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Port M, Barquinero JF, Endesfelder D, Moquet J, Oestreicher U, Terzoudi G, Trompier F, Vral A, Abe Y, Ainsbury L, Alkebsi L, Amundson S, Badie C, Baeyens A, Balajee A, Balázs K, Barnard S, Bassinet C, Beaton-Green L, Beinke C, Bobyk L, Brochard P, Brzoska K, Bucher M, Ciesielski B, Cuceu C, Discher M, D,Oca M, Domínguez I, Doucha-Senf S, Dumitrescu A, Duy P, Finot F, Garty G, Ghandhi S, Gregoire E, Goh V, Güçlü I, Hadjiiska L, Hargitai R, Hristova R, Ishii K, Kis E, Juniewicz M, Kriehuber R, Lacombe J, Lee Y, Lopez Riego M, Lumniczky K, Mai T, Maltar-Strmečki N, Marrale M, Martinez J, Marciniak A, Maznyk N, McKeever S, Meher P, Milanova M, Miura T, Gil OM, Montoro A, Domene MM, Mrozik A, Nakayama R, O’Brien G, Oskamp D, Ostheim P, Pajic J, Pastor N, Patrono C, Pujol-Canadell M, Rodriguez MP, Repin M, Romanyukha A, Rößler U, Sabatier L, Sakai A, Scherthan H, Schüle S, Seong K, Sevriukova O, Sholom S, Sommer S, Suto Y, Sypko T, Szatmári T, Takahashi-Sugai M, Takebayashi K, Testa A, Testard I, Tichy A, Triantopoulou S, Tsuyama N, Unverricht-Yeboah M, Valente M, Van Hoey O, Wilkins R, Wojcik A, Wojewodzka M, Younghyun L, Zafiropoulos D, Abend M. RENEB Inter-Laboratory Comparison 2021: Inter-Assay Comparison of Eight Dosimetry Assays. Radiat Res 2023; 199:535-555. [PMID: 37310880 PMCID: PMC10508307 DOI: 10.1667/rade-22-00207.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/10/2023] [Indexed: 06/15/2023]
Abstract
Tools for radiation exposure reconstruction are required to support the medical management of radiation victims in radiological or nuclear incidents. Different biological and physical dosimetry assays can be used for various exposure scenarios to estimate the dose of ionizing radiation a person has absorbed. Regular validation of the techniques through inter-laboratory comparisons (ILC) is essential to guarantee high quality results. In the current RENEB inter-laboratory comparison, the performance quality of established cytogenetic assays [dicentric chromosome assay (DCA), cytokinesis-block micronucleus assay (CBMN), stable chromosomal translocation assay (FISH) and premature chromosome condensation assay (PCC)] was tested in comparison to molecular biological assays [gamma-H2AX foci (gH2AX), gene expression (GE)] and physical dosimetry-based assays [electron paramagnetic resonance (EPR), optically or thermally stimulated luminescence (LUM)]. Three blinded coded samples (e.g., blood, enamel or mobiles) were exposed to 0, 1.2 or 3.5 Gy X-ray reference doses (240 kVp, 1 Gy/min). These doses roughly correspond to clinically relevant groups of unexposed to low exposed (0-1 Gy), moderately exposed (1-2 Gy, no severe acute health effects expected) and highly exposed individuals (>2 Gy, requiring early intensive medical care). In the frame of the current RENEB inter-laboratory comparison, samples were sent to 86 specialized teams in 46 organizations from 27 nations for dose estimation and identification of three clinically relevant groups. The time for sending early crude reports and more precise reports was documented for each laboratory and assay where possible. The quality of dose estimates was analyzed with three different levels of granularity, 1. by calculating the frequency of correctly reported clinically relevant dose categories, 2. by determining the number of dose estimates within the uncertainty intervals recommended for triage dosimetry (±0.5 Gy or ±1.0 Gy for doses <2.5 Gy or >2.5 Gy), and 3. by calculating the absolute difference (AD) of estimated doses relative to the reference doses. In total, 554 dose estimates were submitted within the 6-week period given before the exercise was closed. For samples processed with the highest priority, earliest dose estimates/categories were reported within 5-10 h of receipt for GE, gH2AX, LUM, EPR, 2-3 days for DCA, CBMN and within 6-7 days for the FISH assay. For the unirradiated control sample, the categorization in the correct clinically relevant group (0-1 Gy) as well as the allocation to the triage uncertainty interval was, with the exception of a few outliers, successfully performed for all assays. For the 3.5 Gy sample the percentage of correct classifications to the clinically relevant group (≥2 Gy) was between 89-100% for all assays, with the exception of gH2AX. For the 1.2 Gy sample, an exact allocation to the clinically relevant group was more difficult and 0-50% or 0-48% of the estimates were wrongly classified into the lowest or highest dose categories, respectively. For the irradiated samples, the correct allocation to the triage uncertainty intervals varied considerably between assays for the 1.2 Gy (29-76%) and 3.5 Gy (17-100%) samples. While a systematic shift towards higher doses was observed for the cytogenetic-based assays, extreme outliers exceeding the reference doses 2-6 fold were observed for EPR, FISH and GE assays. These outliers were related to a particular material examined (tooth enamel for EPR assay, reported as kerma in enamel, but when converted into the proper quantity, i.e. to kerma in air, expected dose estimates could be recalculated in most cases), the level of experience of the teams (FISH) and methodological uncertainties (GE). This was the first RENEB ILC where everything, from blood sampling to irradiation and shipment of the samples, was organized and realized at the same institution, for several biological and physical retrospective dosimetry assays. Almost all assays appeared comparably applicable for the identification of unexposed and highly exposed individuals and the allocation of medical relevant groups, with the latter requiring medical support for the acute radiation scenario simulated in this exercise. However, extreme outliers or a systematic shift of dose estimates have been observed for some assays. Possible reasons will be discussed in the assay specific papers of this special issue. In summary, this ILC clearly demonstrates the need to conduct regular exercises to identify research needs, but also to identify technical problems and to optimize the design of future ILCs.
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Affiliation(s)
- M. Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | | | - J. Moquet
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards Division, Oxfordshire, United Kingdom
| | | | - G. Terzoudi
- National Centre for Scientific Research “Demokritos”, Health Physics, Radiobiology & Cytogenetics Laboratory, Agia Paraskevi, Greece
| | - F. Trompier
- Institut de Radioprotection et de Surete Nucleaire, Fontenay aux Roses, France
| | - A. Vral
- Ghent University, Radiobiology Research Unit, Gent, Belgium
| | - Y. Abe
- Department of Radiation Biology and Protection, Nagasaki University, Japan
| | - L. Ainsbury
- UK Health Security Agency and Office for Health Improvement and Disparities, Cytogenetics and Pathology Group, Oxfordshire, England
| | - L Alkebsi
- Department of Radiation Measurement and Dose Assessment, National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - S.A. Amundson
- Columbia University, Irving Medical Center, Center for Radiological Research, New York, New York
| | - C. Badie
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards Division, Oxfordshire, United Kingdom
| | - A. Baeyens
- Ghent University, Radiobiology Research Unit, Gent, Belgium
| | - A.S. Balajee
- Cytogenetic Biodosimetry Laboratory, Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - K. Balázs
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - S. Barnard
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards Division, Oxfordshire, United Kingdom
| | - C. Bassinet
- Institut de Radioprotection et de Surete Nucleaire, Fontenay aux Roses, France
| | | | - C. Beinke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - L. Bobyk
- Institut de Recherche Biomédicale des Armées (IRBA), Bretigny Sur Orge, France
| | | | - K. Brzoska
- Institute of Nuclear Chemistry and Technology, Warsaw, Poland
| | - M. Bucher
- Bundesamt für Strahlenschutz, Oberschleißheim, Germany
| | - B. Ciesielski
- Medical University of Gdansk, Department of Physics and Biophysics, Gdansk, Poland
| | - C. Cuceu
- Genevolution, Porcheville, France
| | - M. Discher
- Paris-Lodron-University of Salzburg, Department of Environment and Biodiversity, 5020 Salzburg, Austria
| | - M.C. D,Oca
- Università Degli Studi di Palermo, Dipartimento di Fisica e Chimica “Emilio Segrè,” Palermo, Italy
| | - I. Domínguez
- Universidad de Sevilla, Departamento de Biología Celular, Sevilla, Spain
| | | | - A. Dumitrescu
- National Institute of Public Health, Radiation Hygiene Laboratory, Bucharest, Romania
| | - P.N. Duy
- Dalat Nuclear Research Institute, Radiation Technlogy & Biotechnology Center, Dalat City, Vietnam
| | - F. Finot
- Genevolution, Porcheville, France
| | - G. Garty
- Columbia University, Irving Medical Center, Center for Radiological Research, New York, New York
| | - S.A. Ghandhi
- Columbia University, Irving Medical Center, Center for Radiological Research, New York, New York
| | - E. Gregoire
- Institut de Radioprotection et de Surete Nucleaire, Fontenay aux Roses, France
| | - V.S.T. Goh
- Department of Radiobiology, Singapore Nuclear Research and Safety Initiative (SNRSI), National University of Singapore, Singapore
