, Milan, Italy
| | - Angelo Vanzulli
- University of Milan, Department of Oncology and Hemato-oncology and Radiology, Department ASST Niguarda, Milan, Italy
| | - Massimo Primignani
- Gastroenterology and Hepatology Unit Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, CRC "A. M. and A. Migliavacca" Center for Liver Disease, Milan, Italy
| | - Angelo Luca
- Radiology Service, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (IRCCS-ISMETT), Palermo, Italy
| | - Giuseppe Malizia
- Gatroenterology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Italy
| | - Alessandro Federico
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Marcello Dallio
- Hepato-Gastroenterology Unit, Department of Precision Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Angelo Andriulli
- Department of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Angelo Iacobellis
- Department of Gastroenterology and Endoscopy, Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Matteo Garcovich
- Department of Internal Medicine and Gastroenterology, Policlinico Gemelli, Rome, Italy
| | - Antonio Gasbarrini
- Department of Internal Medicine and Gastroenterology, Policlinico Gemelli, Rome, Italy
| | - Luchino Chessa
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Giulia Gobbo
- Internal Medicine Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Manuela Merli
- Gastroenterology and Hepatology Unit, Department of Translational and Precision Medicine, Università Sapienza, Roma, Italy
| | - Lorenzo Ridola
- Gastroenterology Unit, ASL Latina, Department of Translational and Precision Medicine, "Sapienza" University of Rome, Italy
| | | | - Giuseppe Tarantino
- Liver Injury and Transplant Unit, Polytechnic University of Marche, Ancona, Italy
| | - Nicola Caporaso
- Gastroenterology Unit, Federico II University, Naples, Italy
| | | | - Pietro Pozzoni
- General Medicine Unit,Presidio Ospedaliero, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy
| | - Agostino Colli
- General Medicine Unit,Presidio Ospedaliero, Azienda Socio Sanitaria Territoriale di Lecco, Lecco, Italy
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Sampogna G, Barbosa F, Brambillasca P, Montanari E, Rampoldi A, Spinelli M. Prostatic artery embolization in people with spinal cord injury: a safe and effective technique to ease clean intermittent catheterizations in case of concomitant benign prostatic hyperplasia. EUR UROL SUPPL 2021. [DOI: 10.1016/s2666-1683(21)00809-0] [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] Open
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16
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Conticchio M, Inchingolo R, Delvecchio A, Laera L, Ratti F, Gelli M, Anelli F, Laurent A, Vitali G, Magistri P, Assirati G, Felli E, Wakabayashi T, Pessaux P, Piardi T, di Benedetto F, de'Angelis N, Briceño J, Rampoldi A, Adam R, Cherqui D, Aldrighetti LA, Memeo R. Radiofrequency ablation vs surgical resection in elderly patients with hepatocellular carcinoma in Milan criteria. World J Gastroenterol 2021; 27:2205-2218. [PMID: 34025074 PMCID: PMC8117730 DOI: 10.3748/wjg.v27.i18.2205] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/13/2021] [Accepted: 04/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Surgical resection and radiofrequency ablation (RFA) represent two possible strategy in treatment of hepatocellular carcinoma (HCC) in Milan criteria.
AIM To evaluate short- and long-term outcome in elderly patients (> 70 years) with HCC in Milan criteria, which underwent liver resection (LR) or RFA.
METHODS The study included 594 patients with HCC in Milan criteria (429 in LR group and 165 in RFA group) managed in 10 European centers. Statistical analysis was performed using the Kaplan-Meier method before and after propensity score matching (PSM) and Cox regression.
RESULTS After PSM, we compared 136 patients in the LR group with 136 patients in the RFA group. Overall survival at 1, 3, and 5 years was 91%, 80%, and 76% in the LR group and 97%, 67%, and 41% in the RFA group respectively (P = 0.001). Disease-free survival at 1, 3, and 5 years was 84%, 60% and 44% for the LR group, and 63%, 36%, and 25% for the RFA group (P = 0.001).Postoperative Clavien-Dindo III-IV complications were lower in the RFA group (1% vs 11%, P = 0.001) in association with a shorter length of stay (2 d vs 7 d, P = 0.001).In multivariate analysis, Model for End-stage Liver Disease (MELD) score (> 10) [odds ratio (OR) = 1.89], increased value of international normalized ratio (> 1.3) (OR = 1.60), treatment with radiofrequency (OR = 1.46) ,and multiple nodules (OR = 1.19) were independent predictors of a poor overall survival while a high MELD score (> 10) (OR = 1.51) and radiofrequency (OR = 1.37) were independent factors associated with a higher recurrence rate.
CONCLUSION Despite a longer length of stay and a higher rate of severe postoperative complications, surgery provided better results in long-term oncological outcomes as compared to ablation in elderly patients (> 70 years) with HCC in Milan criteria.
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Affiliation(s)
- Maria Conticchio
- Departement of Emergency and Trasplantation of Organs, General Surgery Unit “M. Rubino”, Policlinico di Bari, Bari 70124, Italy
| | - Riccardo Inchingolo
- Interventional Radiology Unit, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Antonella Delvecchio
- Department of Emergency and Organ Transplantation, General Surgery Unit “M. Rubino”, University of Bari, Ceglie Messapica 70124, Italy
| | - Letizia Laera
- Department of Oncology, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Francesca Ratti
- Department of Surgery, Univ Vita Salute San Raffaele, Milan 20132, Italy
| | - Maximiliano Gelli
- Department of Visceral and Oncological Surgery, Gustave Roussy Cancer Campus Grand Paris, Villejuif 94800, France
| | - Ferdinando Anelli
- Unit of Oncologic and Pancreatic Surgery, Hospital University Reina Sofía, Cordoba 14004, Spain
| | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery, Henri Mondor University Hospital, Creteil 94000, France
| | - Giulio Vitali
- Department of Surgery, University of Geneva Hospitals, Geneva 44041, Switzerland
| | - Paolo Magistri
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Giacomo Assirati
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Emanuele Felli
- Institut de Recherche Contre les Cancers de l'Appareil Digestif, Strasbourg 67000, France
| | - Taiga Wakabayashi
- Department of Surgery, Keio University School of Medicine, Shinjuku-ku 160-8582, Japan
| | - Patrick Pessaux
- Hepato-Biliary and Pancreatic Surgical Unit, Nouvel Hôpital Civil, Strasbourg cedex 67091, France
| | - Tullio Piardi
- Department of Hepatobiliary, Pancreatic and Digestive Surgery, University Hospital Robert Debré of Reims, Reims 51100, France
- Hepatobiliary and Pancreatic Surgery Unit, General Surgery Departement, Troyes Hospital, Troyes Zip or Postal Code, France
- University of Champagne - Ardenne, Reims 51100, France
| | - Fabrizio di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Nicola de'Angelis
- Unit of Minimally Invasive and Robotic Digestive Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
| | - Javier Briceño
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba 14004, Spain
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Hospital, Milan 20132, Italy
| | - Renè Adam
- Department of Surgery, Hopital Paul Brousse, Villejuif 94800, France
| | - Daniel Cherqui
- Hepatobiliary Center, Hopital Paul Brousse, Villejuif 94800, France
| | | | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, "F. Miulli" General Regional Hospital, Acquaviva delle Fonti 70021, Italy
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Centonze L, Di Sandro S, Lauterio A, De Carlis R, Frassoni S, Rampoldi A, Tuscano B, Bagnardi V, Vanzulli A, De Carlis L. Surgical Resection vs. Percutaneous Ablation for Single Hepatocellular Carcinoma: Exploring the Impact of Li-RADS Classification on Oncological Outcomes. Cancers (Basel) 2021; 13:1671. [PMID: 33916311 PMCID: PMC8038048 DOI: 10.3390/cancers13071671] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/25/2021] [Accepted: 03/31/2021] [Indexed: 02/06/2023] Open
Abstract
Background: Single hepatocellular carcinoma (HCC) benefits from surgical resection (SR) or US-guided percutaneous ablation (PA), although the best approach is still debated. We evaluated the impact of Li-RADS classification on the oncological outcomes of SR vs. PA as single HCC first-line treatment. Methods: We retrospectively and blindly classified treatment-naïve single HCC that underwent SR or PA between 2010 and 2016 according to Li-RADS protocol. Overall survival (OS), recurrence free survival (RFS) and local recurrence after SR and PA were compared for each Li-RADS subclass before and after propensity-score matching (PS-M). Results: Considering the general population, SR showed better 5-year OS (68.3% vs. 52.2%; p = 0.049) and RFS (42.5% vs. 29.8%; p = 0.002), with lower incidence of local recurrence (8.2% vs. 44.4%; p < 0.001), despite a significantly higher frequency of clinically-relevant complications (12.8% vs. 1.9%; p = 0.002) and a higher Comprehensive Complication Index (12.1 vs. 2.2; p < 0.001). Focusing on different Li-RADS subclasses, we highlighted better 5-year OS (67.1% vs. 46.2%; p = 0.035), RFS (45.0% vs. 27.0% RFS; p < 0.001) and lower incidence of local recurrence (9.7% vs. 48.6%; p < 0.001) after SR for Li-RADS-5 HCCs, while these outcomes did not differ for Li-RADS-3/4 subclasses; such results were confirmed after PS-M. Conclusions: Our analysis suggests a potential prognostic role of Li-RADS classification, supporting SR over PA especially for Li-RADS-5 single HCC.