| | - I. Güçlü
- TENMAK, Nuclear Energy Research Institute, Technology Development and Nuclear Research Department, Türkey
| | - L. Hadjiiska
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - R. Hargitai
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - R. Hristova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - K. Ishii
- Department of Radiation Measurement and Dose Assessment, National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - E. Kis
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - M. Juniewicz
- Medical University of Gdansk, Department of Physics and Biophysics, Gdansk, Poland
| | - R. Kriehuber
- Department of Safety and Radiation Protection, Forschungszentrum Jülich, Jülich, Germany
| | - J. Lacombe
- University of Arizona, Center for Applied Nanobioscience & Medicine, Phoenix, Arizona
| | - Y. Lee
- Laboratory of Biological Dosimetry, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | | | - K. Lumniczky
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - T.T. Mai
- Dalat Nuclear Research Institute, Radiation Technlogy & Biotechnology Center, Dalat City, Vietnam
| | - N. Maltar-Strmečki
- Ruðer Boškovic Institute, Division of Physical Chemistry, Zagreb, Croatia
| | - M. Marrale
- Università Degli Studi di Palermo, Dipartimento di Fisica e Chimica “Emilio Segrè,” Palermo, Italy
| | - J.S. Martinez
- Institut de Radioprotection et de Surete Nucleaire, Fontenay aux Roses, France
| | - A. Marciniak
- Medical University of Gdansk, Department of Physics and Biophysics, Gdansk, Poland
| | - N. Maznyk
- Radiation Cytogenetics Laboratory, S.P. Grigoriev Institute for Medical Radiology and Oncology of Ukrainian National Academy of Medical Science, Kharkiv, Ukraine
| | - S.W.S. McKeever
- Radiation Dosimetry Laboratory, Oklahoma State University, Stillwater, Oklahoma
| | | | - M. Milanova
- University of Defense, Faculty of Military Health Sciences, Hradec Králové, Czech Republic
| | - T. Miura
- Institute of Radiation Emergency Medicine, Hirosaki University, Hirosaki, Japan
| | - O. Monteiro Gil
- Instituto Superior Técnico/ Campus Tecnológico e Nuclear, Lisbon, Portugal
| | - A. Montoro
- Servicio de Protección Radiológica. Laboratorio de Dosimetría Biológica, Valencia, Spain
| | - M. Moreno Domene
- Hospital General Universitario Gregorio Marañón, Laboratorio de dosimetría biológica, Madrid, Spain
| | - A. Mrozik
- Institute of Nuclear Physics, Polish Academy of Sciences, Krakow, Poland
| | - R. Nakayama
- Institute of Radiation Emergency Medicine, Hirosaki University, Hirosaki, Japan
| | - G. O’Brien
- UK Health Security Agency, Radiation, Chemical and Environmental Hazards Division, Oxfordshire, United Kingdom
| | - D. Oskamp
- Department of Safety and Radiation Protection, Forschungszentrum Jülich, Jülich, Germany
| | - P. Ostheim
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - J. Pajic
- Serbian Institute of Occupational Health, Belgrade, Serbia
| | - N. Pastor
- Universidad de Sevilla, Departamento de Biología Celular, Sevilla, Spain
| | - C. Patrono
- Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy
| | | | - M.J. Prieto Rodriguez
- Hospital General Universitario Gregorio Marañón, Laboratorio de dosimetría biológica, Madrid, Spain
| | - M. Repin
- Columbia University, Irving Medical Center, Center for Radiological Research, New York, New York
| | | | - U. Rößler
- Bundesamt für Strahlenschutz, Oberschleißheim, Germany
| | | | - A. Sakai
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - H. Scherthan
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - S. Schüle
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - K.M. Seong
- Laboratory of Biological Dosimetry, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | | | - S. Sholom
- Radiation Dosimetry Laboratory, Oklahoma State University, Stillwater, Oklahoma
| | - S. Sommer
- Institute of Nuclear Chemistry and Technology, Warsaw, Poland
| | - Y. Suto
- Department of Radiation Measurement and Dose Assessment, National Institute of Radiological Sciences, National Institutes for Quantum Science and Technology, Chiba, Japan
| | - T. Sypko
- Radiation Cytogenetics Laboratory, S.P. Grigoriev Institute for Medical Radiology and Oncology of Ukrainian National Academy of Medical Science, Kharkiv, Ukraine
| | - T. Szatmári
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - M. Takahashi-Sugai
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - K. Takebayashi
- Institute of Radiation Emergency Medicine, Hirosaki University, Hirosaki, Japan
| | - A. Testa
- Italian National Agency for New Technologies, Energy and Sustainable Economic Development, Rome, Italy
| | - I. Testard
- CEA-Saclay, Gif-sur-Yvette Cedex, France
| | - A. Tichy
- University of Defense, Faculty of Military Health Sciences, Hradec Králové, Czech Republic
| | - S. Triantopoulou
- National Centre for Scientific Research “Demokritos”, Health Physics, Radiobiology & Cytogenetics Laboratory, Agia Paraskevi, Greece
| | - N. Tsuyama
- Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - M. Unverricht-Yeboah
- Department of Safety and Radiation Protection, Forschungszentrum Jülich, Jülich, Germany
| | - M. Valente
- CEA-Saclay, Gif-sur-Yvette Cedex, France
| | - O. Van Hoey
- Belgian Nuclear Research Center SCK CEN, Mol, Belgium
| | | | - A. Wojcik
- Stockholm University, Stockholm, Sweden
| | - M. Wojewodzka
- Institute of Nuclear Chemistry and Technology, Warsaw, Poland
| | - Lee Younghyun
- Laboratory of Biological Dosimetry, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - D. Zafiropoulos
- Laboratori Nazionali di Legnaro - Istituto Nazionale di Fisica Nucleare, Legnaro, Italy
| | - M. Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
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Vral A, Endesfelder D, Balázs J, Beinke C, Petrenci CC, Finot F, Garty G, Hadjiiska L, Hristova R, Ivanova I, Lee Y, Lumniczky K, Milanova M, Gil OM, Oestreicher U, Pajic J, Patrono C, Pham ND, Perletti G, Seong KM, Sommer S, Szatmári T, Testa A, Tichy A, Tran TM, Wilkins R, Port M, Abend M, Baeyens A. RENEB Inter-Laboratory Comparison 2021: The Cytokinesis-Block Micronucleus Assay. Radiat Res 2023:492244. [PMID: 37057983 DOI: 10.1667/rade-22-00201.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/20/2023] [Indexed: 04/15/2023]
Abstract
The goal of the RENEB inter-laboratory comparison 2021 exercise was to simulate a large-scale radiation accident involving a network of biodosimetry labs. Labs were required to perform their analyses using different biodosimetric assays in triage mode scoring and to rapidly report estimated radiation doses to the organizing institution. This article reports the results obtained with the cytokinesis-block micronucleus assay. Three test samples were exposed to blinded doses of 0, 1.2 and 3.5 Gy X-ray doses (240 kVp, 13 mA, ∼75 keV, 1 Gy/min). These doses belong to 3 triage categories of clinical relevance: a low dose category, for no exposure or exposures inferior to 1 Gy, requiring no direct treatment of subjects; a medium dose category, with doses ranging from 1 to 2 Gy, and a high dose category, after exposure to doses higher than 2 Gy, with the two latter requiring increasing medical attention. After irradiation the test samples (no. 1, no. 2 and no. 3) were sent by the organizing laboratory to 14 centers participating in the micronucleus assay exercise. Laboratories were asked to setup micronucleus cultures and to perform the micronucleus assay in triage mode, scoring 500 binucleated cells manually, or 1,000 binucleated cells in automated/semi-automated mode. One laboratory received no blood samples, but scored pictures from another lab. Based on their calibration curves, laboratories had to provide estimates of the administered doses. The accuracy of the reported dose estimates was further analyzed by the micronucleus assay lead. The micronucleus assay allowed classification of samples in the corresponding clinical triage categories (low, medium, high dose category) in 88% of cases (manual scoring, 88%; semi-automated scoring, 100%; automated scoring, 73%). Agreement between scoring laboratories, assessed by calculating the Fleiss' kappa, was excellent (100%) for semi-automated scoring, good (83%) for manual scoring and poor (53%) for fully automated scoring. Correct classification into triage scoring dose intervals (reference dose ±0.5 Gy for doses ≤2.5 Gy, or reference dose ±1 Gy for doses >2.5 Gy), recommended for triage biodosimetry, was obtained in 79% of cases (manual scoring, 73%; semi-automated scoring, 100%; automated scoring, 67%). The percentage of dose estimates whose 95% confidence intervals included the reference dose was 58% (manual scoring, 48%; semi-automated scoring, 72%; automated scoring, 60%). For the irradiated samples no. 2 and no. 3, a systematic shift towards higher dose estimations was observed. This was also noticed with the other cytogenetic assays in this intercomparison exercise. Accuracy of the rapid triage modality could be maintained when the number of manually scored cells was scaled down to 200 binucleated cells. In conclusion, the micronucleus assay, preferably performed in a semi-automated or manual scoring mode, is a reliable technique to perform rapid biodosimetry analysis in large-scale radiation emergencies.