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Affiliation(s)
- Leonardo Centonze
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Riccardo De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
| | - Samuele Frassoni
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Antonio Rampoldi
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Bruno Tuscano
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20126 Milan, Italy; (S.F.); (V.B.)
| | - Angelo Vanzulli
- Department of Diagnostic and Interventional Radiology, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (A.R.); (B.T.); (A.V.)
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, Niguarda Ca’ Granda Hospital, 20162 Milan, Italy; (S.D.S.); (A.L.); (R.D.C.); (L.D.C.)
- School of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy
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Saraf A, Rampoldi A, Chao M, Li D, Armand L, Hwang H, Liu R, Jha R, Fu H, Maxwell JT, Xu C. Functional and molecular effects of TNF-α on human iPSC-derived cardiomyocytes. Stem Cell Res 2021; 52:102218. [PMID: 33592567 PMCID: PMC8080119 DOI: 10.1016/j.scr.2021.102218] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 01/02/2021] [Accepted: 01/25/2021] [Indexed: 12/17/2022] Open
Abstract
Proinflammatory molecule tumor necrosis factor alpha (TNF-α) is predominantly elevated in cytokine storm as well as worsening cardiac function. Here we model the molecular and functional effects of TNF-α in cardiomyocytes (CMs) derived from human induced pluripotent stem cells (hiPSC). We found that treatment of hiPSC-CMs with TNF-α increased reactive oxygen species (ROS) and caspase 3/7 activity and caused cell death and apoptosis. TNF-α treatment also resulted in dysregulation of cardiomyocyte function with respect to the increased abnormal calcium handling, calcium wave propagation between cells and excitation–contraction coupling. We also uncovered significant changes in gene expression and protein localization caused by TNF-α treatment. Notably, TNF-α treatment altered the expression of ion channels, dysregulated cadherins, and affected the localization of gap-junction protein connexin-43. In addition, TNF-α treatment up-regulated IL-32 (a human specific cytokine, not present in rodents and an inducer of TNF-α) and IL-34 and down-regulated glutamate receptors and cardiomyocyte contractile proteins. These findings provide insights into the molecular and functional consequences from the exposure of human cardiomyocytes to TNF-α. Our study provides a model to incorporate inflammatory factors into hiPSC-CM-based studies to evaluate mechanistic aspects of heart disease.
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Affiliation(s)
- Anita Saraf
- Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA; Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA; University of Pittsburgh, Department of Medicine and Pediatrics and McGowan Regenerative Institute, 200 Lothorop Street, PUH, Pittsburgh, PA 15213, USA.
| | - Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Myra Chao
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Lawrence Armand
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Hyun Hwang
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Rui Liu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Rajnesh Jha
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Haian Fu
- Emory Chemical Biology Discovery Center and the Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Joshua T Maxwell
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA 30322, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30322, USA.
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19
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Bissacco D, Barbosa F, Castronovo EL, Alfonsi A, Solcia M, Rampoldi A. Endovascular approach for arteriovenous limb malformations: a single center experience. INT ANGIOL 2021; 40:165-169. [PMID: 33496159 DOI: 10.23736/s0392-9590.21.04598-3] [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: 11/08/2022]
Abstract
BACKGROUND To assess imaging findings, describe endovascular technical aspects and analyzed procedural outcomes in a population of patients underwent limb arteriovenous malformation (LAVMs). METHODS From January 2015 to December 2018, all consecutive patients underwent an endovascular procedure for ICD-9-CM codex for arteriovenous malformation problems were retrospective reviewed. Among these, patients with LAVMs were selected. Demographic, preoperative imaging, interventional and postprocedural data were collected for each patient and procedure. The International Society of Vascular Anomalies, the Cho-Do angiographic classification and the Schobinger clinical stage were used to describe disease type, aspect and clinical severity. Angiographic and clinical outcomes were also described. RESULTS During the study period, 76 intervention for AVMs were performed in 52 patients. Among these, 26 LAVMs were selected and analyzed in 21 patients (number of LAVMs per patient: 1.2±0.5), 14 affecting upper limbs, 17 lower limbs. Pain, discomfort and swelling were main symptoms reported (95%, 90% and 62%, respectively). Ultrasound scan, computed angiography tomography and magnetic resonance angiography were used - alone or in combination - as preoperative imaging in 67%, 62% and 48% of patients, respectively. Cho-Do class ≥3 was described in 70% of treated LAVMs and a Schobinger stage ≥2 in more than 90%. Ipsilateral femoral access with a 5F introducer was preferred. Selective embolization with glue was the most preferred technique (57%), in combination or not with microsphere embolization (19%) and/or direct nidus sclerotherapy (14%). Optimal and suboptimal results were achieved in 86% of cases. Further interventions were performed in 52% of cases, with more than two interventions in 29% of cases. CONCLUSIONS Quality of life, clinical picture and anatomical structure are items of paramount importance during preoperative LAVMs endovascular treatment planning. Treatment must be focused on LAVMs type, minimizing invasiveness and number of interventions, although secondary intervention rate remains quite high.
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Affiliation(s)
- Daniele Bissacco
- School of Vascular Surgery, University of Milan, Milan, Italy - .,Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy -
| | - Fabiane Barbosa
- Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Angela Alfonsi
- Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Marco Solcia
- Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonio Rampoldi
- Unit of Interventional Radiology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
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Rampoldi A, Jha R, Fite J, Boland G, Xu C. Cryopreservation and CO 2-independent culture of 3D cardiac progenitors for spaceflight experiments. Biomaterials 2021; 269:120673. [PMID: 33493770 DOI: 10.1016/j.biomaterials.2021.120673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 06/29/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 12/18/2022]
Abstract
Space experimentation of cardiomyocyte differentiation from human induced pluripotent stem cells offers an exciting opportunity to explore the potential of these cells for disease modeling, drug discovery and regenerative medicine. Previous studies on the International Space Station were done with 2D non-cryopreserved cultures of cardiomyocytes being loaded and cultivated in spaceflight culture modules with CO2. Here we report the development of methods of cryopreservation and CO2-independent culture of 3D cardiac progenitors. The cryopreservation allows preparation and pretesting of the cells before spaceflight, makes it easier to transport the cell culture, reduces the impact of strong gravitational force exerted on the cells during the launch of spaceflight, and accommodates a more flexible working schedule for the astronauts. The use of CO2-independent medium with supplements supports cell growth and differentiation without a CO2 incubator. With these methods, we conducted a spaceflight experiment through the SpaceX-20 mission to evaluate the effect of microgravity on the survival and differentiation of 3D cardiac progenitors. Our cryopreserved cardiac progenitor spheres were successfully cultivated in a spaceflight culture module without CO2 for 3 weeks aboard the International Space Station. Beating cardiomyocytes were generated and returned to the earth for further study.
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Affiliation(s)
- Antonio Rampoldi
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Rajneesh Jha
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | | | | | - Chunhui Xu
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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21
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Liu R, Li D, Sun F, Rampoldi A, Maxwell JT, Wu R, Fischbach P, Castellino SM, Du Y, Fu H, Mandawat A, Xu C. Melphalan induces cardiotoxicity through oxidative stress in cardiomyocytes derived from human induced pluripotent stem cells. Stem Cell Res Ther 2020; 11:470. [PMID: 33153480 PMCID: PMC7643439 DOI: 10.1186/s13287-020-01984-1] [Citation(s) in RCA: 13] [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] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 10/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment-induced cardiotoxicity is a leading noncancer-related cause of acute and late onset morbidity and mortality in cancer patients on antineoplastic drugs such as melphalan-increasing clinical case reports have documented that it could induce cardiotoxicity including severe arrhythmias and heart failure. As the mechanism by which melphalan impairs cardiac cells remains poorly understood, here, we aimed to use cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CMs) to investigate the cellular and molecular mechanisms of melphalan-induced cardiotoxicity. METHODS hiPSC-CMs were generated and treated with clinically relevant doses of melphalan. To characterize melphalan-induced cardiotoxicity, cell viability and apoptosis were quantified at various treatment durations. Ca2+ transient and contractility analyses were used to examine the alterations of hiPSC-CM function. Proteomic analysis, reactive oxygen species detection, and RNA-Sequencing were conducted to investigate underlying mechanisms. RESULTS Melphalan treatment of hiPSC-CMs induced oxidative stress, caused Ca2+ handling defects and dysfunctional contractility, altered global transcriptomic and proteomic profiles, and resulted in apoptosis and cell death. The antioxidant N-acetyl-L-cysteine attenuated these genomic, cellular, and functional alterations. In addition, several other signaling pathways including the p53 and transforming growth factor-β signaling pathways were also implicated in melphalan-induced cardiotoxicity according to the proteomic and transcriptomic analyses. CONCLUSIONS Melphalan induces cardiotoxicity through the oxidative stress pathway. This study provides a unique resource of the global transcriptomic and proteomic datasets for melphalan-induced cardiotoxicity and can potentially open up new clinical mechanism-based targets to prevent and treat melphalan-induced cardiotoxicity.