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Affiliation(s)
- A Vral
- Faculty of Medicine and Health Sciences, Radiobiology Research Unit, Universiteit Gent, Gent, Belgium
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - D Endesfelder
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - J Balázs
- National Public Health Center, Department of Radiobiology and Radiohygiene, Unit of Radiation Medicine, Budapest, Hungary
| | - C Beinke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | | | - F Finot
- Genevolution, Porcheville, France
| | - G Garty
- Center for Radiological Research, Columbia University, New York, New York
| | - L Hadjiiska
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - R Hristova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - I Ivanova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - Y Lee
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - K Lumniczky
- National Public Health Center, Department of Radiobiology and Radiohygiene, Unit of Radiation Medicine, Budapest, Hungary
| | - M Milanova
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - O Monteiro Gil
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisbon, Portugal
| | - U Oestreicher
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - J Pajic
- Serbian Institute of Occupational Health, Belgrade, Serbia
| | - C Patrono
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile, Rome, Italy
| | - N D Pham
- Center Radiation technlogy & Biotechnology; Dalat Nuclear Research Institute; Dalat City, Vietnam
| | - G Perletti
- Faculty of Medicine and Health Sciences, Radiobiology Research Unit, Universiteit Gent, Gent, Belgium
| | - K M Seong
- Laboratory of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - S Sommer
- Institute of Nuclear Chemistry and Technology, Warsaw, Poland
| | - T Szatmári
- National Public Health Center, Department of Radiobiology and Radiohygiene, Unit of Radiation Medicine, Budapest, Hungary
| | - A Testa
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile, Rome, Italy
| | - A Tichy
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - T M Tran
- Center Radiation technlogy & Biotechnology; Dalat Nuclear Research Institute; Dalat City, Vietnam
| | - R Wilkins
- °Health Canada, Radiation Protection Building, Ottawa, Canada
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - A Baeyens
- Faculty of Medicine and Health Sciences, Radiobiology Research Unit, Universiteit Gent, Gent, Belgium
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3
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Endesfelder D, Oestreicher U, Bucher M, Beinke C, Siebenwirth C, Ainsbury E, Moquet J, Gruel G, Gregoire E, Martinez JS, Vral A, Baeyens A, Valente M, Montoro A, Terzoudi G, Triantopoulou S, Pantelias A, Gil OM, Prieto MJ, Domene MM, Zafiropoulos D, Barquinero JF, Pujol-Canadell M, Lumniczky K, Hargitai R, Kis E, Testa A, Patrono C, Sommer S, Hristova R, Kostova N, Atanasova M, Sevriukova O, Domínguez I, Pastor N, Güçlü I, Pajic J, Sabatier L, Brochard P, Tichy A, Milanova M, Finot F, Petrenci CC, Wilkins RC, Beaton-Green LA, Seong KM, Lee Y, Lee YH, Balajee AS, Maznyk N, Sypko T, Pham ND, Tran TM, Miura T, Suto Y, Akiyamam M, Tsuyama N, Abe Y, Goh VST, Chua CEL, Abend M, Port M. RENEB Inter-Laboratory Comparison 2021: The Dicentric Chromosome Assay. Radiat Res 2023:492028. [PMID: 37018160 DOI: 10.1667/rade-22-00202.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/03/2023] [Indexed: 04/06/2023]
Abstract
After large-scale radiation accidents where many individuals are suspected to be exposed to ionizing radiation, biological and physical retrospective dosimetry assays are important tools to aid clinical decision making by categorizing individuals into unexposed/minimally, moderately or highly exposed groups. Quality-controlled inter-laboratory comparisons of simulated accident scenarios are regularly performed in the frame of the European legal association RENEB (Running the European Network of Biological and Physical retrospective Dosimetry) to optimize international networking and emergency readiness in case of large-scale radiation events. In total 33 laboratories from 22 countries around the world participated in the current RENEB inter-laboratory comparison 2021 for the dicentric chromosome assay. Blood was irradiated in vitro with X rays (240 kVp, 13 mA, ∼75 keV, 1 Gy/min) to simulate an acute, homogeneous whole-body exposure. Three blood samples (no. 1: 0 Gy, no. 2: 1.2 Gy, no. 3: 3.5 Gy) were sent to each participant and the task was to culture samples, to prepare slides and to assess radiation doses based on the observed dicentric yields from 50 manually or 150 semi-automatically scored metaphases (triage mode scoring). Approximately two-thirds of the participants applied calibration curves from irradiations with γ rays and about 1/3 from irradiations with X rays with varying energies. The categorization of the samples in clinically relevant groups corresponding to individuals that were unexposed/minimally (0-1 Gy), moderately (1-2 Gy) or highly exposed (>2 Gy) was successfully performed by all participants for sample no. 1 and no. 3 and by ≥74% for sample no. 2. However, while most participants estimated a dose of exactly 0 Gy for the sham-irradiated sample, the precise dose estimates of the samples irradiated with doses >0 Gy were systematically higher than the corresponding reference doses and showed a median deviation of 0.5 Gy (sample no. 2) and 0.95 Gy (sample no. 3) for manual scoring. By converting doses estimated based on γ-ray calibration curves to X-ray doses of a comparable mean photon energy as used in this exercise, the median deviation decreased to 0.27 Gy (sample no. 2) and 0.6 Gy (sample no. 3). The main aim of biological dosimetry in the case of a large-scale event is the categorization of individuals into clinically relevant groups, to aid clinical decision making. This task was successfully performed by all participants for the 0 Gy and 3.5 Gy samples and by 74% (manual scoring) and 80% (semi-automatic scoring) for the 1.2 Gy sample. Due to the accuracy of the dicentric chromosome assay and the high number of participating laboratories, a systematic shift of the dose estimates could be revealed. Differences in radiation quality (X ray vs. γ ray) between the test samples and the applied dose effect curves can partly explain the systematic shift. There might be several additional reasons for the observed bias (e.g., donor effects, transport, experimental conditions or the irradiation setup) and the analysis of these reasons provides great opportunities for future research. The participation of laboratories from countries around the world gave the opportunity to compare the results on an international level.
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Affiliation(s)
- D Endesfelder
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - U Oestreicher
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - M Bucher
- Bundesamt für Strahlenschutz, BfS, Oberschleissheim, Germany
| | - C Beinke
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - C Siebenwirth
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - E Ainsbury
- UK Health Security Agency, Radiation, Chemicals and Environmental Hazards Directorate, Chilton, Oxfordshire, United Kingdom
| | - J Moquet
- UK Health Security Agency, Radiation, Chemicals and Environmental Hazards Directorate, Chilton, Oxfordshire, United Kingdom
| | - G Gruel
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, SERAMED, LRAcc Fontenay-aux-Roses 92262, France
| | - E Gregoire
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, SERAMED, LRAcc Fontenay-aux-Roses 92262, France
| | - J S Martinez
- Institut de Radioprotection et de Sûreté Nucléaire (IRSN), PSE-Santé, SERAMED, LRAcc Fontenay-aux-Roses 92262, France
| | - A Vral
- Faculty of Medicine and Health Sciences, Universiteit Gent, Gent, Belgium
| | - A Baeyens
- Faculty of Medicine and Health Sciences, Universiteit Gent, Gent, Belgium
| | - M Valente
- Armed Forces Biomedical Research Institute, Department of Radiation Biological, Effects Brétigny-sur-Orge, France
| | - A Montoro
- Laboratorio de Dosimetría Biológica Servicio de Protección Radiológica Hospital Universitario Politécnico la Fe, Spain
| | - G Terzoudi
- National Centre for Scientific Research "Demokritos," Health Physics, Radiobiology & Cytogenetics Laboratory, Athens, Greece
| | - S Triantopoulou
- National Centre for Scientific Research "Demokritos," Health Physics, Radiobiology & Cytogenetics Laboratory, Athens, Greece
| | - A Pantelias
- National Centre for Scientific Research "Demokritos," Health Physics, Radiobiology & Cytogenetics Laboratory, Athens, Greece
| | - O Monteiro Gil
- Centro de Ciências e Tecnologias Nucleares, Instituto Superior Técnico (IST), Universidade de Lisboa, Lisboa, Portugal
| | - M J Prieto
- Hospital General Universitario Gregorio Marañón; Servicio de Oncología Radioterápica; Laboratorio de dosimetría biológica, Madrid, Spain
| | - M M Domene
- Hospital General Universitario Gregorio Marañón; Servicio de Oncología Radioterápica; Laboratorio de dosimetría biológica, Madrid, Spain
| | - D Zafiropoulos
- Laboratori Nazionali di Legnaro - Istituto Nazionale di Fisica Nucleare, Legnaro, Italy
| | | | | | - K Lumniczky
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - R Hargitai
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - E Kis
- Radiation Medicine Unit, Department of Radiobiology and Radiohygiene, National Public Health Centre, Budapest, Hungary
| | - A Testa
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile, Rome, Italy
| | - C Patrono
- Agenzia nazionale per le nuove tecnologie, l'energia e lo sviluppo economico sostenibile, Rome, Italy
| | - S Sommer
- Institute of Nuclear Chemistry and Technology, Warsaw, Poland
| | - R Hristova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - N Kostova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - M Atanasova
- National Centre of Radiobiology and Radiation Protection, Sofia, Bulgaria
| | - O Sevriukova
- Laboratori Nazionali di Legnaro - Istituto Nazionale di Fisica Nucleare, Legnaro, Italy
| | - I Domínguez
- Universidad de Sevilla, Departamento de Biología Celular, Facultad de Biología, Sevilla, Spain
| | - N Pastor
- Universidad de Sevilla, Departamento de Biología Celular, Facultad de Biología, Sevilla, Spain
| | - I Güçlü
- Nükleer Arş Ens. Yarımburgaz mah. Nükleer Arş yolu, Turkey
| | - J Pajic
- Serbian Institute of Occupational Health, Belgrade, Serbia
| | - L Sabatier
- PROCyTOX, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Fontenay-aux-Roses, France and Université Paris-Saclay, France
| | - P Brochard
- PROCyTOX, Commissariat à l'Energie Atomique et aux Energies Alternatives (CEA), Fontenay-aux-Roses, France and Université Paris-Saclay, France
| | - A Tichy
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - M Milanova
- Department of Radiobiology, Faculty of Military Health Sciences, University of Defence, Hradec Králové, Czech Republic
| | - F Finot
- Genevolution, Porcheville, France
| | | | - R C Wilkins
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - L A Beaton-Green
- Consumer and Clinical Radiation Protection Bureau, Health Canada, Ottawa, Canada
| | - K M Seong
- Lab of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - Y Lee
- Lab of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - Y H Lee
- Lab of Biological Dosimetry, National Radiation Emergency Medical Center, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
| | - A S Balajee
- Cytogenetic Biodosimetry Laboratory; Radiation Emergency Assistance Center/Training Site (REAC/TS); Oak Ridge Institute for Science and Education; Oak Ridge Associated Universities; Oak Ridge, Tennessee
| | - N Maznyk
- aa Radiation Cytogenetics Laboratory; S.P. Grigoriev Institute for Medical Radiology and Oncology of Ukrainian National Academy of Medical Science, Kharkiv, Ukraine
| | - T Sypko
- aa Radiation Cytogenetics Laboratory; S.P. Grigoriev Institute for Medical Radiology and Oncology of Ukrainian National Academy of Medical Science, Kharkiv, Ukraine
| | - N D Pham
- bb Biodosimetry Laboratory, Center for Radiation Technology & Biotechnology; Dalat Nuclear Research Institute; Dalat City, Vietnam
| | - T M Tran
- bb Biodosimetry Laboratory, Center for Radiation Technology & Biotechnology; Dalat Nuclear Research Institute; Dalat City, Vietnam
| | - T Miura
- cc Department of Risk Analysis and Biodosimetry Institute of Radiation Emergency Medicine, Hirosaki University, Hirosaki, Japan
| | - Y Suto
- dd National Institutes for Quantum Science and Technology, Chiba, Japan
| | - M Akiyamam
- dd National Institutes for Quantum Science and Technology, Chiba, Japan
| | - N Tsuyama
- ee Department of Radiation Life Sciences, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Y Abe
- ff Department of Radiation Biology and Protection, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - V S T Goh
- ff Department of Radiation Biology and Protection, Atomic Bomb Disease Institute, Nagasaki University, Japan
| | - C E L Chua
- gg Department of Radiobiology, Singapore Nuclear Research and Safety Initiative (SNRSI), National University of Singapore, Singapore
| | - M Abend
- Bundeswehr Institute of Radiobiology, Munich, Germany
| | - M Port
- Bundeswehr Institute of Radiobiology, Munich, Germany
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4
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Petrucci G, Viti L, Sacco M, Hatem D, Lancellotti S, Rizzi A, Zaccardi F, De Cristofaro R, Pitocco D, Patrono C, Rocca B. Effect of low-dose rivaroxaban with low-dose aspirin vs low-dose aspirin on platelet and oxidative biomarkers: a randomized study in diabetes patients with stable peripheral or coronary artery disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Rivaroxaban (Riva), a direct FXa inhibitor, at 2.5 mg twice-daily (bid) combined with low-dose aspirin (ASA, 100 mg once daily-od) reduced major vascular events vs. ASA alone in subjects with stable coronary artery (CAD) or symptomatic peripheral artery disease (PAD). Whether this benefit is due to the anticoagulant effect or additional FXa-mediated effects through the platelet and endothelial cell thrombin receptors is unknown. Type 2 diabetes mellitus (T2DM) is characterized by high platelet activation and oxidative stress that may contribute to increased cardiovascular risk.