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Affiliation(s)
- Rui Liu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
- Department of Pediatrics, The Third Xiangya Hospital of Central South University, Changsha, 410013, Hunan, China
| | - Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Fangxu Sun
- School of Chemistry and Biochemistry and the Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Joshua T Maxwell
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Ronghu Wu
- School of Chemistry and Biochemistry and the Petit Institute for Bioengineering and Bioscience, Georgia Institute of Technology, Atlanta, GA, 30332, USA
| | - Peter Fischbach
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Sharon M Castellino
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA
| | - Yuhong Du
- Emory Chemical Biology Discovery Center and the Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Haian Fu
- Emory Chemical Biology Discovery Center and the Department of Pharmacology and Chemical Biology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Anant Mandawat
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Cardio-Oncology Program, Winship Cancer Institute of Emory University, Atlanta, GA, 30322, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate Drive, Atlanta, GA, 30322, USA.
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, 30322, USA.
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22
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Liu R, Sun F, Forghani P, Armand LC, Rampoldi A, Li D, Wu R, Xu C. Proteomic Profiling Reveals Roles of Stress Response, Ca 2+ Transient Dysregulation, and Novel Signaling Pathways in Alcohol-Induced Cardiotoxicity. Alcohol Clin Exp Res 2020; 44:2187-2199. [PMID: 32981093 DOI: 10.1111/acer.14471] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 07/02/2020] [Accepted: 09/17/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Alcohol use in pregnancy increases the risk of abnormal cardiac development, and excessive alcohol consumption in adults can induce cardiomyopathy, contractile dysfunction, and arrhythmias. Understanding molecular mechanisms underlying alcohol-induced cardiac toxicity could provide guidance in the development of therapeutic strategies. METHODS We have performed proteomic and bioinformatic analysis to examine protein alterations globally and quantitatively in cardiomyocytes derived from human-induced pluripotent stem cells (hiPSC-CMs) treated with ethanol (EtOH). Proteins in both cell lysates and extracellular culture media were systematically quantitated. RESULTS Treatment with EtOH caused severe detrimental effects on hiPSC-CMs as indicated by significant cell death and deranged Ca2+ handling. Treatment of hiPSC-CMs with EtOH significantly affected proteins responsible for stress response (e.g., GPX1 and HSPs), ion channel-related proteins (e.g. ATP1A2), myofibril structure proteins (e.g., MYL2/3), and those involved in focal adhesion and extracellular matrix (e.g., ILK and PXN). Proteins involved in the TNF receptor-associated factor 2 signaling (e.g., CPNE1 and TNIK) were also affected by EtOH treatment. CONCLUSIONS The observed changes in protein expression highlight the involvement of oxidative stress and dysregulation of Ca2+ handling and contraction while also implicating potential novel targets in alcohol-induced cardiotoxicity. These findings facilitate further exploration of potential mechanisms, discovery of novel biomarkers, and development of targeted therapeutics against EtOH-induced cardiotoxicity.
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Affiliation(s)
- Rui Liu
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.,Department of Pediatrics, (RL), the Third Xiangya Hospital of Central South University, Changsha, China
| | - Fangxu Sun
- School of Chemistry and Biochemistry and the Petit Institute for Bioengineering and Bioscience, (FS, RW), Georgia Institute of Technology, Atlanta, Georgia
| | - Parvin Forghani
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Lawrence C Armand
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Antonio Rampoldi
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Dong Li
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Ronghu Wu
- School of Chemistry and Biochemistry and the Petit Institute for Bioengineering and Bioscience, (FS, RW), Georgia Institute of Technology, Atlanta, Georgia
| | - Chunhui Xu
- From the, Department of Pediatrics, (RL, PF, LCA, AR, DL, CX), Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, (CX), Georgia Institute of Technology and Emory University, Atlanta, Georgia
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Secco S, Barbosa F, Brambillasca P, Dell’oglio P, Barbieri M, Caviglia A, Buratto C, Migliorisi C, Napoli G, Di Trapani D, Vercelli R, Solcia M, Strada E, Petralia G, Bocciardi A, Rampoldi A, Galfano A. Current urological indications for Prostatic Artery Embolization (PAE) in a referral hospital. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)34071-4] [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: 10/23/2022] Open
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24
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Rampoldi A, Singh M, Wu Q, Duan M, Jha R, Maxwell JT, Bradner JM, Zhang X, Saraf A, Miller GW, Gibson G, Brown LA, Xu C. Cardiac Toxicity From Ethanol Exposure in Human-Induced Pluripotent Stem Cell-Derived Cardiomyocytes. Toxicol Sci 2020; 169:280-292. [PMID: 31059573 DOI: 10.1093/toxsci/kfz038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Alcohol use prior to and during pregnancy remains a significant societal problem and can lead to developmental fetal abnormalities including compromised myocardia function and increased risk for heart disease later in life. Alcohol-induced cardiac toxicity has traditionally been studied in animal-based models. These models have limitations due to physiological differences from human cardiomyocytes (CMs) and are also not suitable for high-throughput screening. We hypothesized that human-induced pluripotent stem cell-derived CMs (hiPSC-CMs) could serve as a useful tool to study alcohol-induced cardiac defects and/or toxicity. In this study, hiPSC-CMs were treated with ethanol at doses corresponding to the clinically relevant levels of alcohol intoxication. hiPSC-CMs exposed to ethanol showed a dose-dependent increase in cellular damage and decrease in cell viability, corresponding to increased production of reactive oxygen species. Furthermore, ethanol exposure also generated dose-dependent increased irregular Ca2+ transients and contractility in hiPSC-CMs. RNA-seq analysis showed significant alteration in genes belonging to the potassium voltage-gated channel family or solute carrier family, partially explaining the irregular Ca2+ transients and contractility in ethanol-treated hiPSC-CMs. RNA-seq also showed significant upregulation in the expression of genes associated with collagen and extracellular matrix modeling, and downregulation of genes involved in cardiovascular system development and actin filament-based process. These results suggest that hiPSC-CMs can be a novel and physiologically relevant system for the study of alcohol-induced cardiac toxicity.
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Affiliation(s)
- Antonio Rampoldi
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Monalisa Singh
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Qingling Wu
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
| | - Meixue Duan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia
| | - Rajneesh Jha
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joshua T Maxwell
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Joshua M Bradner
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Anita Saraf
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.,Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia
| | - Gary W Miller
- Department of Environmental Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Greg Gibson
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia
| | - Lou Ann Brown
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Chunhui Xu
- Division of Pediatric Cardiology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia
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25
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Centonze L, Di Sandro S, Cereda M, Lauterio A, De Carlis R, Migliorisi C, Morelli F, Rampoldi A, De Carlis L. Endovascular Treatment of Acute Posttransplant Portal Vein Thrombosis Due to Portal Steal From Mesocaval And Coronary Portosystemic Shunts. EXP CLIN TRANSPLANT 2020; 18:653-656. [PMID: 32039666 DOI: 10.6002/ect.2019.0273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The management of portosystemic shunts in liver transplant recipients relies on appropriate perioperative study. There are several strategies for shunt handling, ranging from preoperative interventional procedures to intraoperative surgical interruption or embolization. Appropriate management often results in a successful outcome, although wrong decisions could lead to serious consequences. Here, we report a liver transplant recipient with grade 2 portal vein thrombosis associated with 2 large portosystemic shunts (coronary and mesocaval), which were managed intraoperatively via thrombectomy without shunt ligation. Acute portal vein thrombosis developed early after transplant due to portal steal syndrome. The patient underwent a successful endovascular shunt embolization, with prompt restoration of hepatopetal portal flow and resolution of the portal steal. Use of interventional radiology in perioperative management of transplant patients has recently gained wider importance; our case reported here is particularly suggestive of the good outcomes of a multidisciplinary approach to a threatening complication such as postoperative acute portal vein thrombosis.