Purpose
We investigated the effects of Riva (2.5 mg bid) + ASA (100 mg od) vs. ASA (100 mg od) alone on platelet and oxidative biomarkers in subjects with T2DM and stable vascular disease (stable CAD, symptomatic PAD and/or significant carotid stenosis).
Methods
In this randomized, open-label, cross-over trial, patients were randomized to continue ASA for 4 weeks and then add Riva for 4 weeks, or add Riva in the first 4 weeks and then continue with ASA alone for 4 weeks. Primary endpoints were: in vivo platelet activation and lipid peroxidation, assessed by the urinary excretion of 11-dehydro-TXB2 (TXM) and 8-iso-PGF2alpha (ISOP), respectively. Secondary endpoints included: routine coagulation tests, D-dimer, thrombin generation, serum TXB2, and Riva plasma concentrations.
Results
Seventy-6 subjects (10 females) were recruited: age 68±7 years (mean±SD); BMI 27.1±3.5 kg/m2; fasting glucose 129±31 mg/dL; HbA1c 6.8±0.9%; serum creatinine 1±0.25 mg/dL; LDL-cholesterol 77±31 mg/dL. Two patients dropped out: one for benign, self-limiting hematuria, one for unwillingness to continue, 8 subjects are completing the study leaving 66 who completed the 8-week randomized treatment and showed no sequence effect. Urinary TXM and ISOP were significantly reduced by Riva+ASA vs. ASA alone: TXM was 260 [195–398] vs. 335 [225–441] pg/mg creatinine and ISOP 722 [601–991] vs. 827 [648–1350] pg/mg creatinine (median [IQR]) on Riva+ASA vs. ASA alone, respectively (p<0.001 for paired samples). Riva plasma concentrations were 48±1.9 ng/ml at peak and 21±1.4 ng/ml at trough. The velocity of thrombin formation significantly decreased with Riva+ASA vs. ASA alone (velocity index, 46±3% vs. 83±3%; peak-height, 66±2% vs. 83±1%, respectively). aPTT levels were slightly but significantly prolonged by Riva vs. ASA alone (44±1 vs. 39±1 sec). Serum TXB2, D-dimer, von Willebrand factor, PT, fibrinogen and endogenous thrombin potential values were similar between treatments.
Conclusions
In ASA-treated subjects with T2DM and stable vascular disease, the addition of very low-dose Riva restrained incompletely-suppressed lipid peroxidation and platelet activation and modified the kinetics of thrombin formation. These changes may contribute to the beneficial effects of the Riva+ASA combination.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Investigator-initiated study funded by Bayer AG
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Affiliation(s)
- G Petrucci
- Catholic University School of Medicine , Rome , Italy
| | - L Viti
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - M Sacco
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - D Hatem
- Catholic University School of Medicine , Rome , Italy
| | - S Lancellotti
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - A Rizzi
- Catholic University School of Medicine , Rome , Italy
| | - F Zaccardi
- Leicester Diabetes Centre , Leicester , United Kingdom
| | - R De Cristofaro
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - D Pitocco
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS , Rome , Italy
| | - C Patrono
- Catholic University School of Medicine , Rome , Italy
| | - B Rocca
- Catholic University School of Medicine , Rome , Italy
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5
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Rocca B, Buck G, Petrucci G, Parish S, Pagliaccia F, Baigent C, Mafham M, Bowman L, Armitage J, Patrono C. Thromboxane metabolite excretion is associated with serious vascular events in diabetes mellitus: a sub-study of the ASCEND trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Platelet activation plays a major role in the atherothrombotic complications of diabetes. Thromboxane (TX)A2 is a pro-thrombotic prostanoid, synthesized via cyclooxygenase-1 and released by activated platelets. The metabolism of TXA2 in vivo leads to a major stable end-product, 11-dehydro-TXB2 (TXM), measurable in urine and reflecting the whole-body rate of TXA2 biosynthesis. In two large trials of high-risk, aspirin-treated (mostly, without diabetes) patients, (CHARISMA and HOPE trials), the baseline rate of urinary TXM excretion was an independent predictor of future cardiovascular events.
Purpose
The aim of the ASCEND (A Study of Cardiovascular Events in Diabetes) TXM sub-study was to investigate the association between baseline urinary TXM and future serious vascular events or revascularization (SVE-R), major bleeds and incident cancer independent of other risk factors and treatment, in people with diabetes and no manifest cardiovascular disease at trial entry.
Methods
Urinary TXM was measured by a previously GC/MS-validated, immunoassay in 6,487 participants with eligible baseline samples. Analyses excluded 539 participants using NSAIDs. TXM appeared log-normally distributed, so analyses were by quintiles and per SD (=0.622) of continuous loge TXM. The association of loge TXM with outcome was adjusted by basic factors (age, sex, sample volume and randomized treatment allocation) and by the predictors of log TXM (smoking, type 2 diabetes treated with insulin or oral hypoglycaemics, HDL cholesterol, body mass index, urinary albumin/creatinine ratio, eGFR). The association of log TXM with non-vascular, non-cancer MedDRA outcomes was investigated to determine whether TXM had a general effect on outcome. During a mean of 6.6 years follow-up there were 618 SVE-Rs, 206 bleeds and 700 cancers among these patients.
Results
Log TXM correlated significantly with SVE-R, hazard ratio (HR) per 1 SD of log TXM: 1.13 (1.04–1.23), p=0.003 (Figure 1, panel a), non-significantly with major bleeds [HR 1.15 (1.00–1.32), p=0.055] (Figure 1, panel b), and marginally significantly with cancer [HR 1.09 (1.01–1.17), p=0.03] (Figure 1, panel c). There was no association of log TXM with non-vascular non-cancer MedDRA outcomes (HR per 1 SD, 0.99; 99% CI, 0.94–1.05).
Conclusion
The rate of urinary TXM excretion, a non-invasive biomarker of TXA2-mediated platelet activation in vivo, is log-linearly associated with serious vascular events independent of other risk factors in people with diabetes. Its potential association with cancer must be viewed as hypothesis-generating and needs confirmation.
Figure 1
Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): IMI1: Surrogate markers for micro- and macro-vascular hard endpoints for innovative diabetes tools (SUMMIT).
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Affiliation(s)
- B Rocca
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Buck
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - G Petrucci
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - S Parish
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - F Pagliaccia
- Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - C Baigent
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - M Mafham
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - L Bowman
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - J Armitage
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
| | - C Patrono
- University of Oxford, CTSU and MRC PHRU, Nuffield Department of Population Health, Oxford, United Kingdom
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6
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Testa A, Palma V, Patrono C. A NOVEL BIOLOGICAL DOSIMETRY ASSAY AS A POTENTIAL TOOL FOR TRIAGE DOSE ASSESSMENT IN CASE OF LARGE-SCALE RADIOLOGICAL EMERGENCY. Radiat Prot Dosimetry 2019; 186:9-11. [PMID: 30726995 DOI: 10.1093/rpd/ncz001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/11/2018] [Indexed: 06/09/2023]
Abstract
In case of mass radiological emergencies, new strategies involving biological and clinical endpoints are requested for an efficient triage classification of casualties. For this purpose, we developed a novel protocol combining the two most established cytogenetic methods used in biological dosimetry (dicentric and micronucleus assays) into a single one, in order to have a time-saving, inexpensive and potentially automatable instrument to be used for triage purposes in case of large-scale radiological events. This method could be considered as a 'three in one' assay allowing the simultaneous scoring of chromosome aberrations and micronuclei on a single slide, and also enabling to discriminate between metaphases in first and second cell division without the Fluorescence plus Giemsa staining. This method needs further validation through inter-comparisons involving biological dosimetry laboratories, to verify its reproducibility. Moreover, the possibility to apply the already existing software for automation for dicentric and micronucleus assays could be also verified.
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Affiliation(s)
- A Testa
- ENEA Casaccia Research Center, Department for Sustainability, Division Health Protection Technologies, Via Anguillarese, 301 Rome, Italy
| | - V Palma
- ENEA Casaccia Research Center, Department for Sustainability, Division Health Protection Technologies, Via Anguillarese, 301 Rome, Italy
| | - C Patrono
- ENEA Casaccia Research Center, Department for Sustainability, Division Health Protection Technologies, Via Anguillarese, 301 Rome, Italy
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7
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De Caterina R, Giannessi D, Boem A, Bernini W, Battaglia D, Michelassi C, Dell’Amico F, L’Abbate A, Patrignani P, Patrono C. Equal Antiplatelet Effects of Aspirin 50 or 324 mg/Day in Patients After Acute Myocardial Infarction. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1657890] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThis study explores the effects on some hematological parameters of a low-dose aspirin regimen (50 mg/day) versus a conventional aspirin treatment with reported antithrombotic efficacy (324 mg/day), in patients with acute myocardial infarction. Fifteen patients were randomized into 3 equal groups receiving 50 mg or 324 mg aspirin or placebo, daily for 21 days. Compared with placebo, bleeding time was significantly and similarly prolonged with both aspirin doses (+ 71 ± 22% and + 69 ± 20%, mean ± S.D.). Aspirin 50 mg/day suppressed arachidonate-induced platelet aggregation and secondary phase aggregation after ADP and adrenaline. Collagen aggregation was inhibited by 44 ± 15%. In no case were differences in the antiplatelet effects of the two doses observed. The effects of 50 mg/day persisted without attenuation during the observation period. Platelet thromboxane B2 generation during arachidonate-induced aggregation was inhibited by 95 ± 2 and 99 ± 1% compared to placebo group after 50 and 324 mg/day, respectively (P between doses <0.05). No change was observed with any treatment in coagulation time, prothrombin time or plasma thromboplastin time. Thus, in patients with acute myocardial infarction, the antiplatelet effects of aspirin 50 mg/day are stable over time and superimposable on those of 324 mg/day. The antithrombotic efficacy of aspirin 50 mg/day remains to be tested clinically.
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Affiliation(s)
- R De Caterina
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - D Giannessi
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - A Boem
- The Division of Cardiovascular Medicine, Spedali Riuniti di S. Chiara, Pisa, Italy
| | - W Bernini
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - D Battaglia
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - C Michelassi
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - F Dell’Amico
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - A L’Abbate
- The C.N.R. Institute of Clinical Physiology, Pisa, Italy
| | - P Patrignani
- The Institute of Pharmacology, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - C Patrono
- The Institute of Pharmacology, Universitá Cattolica del Sacro Cuore, Roma, Italy
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8
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Cavalca V, Rocca B, Veglia F, Petrucci G, Porro B, Myasoedova V, De Cristofaro R, Turnu L, Bonomi A, Songia P, Cavallotti L, Zanobini M, Camera M, Alamanni F, Parolari A, Patrono C, Tremoli E. On-pump Cardiac Surgery Enhances Platelet Renewal and Impairs Aspirin Pharmacodynamics: Effects of Improved Dosing Regimens. Clin Pharmacol Ther 2017; 102:849-858. [DOI: 10.1002/cpt.702] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/27/2017] [Accepted: 03/29/2017] [Indexed: 12/11/2022]
Affiliation(s)
- V Cavalca
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - B Rocca
- Department of Pharmacology; Catholic University; Rome Italy
| | - F Veglia
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - G Petrucci
- Department of Pharmacology; Catholic University; Rome Italy
| | - B Porro
- Monzino Cardiology Center, IRCCS; Milan Italy
| | | | | | - L Turnu
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - A Bonomi
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - P Songia
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | | | - M Zanobini
- Monzino Cardiology Center, IRCCS; Milan Italy
| | - M Camera
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - F Alamanni
- Monzino Cardiology Center, IRCCS; Milan Italy
- University of Milan; Milan Italy
| | - A Parolari
- Policlinico San Donato Hospital, IRCCS; San Donato Milanese Italy
| | - C Patrono
- Department of Pharmacology; Catholic University; Rome Italy
| | - E Tremoli
- Monzino Cardiology Center, IRCCS; Milan Italy
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9
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Giaretta A, Rocca B, Di Camillo B, Toffolo GM, Patrono C. In Silico Modeling of the Antiplatelet Pharmacodynamics of Low-dose Aspirin in Health and Disease. Clin Pharmacol Ther 2017; 102:823-831. [PMID: 28378909 DOI: 10.1002/cpt.694] [Citation(s) in RCA: 18] [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] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/06/2017] [Accepted: 03/11/2017] [Indexed: 01/25/2023]
Abstract
The influence of platelet turnover on cyclooxygenase (COX-1) inhibition by low-dose aspirin remains largely uncharacterized due to limited feasibility of studying aspirin pharmacodynamics in bone marrow precursors. We developed an in silico compartmental model describing the aspirin effects on COX-1 activity in a population of megakaryocytes (MK) and in peripheral platelets. Model parameters were inferred from the literature and calibrated using measurements of serum thromboxane B2 (sTXB2 ), as proxy of COX-1 activity in peripheral platelets, in 17 healthy subjects and 24 patients with essential thrombocythemia (ET). The model reproduced well the average time-course of sTXB2 inhibition in healthy (accuracy = 10.4%), the reduced inhibition of sTXB2 observed in ET, and the effect of different dosing regimens. In conclusion, the in silico model accurately describes COX-1 inactivation by low-dose aspirin in MK and platelets in different clinical settings, and might help personalize aspirin regimens in conditions of altered megakaryopoiesis.
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Affiliation(s)
- A Giaretta
- Department of Information Engineering, University of Padova, Padova, Italy
| | - B Rocca
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - B Di Camillo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - G M Toffolo
- Department of Information Engineering, University of Padova, Padova, Italy
| | - C Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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10
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D'Arcangelo C, Di Nardo-Di Maio F, Patrono C, Caputi S. NOS Evaluations in Human Dental Pulp-Capping with MTA and Calcium-Hydroxide. Int J Immunopathol Pharmacol 2017; 20:27-32. [PMID: 17897498 DOI: 10.1177/039463200702001s07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The aim of this study is to compare mineral trioxide aggregate (MTA) with calcium hydroxide when used as pulp-capping material in human teeth. 40 teeth were divided into groups based on clinical diagnosis: healthy and hyperaemic. The teeth were pulp capped with MTA and calcium hydroxide. We localized the eNOS and iNOS by immunohistochemistry, tested their mRNA expression by RT-PCR and protein levels by western blots. The evaluation of the samples was based on the cell inflammatory response and on the pulp tissue organization. In particular, evaluation of eNOS and iNOS differences between the various groups and the cellular evolution after the first 7 days from the treatment, and at a distance of 28 days. Our results suggest that there are differences in localization and expression between eNOS and iNOS in dental pulp. Our study has helped us to better understand the effects that calcium hydroxide and MTA have on pulp tissue.
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Affiliation(s)
- C D'Arcangelo
- Department of Stomatology and Oral Sciences, University of Chieti, Chieti, Italy.
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11
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Patrono C, Baigent C. Coxibs, Traditional NSAIDs, and Cardiovascular Safety Post-PRECISION: What We Thought We Knew Then and What We Think We Know Now. Clin Pharmacol Ther 2017; 102:238-245. [PMID: 28378879 DOI: 10.1002/cpt.696] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 03/15/2017] [Indexed: 01/08/2023]
Abstract
The aim of the present review is to analyze how thinking about the cardiovascular safety of nonsteroidal antiinflammatory drugs has evolved during the past two decades, and discuss to what extent the additional information from the Prospective Randomized Evaluation of Celecoxib Integrated Safety Versus Ibuprofen or Naproxen study may alter our current mechanistic understanding and/or clinical practice.
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Affiliation(s)
- C Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - C Baigent
- Medical Research Council Population Health Research Unit, and Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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12
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Patrono C, Monteiro Gil O, Giesen U, Langner F, Pinto M, Rabus H, Testa A. 'BioQuaRT' project: design of a novel in situ protocol for the simultaneous visualisation of chromosomal aberrations and micronuclei after irradiation at microbeam facilities. Radiat Prot Dosimetry 2015; 166:197-199. [PMID: 25877532 DOI: 10.1093/rpd/ncv160] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The aim of the 'BioQuaRT' (Biologically weighted Quantities in RadioTherapy) project is to develop measurement techniques for characterising charged particle track structure on different length scales, and to correlate at the cellular level the track structure properties with the biological effects of radiation. This multi-scale approach will allow characterisation of the radiation qualities used in radiotherapy and the related biological effects. Charged-particle microbeam facilities were chosen as the platforms for all radiobiology experiments in the 'BioQuaRT' project, because they allow targeting single cells (or compartments of a cell) with a predefined number of ionising particles and correlating the cell-by-cell induced damage with type and energy of the radiation and with the number of ions per cell. Within this project, a novel in situ protocol was developed for the analysis of the misrepaired and/or unrepaired chromosome damage induced by charged-particle irradiations at the Physikalisch-Technische Bundesanstalt (PTB) ion microbeam facility. Among the cytogenetic biomarkers to detect and estimate radiation-induced DNA damage in radiobiology, chromosomal aberrations and micronuclei were chosen. The characteristics of the PTB irradiation system required the design of a special in situ assay: specific irradiation dishes with a base made from a biofoil 25-µm thick and only 3000-4000 cells seeded and irradiated per dish. This method was developed on Chinese hamster ovary (CHO) cells, one of the most commonly used cell lines in radiobiology in vitro experiments. The present protocol allows the simultaneous scoring of chromosome aberrations and micronuclei on the same irradiated dish. Thanks to its versatility, this method could also be extended to other radiobiological applications besides the single-ion microbeam irradiations.