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Affiliation(s)
- Leonardo Centonze
- >From the Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy
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26
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Mutignani M, Forti E, Larghi A, Pugliese F, Cintolo M, Massad M, Italia A, Tringali A, Ferrari GC, De Gasperi A, Rampoldi A, De Carlis L, Chiara O, Paparozzi C, Dioscoridi L. Endoscopic entero-enteral bypass: an effective new approach to the treatment of postsurgical complications of hepaticojejunostomy. Endoscopy 2019; 51:1146-1150. [PMID: 31163496 DOI: 10.1055/a-0914-2855] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/10/2022]
Abstract
BACKGROUND Management of biliary adverse events (BAEs) after biliodigestive anastomosis is challenging. We propose a new endoscopic approach to improve BAEs in this clinical setting. METHODS Patients who had BAEs after a hepaticojejunostomy with Roux-en-Y loop or a Whipple procedure underwent creation of an entero-enteral endoscopic bypass (EEEB) between the duodenal/gastric wall and the biliary jejunal loop under endoscopic ultrasound (EUS) and fluoroscopic guidance using specifically designed fully covered self-expandable metal stents. RESULTS 32 consecutive patients underwent EEEB, which was successful in all but one patient. One procedural and five long-term mild adverse events occurred. Endoscopic retrograde cholangiography (ERC) through the EEEB successfully treated all types of BAEs in these patients. Disease recurred in two patients who were successfully re-treated through the EEEB. CONCLUSIONS Our retrospective study showed that in patients with BAEs after biliodigestive anastomosis, EEEB is safe, feasible, and allows a successful long-term treatment of different BAEs in a tertiary referral center with high-level experience in both endoscopic retrograde cholangiopancreatography and EUS.
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Affiliation(s)
| | - Edoardo Forti
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Alberto Larghi
- Digestive Endoscopy Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Francesco Pugliese
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Marcello Cintolo
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Mutaz Massad
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Angelo Italia
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Alberto Tringali
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | | | - Andrea De Gasperi
- Department of Anaesthesia, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Antonio Rampoldi
- Interventional Radiology, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Luciano De Carlis
- Hepato-biliary-pancreatic Surgery and Liver Transplantation Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Osvaldo Chiara
- Emergency and Trauma Center, Niguarda-Ca' Granda Hospital, Milan, Italy
| | - Carlo Paparozzi
- Department of Surgery and Translational Medicine, Careggi Hospital, Florence, Italy
| | - Lorenzo Dioscoridi
- Digestive and Interventional Endoscopy Unit, Niguarda-Ca' Granda Hospital, Milan, Italy
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Abstract
Introduction: Hemoperitoneum can be a life-threating condition in cirrhotic patients who have a limited compensatory reserve during hemorrhagic shock. We aim to review the literature on the different etiologies associated with non-traumatic hemoperitoneum (NTH), summarizing the most relevant conditions associated with spontaneous and iatrogenic peritoneal and retroperitoneal bleeding that may occur in cirrhotic patients and to illustrate the most relevant diagnostic strategies and optimal management. Area covered: This review encompasses the current literature in hemoperitoneum in cirrhotic patients in the absence of abdominal trauma. Established diagnostic procedures, therapeutic interventions and potential novel targets are reported and discussed. Expert opinion: To ensure the optimal management regardless of the underlying etiology of NTH, the first goal for the clinician is to obtain immediate hemodynamic stabilization with supportive measures and to control the source of bleeding. The latter can be achieved with angiographic embolization, which is usually the first choice, or with open surgery. Other therapeutic options according to specific etiologies include transjugular intrahepatic portosystemic shunt (TIPS), balloon-occluded retrograde transvenous obliteration (BRTO), balloon-occluded anterograde transvenous obliteration (BATO) or intra operative radio frequency (RF).
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | | | | | | | - Cherisse Berry
- Department of Surgery, Division of Acute Care Surgery, New York University School of Medicine , New York , NY , USA
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Di Sandro S, Benuzzi L, Lauterio A, Botta F, De Carlis R, Najjar M, Centonze L, Danieli M, Pezzoli I, Rampoldi A, Bagnardi V, De Carlis L. Single Hepatocellular Carcinoma approached by curative-intent treatment: A propensity score analysis comparing radiofrequency ablation and liver resection. Eur J Surg Oncol 2019; 45:1691-1699. [PMID: 31072620 DOI: 10.1016/j.ejso.2019.04.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2019] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 02/06/2023] Open
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29
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Gentillon C, Li D, Duan M, Yu WM, Preininger MK, Jha R, Rampoldi A, Saraf A, Gibson GC, Qu CK, Brown LA, Xu C. Targeting HIF-1α in combination with PPARα activation and postnatal factors promotes the metabolic maturation of human induced pluripotent stem cell-derived cardiomyocytes. J Mol Cell Cardiol 2019; 132:120-135. [PMID: 31082397 DOI: 10.1016/j.yjmcc.2019.05.003] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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: 08/06/2018] [Revised: 02/21/2019] [Accepted: 05/05/2019] [Indexed: 12/16/2022]
Abstract
Immature phenotypes of cardiomyocytes derived from human induced pluripotent stem cells (hiPSC-CMs) limit the utility of these cells in clinical application and basic research. During cardiac development, postnatal cardiomyocytes experience high oxygen tension along with a concomitant downregulation of hypoxia-inducible factor 1α (HIF-1α), leading to increased fatty acid oxidation (FAO). We hypothesized that targeting HIF-1α alone or in combination with other metabolic regulators could promote the metabolic maturation of hiPSC-CMs. We examined the effect of HIF-1α inhibition on the maturation of hiPSC-CMs and investigated a multipronged approach to promote hiPSC-CM maturation by combining HIF-1α inhibition with molecules that target key pathways involved in the energy metabolism. Cardiac spheres of highly-enriched hiPSC-CMs were treated with a HIF-1α inhibitor alone or in combination with an agonist of peroxisome proliferator activated receptor α (PPARα) and three postnatal factors (triiodothyronine hormone T3, insulin-like growth factor-1 and dexamethasone). HIF-1α inhibition significantly increased FAO and basal and maximal respiration of hiPSC-CMs. Combining HIF-1α inhibition with PPARα activation and the postnatal factors further increased FAO and improved mitochondrial maturation in hiPSC-CMs. Compared with mock-treated cultures, the cultures treated with the five factors had increased mitochondrial content and contained more cells with mitochondrial distribution throughout the cells, which are features of more mature cardiomyocytes. Consistent with these observations, a number of transcriptional regulators of mitochondrial metabolic processes were upregulated in hiPSC-CMs treated with the five factors. Furthermore, these cells had significantly increased Ca2+ transient kinetics and contraction and relaxation velocities, which are functional features for more mature cardiomyocytes. Therefore, targeting HIF-1α in combination with other metabolic regulators significantly improves the metabolic maturation of hiPSC-CMs.
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Affiliation(s)
- Cinsley Gentillon
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Dong Li
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Meixue Duan
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Wen-Mei Yu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Marcela K Preininger
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Rajneesh Jha
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Anita Saraf
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Gregory C Gibson
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA, USA
| | - Cheng-Kui Qu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Lou Ann Brown
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA; Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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Hu D, Rampoldi A, Bratus-Neuenschwander A, Hofer A, Bertschinger HU, Vögeli P, Neuenschwander S. Effective genetic markers for identifying the Escherichia coli F4ac receptor status of pigs. Anim Genet 2019; 50:136-142. [PMID: 30724375 DOI: 10.1111/age.12770] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2018] [Indexed: 11/28/2022]
Abstract
The F4ac receptor locus (F4acR), which encodes susceptibility or resistance to Escherichia coli diarrhoea, is inherited as an autosomal recessive monogenetic trait. F4acR is localized on pig chromosome 13 (SSC13q41-q44) near the MUC13 gene. Two flanking markers (CHCF1 and ALGA0106330) with a high linkage disequilibrium (LD) with F4acR were found to be effective for the genetic identification of F4ac-resistant pigs in the Swiss Large White breed (one recombinant out of 2034 genotyped pigs). Three recombinant boars, one each from the Duroc, Swiss Landrace and Piétrain breeds, were genotyped with seven different markers and phenotyped by means of a microscopic adhesion test. Only ALGA0072075, CHCF1 and CHCF3 indicated the correct phenotype. To test the effect of the resistance allele on production traits, 530 Large White pigs from the national test station were investigated. A significant difference existed among the F4acR locus genotypes in the intramuscular fat content of the longissimus dorsi muscle, whereas no other production traits were influenced by the resistance allele. The frequency of the CHCF1-C and ALGA0106330-A alleles associated with resistance in the Swiss Large White population was 60%, which is advantageous for implementing this trait in a breeding programme to select for E. coli F4ac-resistant animals. The selection of resistant pigs should start on the male side due to the inability of resistant sows to produce sufficient amounts of protecting antibodies in the colostrum. Selection of genetically F4ac-resistant pigs is a sustainable and suitable alternative to decreasing animal loss and antibiotic use due to diarrhoea.