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Affiliation(s)
- C Patrono
- Technical Unit of Radiation Biology and Human Health, ENEA Casaccia, Rome, Italy
| | - O Monteiro Gil
- Instituto Superior Técnico, Universidade de Lisboa, Lisboa, Portugal
| | - U Giesen
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
| | - F Langner
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
| | - M Pinto
- National Institute of Ionizing Radiation Metrology, ENEA, Rome, Italy
| | - H Rabus
- Physikalisch-Technische Bundesanstalt (PTB), Braunschweig, Germany
| | - A Testa
- Technical Unit of Radiation Biology and Human Health, ENEA Casaccia, Rome, Italy
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Giaretta A, Rocca B, Di Camillo B, Toffolo G, Patrono C. An in silico model of aspirin-iduced inactivation of platelet and Megakaryocyte Cyclooxygenase-1. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.030] [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]
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Giaretta A, Rocca B, Di Camillo B, Toffolo G, Patrono C. An in silico model of aspirin-iduced inactivation of platelet and Megakaryocyte Cyclooxygenase-1. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.293] [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]
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Patrono C. Renal prostaglandins: biochemistry and functional significance in man. Contrib Nephrol 2015; 69:55-66. [PMID: 2661143 DOI: 10.1159/000416746] [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] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- C Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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Patrignani P, Tacconelli S, Piazuelo E, Di Francesco L, Dovizio M, Sostres C, Marcantoni E, Guillem-Llobat P, Del Boccio P, Zucchelli M, Patrono C, Lanas A. Reappraisal of the clinical pharmacology of low-dose aspirin by comparing novel direct and traditional indirect biomarkers of drug action. J Thromb Haemost 2014; 12:1320-30. [PMID: 24942808 DOI: 10.1111/jth.12637] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 04/09/2014] [Accepted: 06/10/2014] [Indexed: 12/21/2022]
Abstract
BACKGROUND Even though the acetylation of platelet cyclooxygenase (COX)-1 at serine-529 is the direct mechanism of action of low-dose aspirin, its antiplatelet effect has been characterized using indirect indexes of COX-1 activity. OBJECTIVES We performed a clinical study with enteric-coated low-dose aspirin (EC-aspirin), in healthy subjects, to evaluate the effects on the extent and duration of platelet COX-1 acetylation, using a novel proteomic strategy for absolute protein quantification (termed AQUA), as compared with traditional pharmacokinetic and pharmacodynamic parameters. SUBJECTS AND METHODS In a phase I, single-arm, open-label study of EC aspirin (100 mg day(-1) ) administered to 24 healthy subjects, we compared, over a 24 h-period on day 1 and 7, % platelet acetylated COX-1 (AceCOX-1) with traditional pharmacokinetic and pharmacodynamics [i.e. serum thromboxane (TX) B2 , platelet function by monitoring CEPI(collagen/epinephrine) closure time (CT) using whole-blood PFA-100 and urinary excretion of 11-dehydro-TXB2 ] parameters. RESULTS Acetylation of platelet COX-1 was measurable before detection of aspirin levels in the systemic circulation and increased in a cumulative fashion upon repeated dosing. After the last dose of EC-aspirin, %AceCOX-1, serum TXB2 and CEPI-CT values were maximally and persistently modified throughout 24 h; they averaged 76 ± 2%, 99.0 ± 0.4% and 271 ± 5 s, respectively. EC-aspirin caused 75% reduction in urinary 11-dehydro-TXB2 excretion. After chronic dosing with aspirin, the pharmacokinetics of acetylsalicylic acid was completely dissociated from pharmacodynamics. CONCLUSIONS The demonstrated feasibility of quantifying the extent and duration of platelet COX-1 acetylation will allow characterizing the genetic, pharmacokinetic and pharmacodynamic determinants of the inter-individual variability in the antiplatelet response to low-dose aspirin as well as identifying extra-platelet sites of drug action.
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Affiliation(s)
- P Patrignani
- Section of Cardiovascular and Pharmacological Sciences, Department of Neuroscience, Imaging and Clinical Science, Center of Excellence on Aging (CeSI), 'G. d'Annunzio' University, Chieti, Italy; Center of Excellence on Aging (CeSI), "G. d'Annunzio" University, Chieti, Italy
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Cavalca V, Rocca B, Squellerio I, Dragani A, Veglia F, Pagliaccia F, Porro B, Barbieri SS, Tremoli E, Patrono C. In vivo prostacyclin biosynthesis and effects of different aspirin regimens in patients with essential thrombocythaemia. Thromb Haemost 2014; 112:118-27. [PMID: 24671522 DOI: 10.1160/th13-10-0844] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 01/24/2014] [Indexed: 02/01/2023]
Abstract
Essential thrombocythaemia (ET) is characterised by enhanced platelet generation and thrombosis. Once daily (od) aspirin incompletely inhibits platelet thromboxane (TX)A2 production in ET. A twice daily (bid) dosing is necessary to fully inhibit TXA2. Whether this dosing regimen affects in vivo prostacyclin (PGI2) biosynthesis is unknown. PGI2 biosynthesis was characterised in 50 ET patients on enteric-coated (EC) aspirin 100 mg od, by measuring its urinary metabolite, 2,3-dinor-6-keto-PGF1α (PGI-M). Moreover, in a crossover study 22 patients poorly responsive to standard aspirin based on serum TXB2 levels (≥4 ng/ml) were randomised to different seven-day aspirin regimens: EC aspirin 100 mg od, 100 mg bid, 200 mg od, or plain aspirin 100 mg od. PGI-M measured 24 hours after the last aspirin intake (EC, 100 mg od) was similar in patients and healthy subjects both on (n=10) and off (n=30) aspirin. PGI-M was unrelated to in vivo TXA2 biosynthesis, and not affected by EC aspirin 100 mg bid or 200 mg od as compared to EC 100 mg od. PGI2 biosynthesis in aspirin-treated ET patients appears unrelated to TXA2 biosynthesis, and not affected by an improved aspirin regimen, demonstrating its vascular safety for future trials.
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Affiliation(s)
- V Cavalca
- Viviana Cavalca, Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Via Parea 4, 20138 Milan, Italy, Tel.: +39 02 58002345, Fax: +39 02 58002750, E-mail:
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Ryden L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J 2014. [DOI: 10.1093/eurheartj/ehu076] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Bhala N, Emberson J, Merhi A, Abramson S, Arber N, Baron JA, Bombardier C, Cannon C, Farkouh ME, FitzGerald GA, Goss P, Halls H, Hawk E, Hawkey C, Hennekens C, Hochberg M, Holland LE, Kearney PM, Laine L, Lanas A, Lance P, Laupacis A, Oates J, Patrono C, Schnitzer TJ, Solomon S, Tugwell P, Wilson K, Wittes J, Baigent C. Vascular and upper gastrointestinal effects of non-steroidal anti-inflammatory drugs: meta-analyses of individual participant data from randomised trials. Lancet 2013; 382:769-79. [PMID: 23726390 PMCID: PMC3778977 DOI: 10.1016/s0140-6736(13)60900-9] [Citation(s) in RCA: 1106] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The vascular and gastrointestinal effects of non-steroidal anti-inflammatory drugs (NSAIDs), including selective COX-2 inhibitors (coxibs) and traditional non-steroidal anti-inflammatory drugs (tNSAIDs), are not well characterised, particularly in patients at increased risk of vascular disease. We aimed to provide such information through meta-analyses of randomised trials. METHODS We undertook meta-analyses of 280 trials of NSAIDs versus placebo (124,513 participants, 68,342 person-years) and 474 trials of one NSAID versus another NSAID (229,296 participants, 165,456 person-years). The main outcomes were major vascular events (non-fatal myocardial infarction, non-fatal stroke, or vascular death); major coronary events (non-fatal myocardial infarction or coronary death); stroke; mortality; heart failure; and upper gastrointestinal complications (perforation, obstruction, or bleed). FINDINGS Major vascular events were increased by about a third by a coxib (rate ratio [RR] 1·37, 95% CI 1·14-1·66; p=0·0009) or diclofenac (1·41, 1·12-1·78; p=0·0036), chiefly due to an increase in major coronary events (coxibs 1·76, 1·31-2·37; p=0·0001; diclofenac 1·70, 1·19-2·41; p=0·0032). Ibuprofen also significantly increased major coronary events (2·22, 1·10-4·48; p=0·0253), but not major vascular events (1·44, 0·89-2·33). Compared with placebo, of 1000 patients allocated to a coxib or diclofenac for a year, three more had major vascular events, one of which was fatal. Naproxen did not significantly increase major vascular events (0·93, 0·69-1·27). Vascular death was increased significantly by coxibs (1·58, 99% CI 1·00-2·49; p=0·0103) and diclofenac (1·65, 0·95-2·85, p=0·0187), non-significantly by ibuprofen (1·90, 0·56-6·41; p=0·17), but not by naproxen (1·08, 0·48-2·47, p=0·80). The proportional effects on major vascular events were independent of baseline characteristics, including vascular risk. Heart failure risk was roughly doubled by all NSAIDs. All NSAID regimens increased upper gastrointestinal complications (coxibs 1·81, 1·17-2·81, p=0·0070; diclofenac 1·89, 1·16-3·09, p=0·0106; ibuprofen 3·97, 2·22-7·10, p<0·0001; and naproxen 4·22, 2·71-6·56, p<0·0001). INTERPRETATION The vascular risks of high-dose diclofenac, and possibly ibuprofen, are comparable to coxibs, whereas high-dose naproxen is associated with less vascular risk than other NSAIDs. Although NSAIDs increase vascular and gastrointestinal risks, the size of these risks can be predicted, which could help guide clinical decision making. FUNDING UK Medical Research Council and British Heart Foundation.
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Pippucci T, Panza E, Pompilii E, Donadio V, Borreca A, Babalini C, Patrono C, Zuntini R, Kawarai T, Bernardi G, Liguori R, Romeo G, Montagna P, Orlacchio A, Seri M. Autosomal recessive hereditary spastic paraplegia with thin corpus callosum: a novel mutation in the SPG11 gene and further evidence for genetic heterogeneity. Eur J Neurol 2012; 16:121-6. [PMID: 19087158 DOI: 10.1111/j.1468-1331.2008.02367.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Autosomal Recessive Hereditary Spastic Paraplegia with Thin Corpus Callosum (AR-HSPTCC) is a clinically and genetically heterogeneous complicated form of spastic paraplegia. Two AR-HSPTCC loci have been assigned to chromosome 15q13-15 (SPG11) and chromosome 8p12-p11.21 respectively. Mutations in the SPG11 gene, encoding the spatacsin protein, have been found in the majority of SPG11 families. In this study, involvement of the SPG11 or 8p12-p11.21 loci was investigated in five Italian families, of which four consanguineous. METHODS Families were tested for linkage to the SPG11 or 8p12-p11.21 loci and the SPG11 gene was screened in all the affected individuals. RESULTS Linkage was excluded in the four consanguineous families. In the only SPG11-linked family the same homozygous haplotype 4.2 cM across the SPG11 locus was shared by all the three affected siblings. A novel c.2608A>G mutation predicted to affect the splicing was found in exon 14 of the SPG11 gene. DISCUSSION This collection of families contributes to highlight the intra and inter locus heterogeneity in AR-HSPTCC, already remarked in previous reports. In particular, it confirms heterogeneity amongst Italian families and reports a new mutation predicted to affect splicing in the spatacsin gene.
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Affiliation(s)
- T Pippucci
- Laboratorio di Genetica Medica, Dipartimento di Scienze Ginecologiche, Ostetriche e Pediatriche, Policlinico Sant'Orsola Malpighi, Università di Bologna, Bologna, Italy.
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Abstract
Enhanced platelet biosynthesis of thromboxane A(2) is associated with several cardiovascular risk factors, as a consequence of a direct effect on platelet biochemistry and/or some form of endothelial dysfunction. Moreover, episodic increases in thromboxane biosynthesis occur in acute coronary and cerebral ischemic syndromes. Thromboxane-dependent platelet activation represents an important mechanism that amplifies the consequences of acute vascular lesions as well as those of longstanding metabolic or hemodynamic disturbances, and results in increased risk of vascular occlusive events.
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Affiliation(s)
- C Patrono
- Departments of Pharmacology and Hematology, University of Chieti "G. D'Annunzio" School of Medicine, Chieti Italy
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Rocca B, Santilli F, Pitocco D, Mucci L, Petrucci G, Vitacolonna E, Lattanzio S, Mattoscio D, Zaccardi F, Liani R, Vazzana N, Del Ponte A, Ferrante E, Martini F, Cardillo C, Morosetti R, Mirabella M, Ghirlanda G, Davì G, Patrono C. The recovery of platelet cyclooxygenase activity explains interindividual variability in responsiveness to low-dose aspirin in patients with and without diabetes. J Thromb Haemost 2012; 10:1220-30. [PMID: 22471290 DOI: 10.1111/j.1538-7836.2012.04723.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Interindividual variability in response to aspirin has been popularized as 'resistance'. We hypothesized that faster recovery of platelet cyclooxygenase-1 activity may explain incomplete thromboxane (TX) inhibition during the 24-h dosing interval. OBJECTIVE To characterize the kinetics and determinants of platelet cyclooxygenase-1 recovery in aspirin-treated diabetic and non-diabetic patients. PATIENTS/METHODS One hundred type 2 diabetic and 73 non-diabetic patients on chronic aspirin 100 mg daily were studied. Serum TXB(2) was measured every 3 h, between 12 and 24 h after a witnessed aspirin intake, to characterize the kinetics of platelet cyclooxygenase-1 recovery. Patients with the fastest TXB(2) recovery were randomized to aspirin 100 mg once daily, 200 mg once daily or 100 mg twice daily, for 28 days and TXB(2) recovery was reassessed. RESULTS AND CONCLUSIONS Platelet TXB(2) production was profoundly suppressed at 12 h in both groups. Serum TXB(2) recovered linearly, with a large interindividual variability in slope. Diabetic patients in the third tertile of recovery slopes (≥ 0.10 ng mL(-1) h(-1) ) showed significantly higher mean platelet volume and body mass index, and younger age. Higher body weight was the only independent predictor of a faster recovery in non-diabetics. Aspirin 100 mg twice daily completely reversed the abnormal TXB(2) recovery in both groups. Interindividual variability in the recovery of platelet cyclooxygenase activity during the dosing interval may limit the duration of the antiplatelet effect of low-dose aspirin in patients with and without diabetes. Inadequate thromboxane inhibition can be easily measured and corrected by a twice daily regimen.
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Affiliation(s)
- B Rocca
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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Santilli F, Davì G, Basili S, Lattanzio S, Cavoni A, Guizzardi G, De Feudis L, Traisci G, Pettinella C, Paloscia L, Minuz P, Meneguzzi A, Ciabattoni G, Patrono C. Thromboxane and prostacyclin biosynthesis in heart failure of ischemic origin: effects of disease severity and aspirin treatment. J Thromb Haemost 2010; 8:914-22. [PMID: 20180823 DOI: 10.1111/j.1538-7836.2010.03820.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
SUMMARY BACKGROUND Thromboembolism is a relatively common complication of chronic heart failure (HF) and the place of antiplatelet therapy is uncertain. OBJECTIVES We characterized the rate of thromboxane and prostacyclin biosynthesis in chronic HF of ischemic origin, with the aim of separating the influence of HF on platelet activation from that of the underlying ischemic heart disease (IHD). PATIENTS AND METHODS We compared urinary 11-dehydro-thromboxane (TX)B(2), 2,3 dinor 6-keto-PGF(1alpha,) 8-iso-prostaglandin (PG)F(2alpha), and plasma N-terminal pro-brain natriuretic peptide (NT-pro-BNP), asymmetric dimethylarginine (ADMA), and soluble CD40 ligand (sCD40L), in 84 patients with HF secondary to IHD, 61 patients with IHD without HF and 42 healthy subjects. RESULTS HF patients not on aspirin had significantly higher urinary 11-dehydro-TXB(2) as compared with healthy subjects (P < 0.0001) and IHD patients not on aspirin (P = 0.028). They also showed significantly higher 8-iso-PGF(2alpha) (P = 0.018), NT-pro-BNP (P = 0.021) and ADMA (P < 0.0001) than IHD patients not on aspirin. HF patients on low-dose aspirin had significantly lower 11-dehydro-TXB(2) (P < 0.0001), sCD40L (P = 0.007) and 2,3-dinor-6-keto-PGF(1alpha) (P = 0.005) than HF patients not treated with aspirin. HF patients in NYHA classes III and IV had significantly higher urinary 11-dehydro-TXB(2) than patients in classes I and II, independently of aspirin treatment (P < 0.05). On multiple linear regression analysis, higher NT-pro-BNP levels, lack of aspirin therapy and sCD40L, predicted 11-dehydro-TXB(2) excretion rate in HF patients (R(2) = 0.771). CONCLUSIONS Persistent platelet activation characterizes HF patients. This phenomenon is related to disease severity and is largely suppressable by low-dose aspirin. The homeostatic increase in prostacyclin biosynthesis is impaired, possibly contributing to enhanced thrombotic risk in this setting.
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Affiliation(s)
- F Santilli
- Center of Excellence on Aging, G D'Annunzio University Foundation, Chieti, Italy
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Santilli F, Formoso G, Sbraccia P, Averna M, Miccoli R, Di Fulvio P, Ganci A, Pulizzi N, Lattanzio S, Ciabattoni G, Consoli A, Lauro R, Patrono C, Davì G. Postprandial hyperglycemia is a determinant of platelet activation in early type 2 diabetes mellitus. J Thromb Haemost 2010; 8:828-37. [PMID: 20088941 DOI: 10.1111/j.1538-7836.2010.03742.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Chronic hyperglycemia is a major contributor to in vivo platelet activation in diabetes mellitus. OBJECTIVES To evaluate the effects of acarbose, an alpha-glucosidase inhibitor, on platelet activation and its determinants in newly diagnosed type 2 diabetic patients. METHODS Forty-eight subjects (26 males, aged 61 +/- 8 years) with early type 2 diabetes (baseline hemoglobin A(1c) < or = 7% and no previous hypoglycemic treatment) were randomly assigned to acarbose up to 100 mg three times a day or placebo, and evaluated every 4 weeks for 20 weeks. The main outcome measures were urinary 11-dehydro-thromboxane (TX)B(2) (marker of in vivo platelet activation) and 8-iso-prostaglandin (PG)F(2alpha) (marker of in vivo lipid peroxidation) excretion rate, 2-h postprandial plasma glucose (PPG) after a test meal, and assessment of glucose fluctuations by mean amplitude of glycemic excursions (MAGE). RESULTS Baseline measurements revealed biochemical evidence of enhanced lipid peroxidation and platelet activation. As compared with the placebo group, patients treated with acarbose had statistically significant reductions in urinary 11-dehydro-TXB(2) and 8-iso-PGF(2alpha) excretion rate as early as after 8 weeks and at each subsequent time point (between-group P < 0.0001 at 12, 16 and 20 weeks), following earlier decreases in PPG and MAGE. Multiple regression analyses in the acarbose group revealed that PPG was the only significant predictor of 11-dehydro-TXB(2) urinary excretion rate (beta = 0.39, P = 0.002) and MAGE the only predictor of 8-iso-PGF(2alpha) urinary excretion rate (beta = 0.42, P = 0.001). CONCLUSIONS Postprandial hyperglycemia is associated with enhanced lipid peroxidation and platelet activation in early type 2 diabetes. A moderate decrease in PPG achieved with acarbose causes time-dependent downregulation of these phenomena, suggesting a causal link between early metabolic abnormalities and platelet activation in this setting.