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Affiliation(s)
- D Hu
- Institute of Agricultural Sciences, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland
| | - A Rampoldi
- Institute of Agricultural Sciences, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland
| | | | - A Hofer
- SUISAG, Allmend 8, 6204 Sempach, Switzerland
| | - H U Bertschinger
- Institute of Agricultural Sciences, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland
| | - P Vögeli
- Institute of Agricultural Sciences, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland
| | - S Neuenschwander
- Institute of Agricultural Sciences, ETH Zurich, Tannenstrasse 1, 8092, Zurich, Switzerland
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Colombo P, De Mattia C, Rottoli F, Sutto M, Rampoldi A, Barbosa F, Torresin A. 104. Use of a RDIM system to analyse and optimize an interventional radiology procedure. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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32
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Rampoldi A, Crooke SN, Preininger MK, Jha R, Maxwell J, Ding L, Spearman P, Finn MG, Xu C. Targeted Elimination of Tumorigenic Human Pluripotent Stem Cells Using Suicide-Inducing Virus-like Particles. ACS Chem Biol 2018; 13:2329-2338. [PMID: 29979576 DOI: 10.1021/acschembio.8b00490] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Sensitization to prodrugs via transgenic expression of suicide genes is a leading strategy for the selective elimination of potentially tumorigenic human pluripotent stem cells (hPSCs) in regenerative medicine, but transgenic modification poses safety risks such as deleterious mutagenesis. We describe here an alternative method of delivering suicide-inducing molecules explicitly to hPSCs using virus-like particles (VLPs) and demonstrate its use in eliminating undifferentiated hPSCs in vitro. VLPs were engineered from Qβ bacteriophage capsids to contain enhanced green fluorescent protein (EGFP) or cytosine deaminase (CD) and to simultaneously display multiple IgG-binding ZZ domains. After labeling with antibodies against the hPSC-specific surface glycan SSEA-5, EGFP-containing particles were shown to specifically bind undifferentiated cells in culture, and CD-containing particles were able to eliminate undifferentiated hPSCs with virtually no cytotoxicity to differentiated cells upon treatment with the prodrug 5-fluorocytosine.
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Affiliation(s)
- Antonio Rampoldi
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - Stephen N. Crooke
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30318, United States
| | - Marcela K. Preininger
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332, United States
| | - Rajneesh Jha
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - Joshua Maxwell
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - Lingmei Ding
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - Paul Spearman
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
| | - M. G. Finn
- School of Chemistry and Biochemistry, Georgia Institute of Technology, Atlanta, Georgia 30318, United States
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia 30332, United States
| | - Chunhui Xu
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, Georgia 30322, United States
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia 30332, United States
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Colombo PE, Rottoli F, Sutto M, De Mattia C, Rampoldi A, Torresin A. [P021] Analysis and optimization of an interventional radiology procedure using a radiation dose index monitoring software. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.06.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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34
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Harbuzariu A, Rampoldi A, Daley-Brown DS, Candelaria P, Harmon TL, Lipsey CC, Beech DJ, Quarshie A, Ilies GO, Gonzalez-Perez RR. Leptin-Notch signaling axis is involved in pancreatic cancer progression. Oncotarget 2018; 8:7740-7752. [PMID: 27999190 PMCID: PMC5352357 DOI: 10.18632/oncotarget.13946] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 12/07/2016] [Indexed: 12/15/2022] Open
Abstract
Pancreatic cancer (PC) shows a high death rate. PC incidence and prognosis are affected by obesity, a pandemic characterized by high levels of leptin. Notch is upregulated by leptin in breast cancer. Thus, leptin and Notch crosstalk could influence PC progression. Here we investigated in PC cell lines (BxPC-3, MiaPaCa-2, Panc-1, AsPC-1), derived tumorspheres and xenografts whether a functional leptin-Notch axis affects PC progression and expansion of pancreatic cancer stem cells (PCSC). PC cells and tumorspheres were treated with leptin and inhibitors of Notch (gamma-secretase inhibitor, DAPT) and leptin (iron oxide nanoparticle-leptin peptide receptor antagonist 2, IONP-LPrA2). Leptin treatment increased cell cycle progression and proliferation, and the expression of Notch receptors, ligands and targeted molecules (Notch1-4, DLL4, JAG1, Survivin and Hey2), PCSC markers (CD24/CD44/ESA, ALDH, CD133, Oct-4), ABCB1 protein, as well as tumorsphere formation. Leptin-induced effects on PC and tumorspheres were decreased by IONP-LPrA2 and DAPT. PC cells secreted leptin and expressed the leptin receptor, OB-R, which indicates a leptin autocrine/paracrine signaling loop could also affect tumor progression. IONP-LPrA2 treatment delayed the onset of MiaPaCa-2 xenografts, and decreased tumor growth and the expression of proliferation and PCSC markers. Present data suggest that leptin-Notch axis is involved in PC. PC has no targeted therapy and is mainly treated with chemotherapy, whose efficiency could be decreased by leptin and Notch activities. Thus, the leptin-Notch axis could be a novel therapeutic target, particularly for obese PC patients.
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Affiliation(s)
- Adriana Harbuzariu
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Antonio Rampoldi
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Danielle S Daley-Brown
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Pierre Candelaria
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Tia L Harmon
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Crystal C Lipsey
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Derrick J Beech
- Department of Surgery, Morehouse School of Medicine, Atlanta, GA, 30310 USA
| | - Alexander Quarshie
- Biomedical Informatics Program and Master of Science in Clinical Research Program, Clinical Research Center, Morehouse School of Medicine, Atlanta, GA 30310, USA
| | - Gabriela Oprea Ilies
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, 30303 USA
| | - Ruben R Gonzalez-Perez
- Department of Microbiology, Biochemistry and Immunology, Morehouse School of Medicine, Atlanta, GA, 30310 USA
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Candelaria PV, Rampoldi A, Harbuzariu A, Gonzalez-Perez RR. Leptin signaling and cancer chemoresistance: Perspectives. World J Clin Oncol 2017; 8:106-119. [PMID: 28439492 PMCID: PMC5385432 DOI: 10.5306/wjco.v8.i2.106] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/20/2016] [Accepted: 03/02/2017] [Indexed: 02/06/2023] Open
Abstract
Obesity is a major health problem and currently is endemic around the world. Obesity is a risk factor for several different types of cancer, significantly promoting cancer incidence, progression, poor prognosis and resistance to anti-cancer therapies. The study of this resistance is critical as development of chemoresistance is a serious drawback for the successful and effective drug-based treatments of cancer. There is increasing evidence that augmented adiposity can impact on chemotherapeutic treatment of cancer and the development of resistance to these treatments, particularly through one of its signature mediators, the adipokine leptin. Leptin is a pro-inflammatory, pro-angiogenic and pro-tumorigenic adipokine that has been implicated in many cancers promoting processes such as angiogenesis, metastasis, tumorigenesis and survival/resistance to apoptosis. Several possible mechanisms that could potentially be developed by cancer cells to elicit drug resistance have been suggested in the literature. Here, we summarize and discuss the current state of the literature on the role of obesity and leptin on chemoresistance, particularly as it relates to breast and pancreatic cancers. We focus on the role of leptin and its significance in possibly driving these proposed chemoresistance mechanisms, and examine its effects on cancer cell survival signals and expansion of the cancer stem cell sub-populations.
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Candelaria P, Harmon T, Harbuzariu A, Rampoldi A, Lipsey C, Mullen M, Kurian A, Dill C, Tchio C, Daley-Brown D, Nunez S, Lanier V, Gonzalez-Perez RR. Abstract B66: Novel adjuvant therapy for obesity-related cancers. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1538-7755.disp16-b66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
Obesity incidence has reached alarming levels, particularly in minority populations: African American (AA) and Latinos. The risk of develop several cancers (i.e., breast, pancreatic and endometrial cancers) is strongly correlated to obesity. One of the essential factors involved in this relationship is leptin, the major adipokine secreted by adipose and tumor cells. Leptin is a mitogenic, proangiogenic, antiapoptotic and inflammatory factor that induces tumor growth and metastasis. Leptin has also been shown to increase cancer stem cell population and drug resistance in tumors. We have produced a potent and specific antagonist (LPrA2) that blocks leptin signaling and impairs its effects on cancer cells. LPrA2 conjugated to iron-oxide nanoparticles (IONP-LPrA2) shows enhanced bioavailability (half-life 8x higher) and inhibition effectiveness on leptin signaling in cancer cells. It is hypothesized that IONP-LPrA2 could serve as an adjuvant that increases effectiveness and allows the reduction of dosage of chemotherapeutic drugs, particularly in obesity contexts. Breast (E0771-TAM tamoxifen resistant, Py-8119, MDA-MB231, HCC1806 and MCF-7) and pancreatic cancer cells (Panc-1, BxPC-3, MiaPaca2), and their derived tumorspheres were treated with leptin, chemotherapeutics (Cisplatin, Doxorubicin, Paclitaxel and Gemcitabine) and IONP-LPrA2. Additionally, E0771-TAM and Py-8119 cells, and MDA-MB231 and Panc-1 tumorspheres were inoculated in C57BL/6J female mice (obese and lean) and female and male CD1 nu/nu mice. The mice were treated with IONP-LPrA2 during 4 weeks. Leptin induced proliferation and cell cycle progression in all cancer cells tested. Leptin also increased the number and size of breast and pancreatic cancer tumorspheres, and the levels of cancer stem cell (ALDH1, CD44, CD24, ESA), and chemoresistant (ABCB1) and pluripotent (NANOG) markers. IONP-LPrA2 treatment increased the effects of chemotherapeutics on cancer cells, and delayed tumor onset and growth. These data suggest that leptin is a mitogenic factor that increases cancer aggressiveness and survival. IONP-LPrA2 is a promising chemotherapeutic adjuvant, especially for patients suffering from obesity-related cancers.
Citation Format: Pierre Candelaria, Tia Harmon, Adriana Harbuzariu, Antonio Rampoldi, Crystal Lipsey, Mckay Mullen, Ann Kurian, Courtney Dill, Cynthia Tchio, Danielle Daley-Brown, Shakeyla Nunez, Viola Lanier, Ruben Rene Gonzalez-Perez. Novel adjuvant therapy for obesity-related cancers. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr B66.
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Affiliation(s)
| | - Tia Harmon
- Morehouse School of Medicine, Atlanta, GA
| | | | | | | | | | - Ann Kurian
- Morehouse School of Medicine, Atlanta, GA
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Rampoldi A, Barbosa F, Secco S, Migliorisi C, Galfano A, Prestini G, Harward SH, Di Trapani D, Brambillasca PM, Ruggero V, Solcia M, Carnevale FC, Bocciardi AM. Prostatic Artery Embolization as an Alternative to Indwelling Bladder Catheterization to Manage Benign Prostatic Hyperplasia in Poor Surgical Candidates. Cardiovasc Intervent Radiol 2017; 40:530-536. [PMID: 28130568 DOI: 10.1007/s00270-017-1582-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [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: 10/28/2016] [Accepted: 01/17/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To prospectively assess discontinuation of indwelling bladder catheterization (IBC) and relief of lower urinary tract symptoms (LUTS) due to benign prostatic hyperplasia (BPH) following prostate artery embolization (PAE) in poor surgical candidates. METHODS Patients ineligible for surgical intervention were offered PAE after at least 1 month of IBC for management of urinary retention secondary to BPH; exclusion criteria for PAE included eligibility for surgery, active bladder cancer or known prostate cancer. Embolization technical and clinical success were defined as bilateral prostate embolization and removal of IBC, respectively. Patients were followed for at least 6 months and evaluated for International Prostate Symptom Score, quality of life, prostate size and uroflowmetric parameters. RESULTS A total of 43 patients were enrolled; bilateral embolization was performed in 33 (76.7%), unilateral embolization was performed in 8 (18.6%), and two patients could not be embolized due to tortuous and atherosclerotic pelvic vasculature (4.7%). Among the patients who were embolized, mean prostate size decreased from 75.6 ± 33.2 to 63.0 ± 23.2 g (sign rank p = 0.0001, mean reduction of 19.6 ± 17.3%), and IBC removal was achieved in 33 patients (80.5%). Clavien II complications were reported in nine patients (21.9%) and included urinary tract infection (three patients, 7.3%) and recurrent acute urinary retention (six patients, 14.6%). Nine patients (22.0%) experienced post-embolization syndrome. CONCLUSIONS PAE is a safe and feasible for the relief of LUTS and IBC in highly comorbid patients without surgical treatment options.
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Affiliation(s)
- Antonio Rampoldi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Fabiane Barbosa
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy.
| | - Silvia Secco
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Carmelo Migliorisi
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Antonio Galfano
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Giovanni Prestini
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Sardis Honoria Harward
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA
| | - Dario Di Trapani
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Pietro Maria Brambillasca
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Vercelli Ruggero
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Marco Solcia
- Department of Interventional Radiology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
| | - Francisco Cesar Carnevale
- Department of Interventional Radiology, University of Sao Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo, SP, 05403-001, Brazil
| | - Aldo Massimo Bocciardi
- Department of Urology, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore, 3, 20100, Milan, Italy
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Harbuzariu A, Rampoldi A, Daley-Brown DS, Harmon TL, Beech DJ, Oprea-Ilies G, Gonzalez-Perez RR. Abstract 1034: Leptin induces early onset and aggressiveness of pancreatic cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: During the past 30 years, pancreatic cancer (PC) has constantly been the fourth leading cause of cancer death. PC is usually advanced at the time of diagnosis, with an overall five years survival rate of less than 5%. Obesity, characterized by high levels of leptin, is pandemic in United States and a risk factor for PC. Notch abnormal signaling is linked to carcinogenesis, tumor angiogenesis and self renewal capacity of PC stem cells (PCSC). We have previously shown that leptin induces proliferation of PC cell lines, increases Notch expression, PCSC and tumorsphere formation. To test leptin effects in a PC mouse model, a specific and potent signaling inhibitor bound to nanoparticles, IONP-LPrA2 was produced by us.
Hypothesis: High levels of leptin induce early onset and multiplicity of PC xenografts, which is abrogated by IONP-LPrA2 treatment.
Methods: Human PC cell line MiaPaCa-2 was challenged with leptin or IONP-LPrA2. The expression of pluripotency associated genes (STAT3, Oct4, Sox2 and NANOG) was evaluated. MiaPaCa-2 cells forming tumorspheres were treated with leptin or IONP-LPrA2 and inoculated into CD1 nu/nu mice. Untreated tumorspheres were inoculated as controls. A group of mice were injected twice a week with IONP-LPrA2. Tumor onset and growth were assessed. PC xenografts were analyzed for expression of Ki67 (proliferation marker), leptin targeted molecules (Notch), PCSC markers etc.
Results: Leptin induced the expression of PCSC pluripotency markers. Moreover, leptin treatment of tumorspheres induced early tumor onset and multiplicity. Also, leptin increased proliferation, PCSC and oncogenic markers in PC xenografts. IONP-LPrA2 reduced leptin effects. No changes of mice food intake and body weight were observed.
Conclusions: This observation might imply that obese patients are at high risk to develop PC. Inhibition of leptin signaling may be used as preventative or therapeutic strategy for PC, especially in obese patients.
Acknowledgements: this work was supported by DOD W81XWH-13-1-0382; NIH/SBIR 1R41CA183399-01A1; Pilot Project Award from MSM/Tuskegee University/UAB Cancer Center partnership grant 5U54CA118638; PC SPORE Grant from UAB to RRGP, and facilities and support services at Morehouse School of Medicine (1G12RR026250-03; NIH RR 03034 and 1C06 RR18386).
Citation Format: Adriana Harbuzariu, Antonio Rampoldi, Danielle S. Daley-Brown, Tia L. Harmon, Derrick J. Beech, Gabriela Oprea-Ilies, Ruben R. Gonzalez-Perez. Leptin induces early onset and aggressiveness of pancreatic cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1034.
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Dill CD, Harbuzariu A, Rampoldi A, Lipsey CC, Lanier V, Harmon T, Daley-Brown D, Tchio C, Candelaria P, Gonzalez-Perez RR. Abstract 1026: PEG-LPrA2 is a non-toxic adjuvant for triple negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Triple Negative Breast Cancer (TNBC) is an aggressive cancer with poor prognosis and is difficult to treat. Current standard therapy for the disease includes a combination of chemotherapeutic drugs: doxorubicin (DOX), paclitaxel (TAX), and cyclophosphamide (CTX). These drugs are ineffective as they exhibit shortcomings and several side effects. TNBC patients develop chemoresistance that may be enhanced by leptin, which affects survival, proliferation, and angiogenesis. Our lab developed and tested a novel and specific inhibitor of leptin signaling, LPrA2. A pegylated derivative of LPrA2 (PEG-LPrA2), with enhanced bioavailability, was successfully used in mouse breast cancer models. Preliminary data showed that PEG-LPrA2 was non-toxic in vitro. Therefore, it is hypothesized that PEG-LPrA2 is not toxic in vivo.
Methods: To determine potential toxicity of PEG-LPrA2, in vitro and in vivo assays were performed. In vitro toxicity of PEG-LPrA2 was tested in a human non-malignant mammary epithelial cell line (MCF-10A). MCF-10A cells were cultured in 96 well plates (5,000 cells/ well) and grown to 70-80% confluence. Cells were treated with PEG-LPrA2 for 24 hrs and viability was determined via MTT assay. In vivo toxicity studies were performed in obese mice. Fifty-seven, eight week old C57BL/6J mice (Charles River Laboratories) were divided into 6 groups. Control mice were fed a low fat diet (10% Kcal from fat) and the rest of the mice were fed a high fat diet (60% Kcal from fat) for 11 weeks. Obesity was characterized as body weight (BW) ≥ 25% BW of control mice. Obese mice were divided into six groups (n = 7/each). Mice were injected with 50 μL of either Sc-PEG-LPrA2 (scramble control) or active inhibitor, PEG-LPrA2, (0.1 mM, 1 mM, or 5 mM) two times a week, for eight weeks. Blood chemistries were analyzed. Additionally, heart, liver, and kidney tissue were harvested and examined to determine toxicity. The tissues were probed for OB-R via immuno histochemistry.
Results: The results showed no changes in BW or food intake. Additionally, no evident changes in blood parameters and organ histology were found.
Conclusions: PEG-LPrA2 is non-toxic and could serve as an adjuvant therapy for standard TNBC chemotherapeutics.
Citation Format: Courtney D. Dill, Adriana Harbuzariu, Antonio Rampoldi, Crystal C. Lipsey, Viola Lanier, Tia Harmon, Danielle Daley-Brown, Cynthia Tchio, Pierre Candelaria, Ruben Rene Gonzalez-Perez. PEG-LPrA2 is a non-toxic adjuvant for triple negative breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1026.
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Affiliation(s)
| | | | | | | | | | - Tia Harmon
- Morehouse School of Medicine, Atlanta, GA
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Rampoldi A, Harbuzariu A, Harmon TL, Gonzalez-Perez RR. Abstract 1006: Novel adjuvants in triple negative breast cancer chemotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-1006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Obese patients develop more frequently triple negative breast cancer (TNBC) that has not target therapy and are commonly treated with chemotherapeutics. Leptin, whose levels are elevated in obesity, can induce TNBC proliferation, angiogenesis and resistance to chemotherapeutics. An antagonist for leptin receptor OB-R, leptin peptide receptor antagonist 2 (LPrA2), has been shown to block leptin signaling and decrease tumor progression. LPrA2 also countervails leptin induced resistance to chemotherapeutic agents. We used pegylation or iron oxide nanoparticle (IONPs) as adjuvants to increase LPrA2 solubility, stability and effectiveness.
Hypothesis: Conjugated LPrA2 will decrease TNBC cells proliferation, expression of leptin target molecules and tumorigenesis.
Methods: Human TNBC and murine breast adenocarcinoma derived cell line E0771 (progesterone and HER2 receptor negative) were used. The E0771 cell line was generated from an estrogen receptor positive (ER+) mammary adenocarcinoma isolated from a C57BL/6J mouse. E0771 was made insensitive to estrogen by treatment with drug Tamoxifen (TAM) mimicking TNBC. To specifically assess the role of RBP-Jk (CBS/CSL, an essential transcription factor for Notch signaling) the CRISPR/Cas9 system was used to disrupt RBP-JK gene expression in both wild-type and TAM treated E0771 cells. Cells were treated with chemotherapeutics (Paclitaxel, Doxorubicine, Ciclophosphamide) in presence of leptin and LPrA2-conjugates. The expression of leptin-targeted molecules, Breast Cancer Stem Cells (BCSC) and EMT markers were analyzed after cell treatment.
Results: Chemotherapeutics effects on proliferation, survival and molecular markers were modified by the addition of LPrA2-conjugates. Notch molecules (receptors and ligands) were downregulated by LPrA2 treatment.
Conclusion: The current data indicate that Leptin inhibition could be used as an adjuvant for chemotherapeutic treatments in TNBC patients. LPrA2-conjugates could increase the efficacy of chemotherapy.
Acknowledgements: This work was partially supported by the National Institute of Health and National Cancer Institute Grant U54 CA118638, NIH/SBIR 1R41CA183399-01A1, and DOD Idea Award BC W81XWH-13-1-0382 to RRGP; and facilities, and support services at Morehouse School of Medicine (NIH RR03034 and 1C06 RR18386) and NIH/NCRR grant 1G12RR026250-03.
Citation Format: Antonio Rampoldi, Adriana Harbuzariu, Tia L. Harmon, Ruben R. Gonzalez-Perez. Novel adjuvants in triple negative breast cancer chemotherapy. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1006.
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Harmon TL, Harbuzariu A, Rampoldi A, Dill C, Lanier V, Daley-Brown D, Lipsey C, Tchio C, Yang L, Gonzalez-Perez RR. Abstract 2079: IONP-LPrA2 and PEG-LPrA2 therapies for triple negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.am2016-2079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) is an epidemic in the US. It is estimated that there will be over 230,000 new BC diagnoses in 2016. Triple Negative Breast Cancer (TNBC) comprises ∼15% of BC cases and lacks targeted therapeutic options. Obesity and high leptin levels are associated with higher TNBC incidence and poorer patient outcomes. Overexpression of leptin and its receptor, Ob-R, induce BC cell growth and angiogenesis; therefore leptin/Ob-R may serve as a TNBC therapeutic target. We have developed a Leptin Peptide Receptor Antagonist, LPrA2, which effectively inhibits leptin signaling. To increase its efficacy LPrA2
was coupled to iron oxide nanoparticles (IONPs) and polyethylene glycol (PEG), and subsequently tested in vitro and in vivo in obese mice hosting syngeneic TNBC-like mammary tumors.
Methods: The conjugation of LPrA2 to IONPs and PEG was confirmed by immunoblotting analysis. E0771, mouse BC cells, which are progesterone receptor and HER2 negative were made insensitive to estrogen stimuli by long-term treatment with Tamoxifen (TAM). Cell cycle and MTT assays were performed to determine the effectiveness of leptin signaling inhibition by conjugated LPrA2 in vitro. C57BL/6 female mice were fed a 60% fat diet
to induce obesity. The obese mice were injected with E0771-TAM cells in the mammary fat pad and treated with IONP-LPrA2 and PEG-LPrA2 after tumor development. Obese mice treated with IONP-LPrA2 Scramble (Sc) and PEG-LPrA2 Sc served as negative controls.
Results and Conclusion: IONP-LPrA2 and PEG-LPrA2 attenuated leptin signaling in vitro and decreased tumor growth and progression in vivo in comparison to the controls. These findings indicate that conjugated LPrA2
may serve as a targeted therapy for TNBC. IONP-LPrA2 may be especially useful in treating this more aggressive form of BC due to its ability to capture multiple LPrA2 peptides as well as its small and uniform particle size.
Citation Format: Tia L. Harmon, Adriana Harbuzariu, Antonio Rampoldi, Courtney Dill, Viola Lanier, Danielle Daley-Brown, Crystal Lipsey, Cynthia Tchio, Lily Yang, Ruben Rene Gonzalez-Perez. IONP-LPrA2 and PEG-LPrA2 therapies for triple negative breast cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 2079.
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Mutignani M, Manta R, Pugliese F, Rampoldi A, Dioscoridi L, Forti E. Endoscopic ultrasound-guided duodenojejunal anastomosis to treat postsurgical Roux-en-Y hepaticojejunostomy stricture: a dream or a reality? Endoscopy 2016. [PMID: 26218044 DOI: 10.1055/s-0034-1392424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 12/10/2022]
Affiliation(s)
- Massimiliano Mutignani
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Raffaele Manta
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Francesco Pugliese
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Rampoldi
- Interventional Radiology Unit, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Lorenzo Dioscoridi
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Edoardo Forti
- Diagnostic and Interventional Digestive Endoscopy, Niguarda Ca' Granda Hospital, Milan, Italy
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Baroni M, Nava S, Giupponi L, Meani P, Panzeri F, Varrenti M, Maloberti A, Soriano F, Agrati AM, Ferraro G, Colombo F, Rampoldi A, Mancia G, Colombo P, Klugmann S, Giannattasio C. Erratum to: Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study. High Blood Press Cardiovasc Prev 2015; 22:451. [DOI: 10.1007/s40292-015-0124-1] [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: 10/22/2022] Open
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Baroni M, Nava S, Giupponi L, Meani P, Panzeri F, Varrenti M, Maloberti A, Soriano F, Agrati AM, Ferraro G, Colombo F, Rampoldi A, Mancia G, Colombo P, Klugmann S, Giannattasio C. Effects of Renal Sympathetic Denervation on Arterial Stiffness and Blood Pressure Control in Resistant Hypertensive Patients: A Single Centre Prospective Study. High Blood Press Cardiovasc Prev 2015; 22:411-6. [PMID: 26458940 DOI: 10.1007/s40292-015-0121-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/01/2015] [Indexed: 12/29/2022] Open
Abstract
Renal denervation (RD) is an intriguing treatment strategy for resistant hypertension. However, limited data are available about its long time efficacy as well as its effects on intermediate phenotypes like arterial stiffness and carotid IMT. 12 patients (9 males, mean 69 years) with resistant hypertension underwent bilateral RDN (Medtronic System) since April 2012 in Niguarda Ca' Granda Hospital (Milan). Patients were studied before intervention, and at 1, 3, 6 and 12 months after RD. Carotid intima media thickness (Esaote Mylab) and carotid-femoral pulse wave velocity (Complior, Alam medical) were assessed at each step. Compared to baseline, patients showed a marked reduction of office systolic blood pressure at each follow-up step (p < 0.05 versus baseline for all steps) as well as pulse wave velocity (p < 0.01 at 1 year versus baseline). Moreover, reduction in pulse wave velocity was higher than the expected value obtained only considering blood pressure drop. Conversely, no significant effect was observed on diastolic blood pressure as well as carotid intima-media thickness. In our study, renal denervation was a safe and effective procedure. The BP lowering effect was maintained during follow-up and a beneficial effect on arterial stiffness was observed, which implies that this effect can't passively originate from the BP fall but rather from an improvement of arterial mechanical properties, possibly related to a reduced sympathetic arterial drive.
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Affiliation(s)
- Matteo Baroni
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy. .,Health Science Department, Milan-Bicocca University, Milan, Italy.
| | - Stefano Nava
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Luca Giupponi
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Paolo Meani
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Francesco Panzeri
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Marisa Varrenti
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Alessandro Maloberti
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Francesco Soriano
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | | | - Giovanni Ferraro
- Internal Medicine Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Fabrizio Colombo
- Internal Medicine Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Antonio Rampoldi
- Interventional Radiology, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Giuseppe Mancia
- Health Science Department, Milan-Bicocca University, Milan, Italy
| | - Paola Colombo
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Silvio Klugmann
- Cardiology I, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy
| | - Cristina Giannattasio
- Cardiology IV, Cardiovascular "A' De Gasperis" Department, Niguarda Ca' Granda Hospital, Piazza Ospedale Maggiore 3, 20161, Milan, Italy.,Health Science Department, Milan-Bicocca University, Milan, Italy
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De Biase A, Varrenti M, Meani P, Cesana F, Pirola R, Giupponi L, Alloni M, Vallerio P, Moreo A, Rampoldi A, Giannattasio C. Renal artery stenosis as the cause of resistant arterial hypertension: an unusual technique for revascularization. J Clin Hypertens (Greenwich) 2014; 16:536-7. [PMID: 24754495 DOI: 10.1111/jch.12331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anna De Biase
- Cardiology IV, Cardiovascular "A.De Gasperis" Department, Niguarda Ca' Granda Hospital, Milan, Italy, Milan, Italy
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Magnone S, Coccolini F, Manfredi R, Piazzalunga D, Agazzi R, Arici C, Barozzi M, Bellanova G, Belluati A, Berlot G, Biffl W, Camagni S, Campanati L, Castelli CC, Catena F, Chiara O, Colaianni N, De Masi S, Di Saverio S, Dodi G, Fabbri A, Faustinelli G, Gambale G, Capponi MG, Lotti M, Marchesi G, Massè A, Mastropietro T, Nardi G, Niola R, Nita GE, Pisano M, Poiasina E, Poletti E, Rampoldi A, Ribaldi S, Rispoli G, Rizzi L, Sonzogni V, Tugnoli G, Ansaloni L. Management of hemodynamically unstable pelvic trauma: results of the first Italian consensus conference (cooperative guidelines of the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology -Section of Vascular and Interventional Radiology- and the World Society of Emergency Surgery). World J Emerg Surg 2014; 9:18. [PMID: 24606950 PMCID: PMC3975341 DOI: 10.1186/1749-7922-9-18] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 02/24/2014] [Indexed: 11/30/2022] Open
Abstract
Hemodynamically Unstable Pelvic Trauma is a major problem in blunt traumatic injury. No cosensus has been reached in literature on the optimal treatment of this condition. We present the results of the First Italian Consensus Conference on Pelvic Trauma which took place in Bergamo on April 13 2013. An extensive review of the literature has been undertaken by the Organizing Committee (OC) and forwarded to the Scientific Committee (SC) and the Panel (JP). Members of them were appointed by surgery, critical care, radiology, emergency medicine and orthopedics Italian and International societies: the Italian Society of Surgery, the Italian Association of Hospital Surgeons, the Multi-specialist Italian Society of Young Surgeons, the Italian Society of Emergency Surgery and Trauma, the Italian Society of Anesthesia, Analgesia, Resuscitation and Intensive Care, the Italian Society of Orthopaedics and Traumatology, the Italian Society of Emergency Medicine, the Italian Society of Medical Radiology, Section of Vascular and Interventional Radiology and the World Society of Emergency Surgery. From November 2012 to January 2013 the SC undertook the critical revision and prepared the presentation to the audience and the Panel on the day of the Conference. Then 3 recommendations were presented according to the 3 submitted questions. The Panel voted the recommendations after discussion and amendments with the audience. Later on a email debate took place until December 2013 to reach a unanimous consent. We present results on the 3 following questions: which hemodynamically unstable patient needs an extraperitoneal pelvic packing? Which hemodynamically unstable patient needs an external fixation? Which hemodynamically unstable patient needs emergent angiography? No longer angiography is considered the first therapeutic maneuver in such a patient. Preperitoneal pelvic packing and external fixation, preceded by pelvic binder have a pivotal role in the management of these patients. Hemodynamically Unstable Pelvic Trauma is a frequent death cause among people who sustain blunt trauma. We present the results of the First Italian Consensus Conference.
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Affiliation(s)
- Stefano Magnone
- First General Surgery Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy.
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Zavaglia C, Mancuso A, Foschi A, Rampoldi A. High-intensity focused ultrasound (HIFU) for the treatment of hepatocellular carcinoma: is it time to abandon standard ablative percutaneous treatments? Hepatobiliary Surg Nutr 2014; 2:184-7. [PMID: 24570943 DOI: 10.3978/j.issn.2304-3881.2013.05.02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 05/13/2013] [Indexed: 12/30/2022]
Affiliation(s)
- Claudio Zavaglia
- Gastroenterology and Hepatology Department, Ospedale Niguarda, Milano, Italy
| | - Andrea Mancuso
- Gastroenterology and Hepatology Department, Ospedale Niguarda, Milano, Italy
| | - Antonella Foschi
- Gastroenterology and Hepatology Department, Ospedale Niguarda, Milano, Italy
| | - Antonio Rampoldi
- Interventional Radiology Department, Ospedale Niguarda, Milano, Italy
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Botta L, Fratto P, Cannata A, Bruschi G, Rampoldi A, Martinelli L. Aortic-arch Reconstruction with Bolton Medical Branched Thoracic Stent Graft. Eur J Vasc Endovasc Surg 2013. [DOI: 10.1016/j.ejvs.2013.01.020] [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: 11/29/2022]
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Jacobsen M, Cirera S, Joller D, Esteso G, Kracht SS, Edfors I, Bendixen C, Archibald AL, Vogeli P, Neuenschwander S, Bertschinger HU, Rampoldi A, Andersson L, Fredholm M, Jørgensen CB. Characterisation of five candidate genes within the ETEC F4ab/ac candidate region in pigs. BMC Res Notes 2011; 4:225. [PMID: 21718470 PMCID: PMC3160978 DOI: 10.1186/1756-0500-4-225] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 06/30/2011] [Indexed: 12/22/2022] Open
Abstract
Background Enterotoxigenic Escherichia coli (ETEC) that express the F4ab and F4ac fimbriae is a major contributor to diarrhoea outbreaks in the pig breeding industry, infecting both newborn and weaned piglets. Some pigs are resistant to this infection, and susceptibility is inherited as a simple dominant Mendelian trait. Indentifying the genetics behind this trait will greatly benefit pig welfare as well as the pig breeding industry by providing an opportunity to select against genetically susceptible animals, thereby reducing the number of diarrhoea outbreaks. The trait has recently been mapped by haplotype sharing to a 2.5 Mb region on pig chromosome 13, a region containing 18 annotated genes. Findings The coding regions of five candidate genes for susceptibility to ETEC F4ab/ac infection (TFRC, ACK1, MUC20, MUC4 and KIAA0226), all located in the 2.5 Mb region, were investigated for the presence of possible causative mutations. A total of 34 polymorphisms were identified in either coding regions or their flanking introns. The genotyping data for two of those were found to perfectly match the genotypes at the ETEC F4ab/ac locus, a G to C polymorphism in intron 11 of TFRC and a C to T silent polymorphism in exon 22 of KIAA0226. Transcriptional profiles of the five genes were investigated in a porcine tissue panel including various intestinal tissues. All five genes were expressed in intestinal tissues at different levels but none of the genes were found differentially expressed between ETEC F4ab/ac resistant and ETEC F4ab/ac susceptible animals in any of the tested tissues. Conclusions None of the identified polymorphisms are obvious causative mutations for ETEC F4ab/ac susceptibility, as they have no impact on the level of the overall mRNA expression nor predicted to influence the composition of the amino acids composition. However, we cannot exclude that the five tested genes are bona fide candidate genes for susceptibility to ETEC F4ab/ac infection since the identified polymorphism might affect the translational apparatus, alternative splice forms may exist and post translational mechanisms might contribute to disease susceptibility.
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Affiliation(s)
- Mette Jacobsen
- Department of Basic Animal and Veterinary Sciences, University of Copenhagen, 1870 Frederiksberg, Denmark.
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Airoldi A, Vangeli M, Vizzutti F, Pinzani M, Minola E, Rampoldi A, Pinzello G. Expanding the severity range of polytetrafluoroethylene-related hepatic outflow occlusion. Liver Int 2009; 29:1288-9. [PMID: 19515219 DOI: 10.1111/j.1478-3231.2009.02057.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
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