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Affiliation(s)
- F Santilli
- Centre of Excellence on Aging, G. d'Annunzio University Foundation, Chieti, Italy
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Patrono C. Cardiovascular effects of low-dose aspirin, traditional non-steroidal anti-inflammatory drugs and coxibs. Bull Mem Acad R Med Belg 2010; 165:115-124. [PMID: 21162342] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Affiliation(s)
- C Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy
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Abstract
Although conceived at the end of the 19th century as a synthetic analgesic agent with improved gastric tolerability vs. naturally occurring salicylates, acetylsalicylic acid (marketed as aspirin in 1899) turned out to be an ideal antiplatelet agent about 90 years later, following the understanding of its mechanism of action, the development of a mechanism-based biomarker for dose-finding studies, and the initiation of a series of appropriately sized, randomized clinical trials to test its efficacy and safety at low doses given once daily. At the turn of its 110th anniversary, aspirin continues to attract heated debates on a number of issues including (i) the optimal dose to maximize efficacy and minimize toxicity; (ii) the possibility that some patients may be 'resistant' to its antiplatelet effects; and (iii) the balance of benefits and risks in primary vs. secondary prevention.
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Affiliation(s)
- C Patrono
- Department of Pharmacology, Catholic University School of Medicine, Rome, Italy.
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Patrignani P, Renda G, Tacconelli S, Capone ML, Sacchetta D, Santarelli F, Sciulli MG, Zimarino M, Grana M, D’Amelio E, Zurro M, Patrono C, De Caterina R. Response to “Pharmacodynamic Interaction Between Aspirin and Ibuprofen: A Plausible Mechanism of Aspirin Resistance”. Clin Pharmacol Ther 2008. [DOI: 10.1038/sj.clpt.6100368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Orlacchio A, Patrono C, Borreca A, Babalini C, Bernardi G, Kawarai T. Spastic paraplegia in Romania: high prevalence of SPG4 mutations. J Neurol Neurosurg Psychiatry 2008; 79:606-7. [PMID: 17971434 DOI: 10.1136/jnnp.2007.128827] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orlacchio A, Patrono C, Gaudiello F, Rocchi C, Moschella V, Floris R, Bernardi G, Kawarai T. Silver syndrome variant of hereditary spastic paraplegia: A locus to 4p and allelism with SPG4. Neurology 2008; 70:1959-66. [PMID: 18401025 DOI: 10.1212/01.wnl.0000294330.27058.61] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To perform a clinical and genetic study of two large Italian families (RM-36 and RM-51) showing the cardinal clinical features of Silver syndrome (SS), a rare dominantly inherited form of hereditary spastic paraplegia (HSP) complicated by amyotrophy of the small hand muscles. METHODS Clinical assessment including neurophysiologic, neuropsychological, and neuroimaging evaluations. Genetic studies included linkage and sequence analyses. RESULTS Using a genome-wide survey in the RM-36 family, a novel locus (SPG38) has been identified and mapped within the 13.1-cM region on chromosome 4p16-p15 between markers D4S432 and D4S1599. The RM-51 family was linked to the SPG4 locus at 2p21-p24 and sequence analysis of SPG4 showed a novel frameshift mutation p.Asp321GlyfsX6. Clinical examination of the affected members carrying the mutation showed high frequency of additional clinical features including decreased vibration sense, pes cavus, temporal lobe epilepsy, and cognitive impairment. CONCLUSIONS This study demonstrates evidence of a novel locus SPG38 for Silver syndrome (SS) and suggests that genetic defects in SPG4 might lead to broad clinical features overlapped with those of SS.
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Affiliation(s)
- A Orlacchio
- Laboratorio di Neurogenetica, Centro Europeo di Ricerca sul Cervello (CERC), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Santa Lucia, 64 Via del Fosso di Fiorano, Rome 00143, Italy.
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Santilli F, Basili S, Lattanzio S, Cavoni A, Guizzardi G, De Feudis L, Traisci G, Ciabattoni G, Davì G, Patrono C. DETERMINANTS OF PLATELET ACTIVATION IN HEART FAILURE. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb02934.x] [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: 11/30/2022]
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Basili S, Santilli F, Pacini G, Guagnano M, Manigrasso M, Pescara L, Ciabattoni G, Patrono C, Davì G. We-P11:78 Insulin resistance as a determinant of platelet activation in obese women. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81433-9] [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]
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Pettinella C, Lee S, Cipollone F, Patrono C, Blair I. Th-P17:431 Analysis of free fatty acids in atherosclerotic plaques. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)82389-5] [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]
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Ferroni P, Falco A, Guagnano M, Paoletti V, Manigrasso M, Michetti N, Ciabattoni G, Patrono C, Davì G. Th-W51:4 Lipid peroxidation as a determinant of platelet activation in hypertensives with microalbuminuria. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81882-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Falco A, Basili S, Dragani A, Rolandi G, La Barba G, Passeri C, Ciabattoni G, Patrono C, Davi G. Tu-W26:7 Oxidative stress and platelet activation in subjects with moderate hyperhomocysteinemia due to MTHFR C677T polymorphism. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80675-6] [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]
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Abstract
The aim of this review article is to discuss the main determinants of the interindividual variability in response to antiplatelet agents. The main sources of pharmacokinetic and pharmacodynamic variability are reviewed, with particular emphasis on aspirin and clopidogrel. The term 'resistance' is uninformative of the mechanism(s) underlying interindividual variability in response to these antiplatelet agents, and is potentially misleading. Increased awareness of the distinct factors potentially interfering with the desired antiplatelet effects of aspirin or clopidogrel, particularly avoidable drug interactions, may ultimately result in better patient management than requesting unnecessary costly tests of platelet function. Similarly, new studies addressing the interindividual variability in response to these antiplatelet agents should rely upon mechanism-based biochemical end-points rather than platelet aggregation measurements. As with any drug used to prevent atherothrombosis, treatment 'failure' can occur with aspirin or clopidogrel perhaps not surprisingly, given the multifactorial nature of atherothrombosis. There is no scientific basis for changing antiplatelet therapy in the face of a treatment 'failure', as we cannot be sure whether a second vascular event occurring in the same patient will reflect the same pathophysiological event that led to the first. Moreover, we have no controlled evidence that changing therapy is a more effective strategy than maintaining an evidence-based therapy.
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Affiliation(s)
- B Rocca
- Center of Excellence on Aging, G. D'Annunzio University Foundation, Chieti, Italy
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Patrono C, Di Giacinto G, Eymard-Pierre E, Santorelli FM, Rodriguez D, De Stefano N, Federico A, Gatti R, Benigno V, Megarbané A, Tabarki B, Boespflug-Tanguy O, Bertini E. Genetic heterogeneity of megalencephalic leukoencephalopathy and subcortical cysts. Neurology 2003; 61:534-7. [PMID: 12939431 DOI: 10.1212/01.wnl.0000076184.21183.ca] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Reported are the clinical, neuroradiologic, and molecular findings in 18 patients with megalencephalic leukoencephalopathy and subcortical cysts (MLC) syndrome. Marked clinical intrafamilial and interfamilial variability in mutation-proven cases was found. A broad spectrum of pathogenetic mutations (missense, splice site, insertion, and deletions) were identified in the MLC1 gene, enlarging the spectrum of allelic variants without a straightforward genotype-phenotype correlation. Five patients did not harbor mutations in MLC1, supporting the existence of at least one other MLC locus.
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Affiliation(s)
- C Patrono
- Unit of Molecular Medicine and Division of Pediatric Neurology, Bambino Gesù Children's Hospital, Rome, Italy
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Affiliation(s)
- C Patrono
- University of Rome 'La Sapienza', Rome, Italy.
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40
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De Cristofaro R, Rocca B, Vitacolonna E, Falco A, Marchesani P, Ciabattoni G, Landolfi R, Patrono C, Davì G. Lipid and protein oxidation contribute to a prothrombotic state in patients with type 2 diabetes mellitus. J Thromb Haemost 2003; 1:250-6. [PMID: 12871497 DOI: 10.1046/j.1538-7836.2003.00072.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Diabetes mellitus (DM) is associated with enhanced lipid oxidation and persistent platelet activation. We investigated whether oxidant stress (OS) also affects circulating proteins and is associated with an abnormal coagulative pattern. In 72 type 2 DM (T2DM) patients, urinary 8-iso-prostaglandin (PG) F2alpha and 11-dehydro-thromboxane B2 (TXM) were measured as markers of lipid peroxidation and platelet activation, respectively. The carbonyl content of plasma proteins (PCARB) was measured as global index of protein oxidation. 8-Iso-PGF2alpha and PCARB levels were higher in DM patients than in controls (P < 0.05). Likewise, both TXM and prothrombin F1+2 levels were higher in diabetics (P < 0.05). By contrast, anticoagulant markers, such as activated protein C, protein C activation peptide, and soluble thrombomodulin (TM) were depressed in T2DM (P < 0.05). In conclusion, OS in T2DM involves circulating proteins and is associated with an unbalanced promotion of procoagulant reactions. These effects in concert with platelet activation may contribute to atherothrombotic complications in T2DM.
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Affiliation(s)
- R De Cristofaro
- Center of Excellence on Aging, G. D'Annunziou University School of Medicine and Pharmacy, Chieti, Italy.
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Tessa A, Casali C, Damiano M, Bruno C, Fortini D, Patrono C, Cricchi F, Valoppi M, Nappi G, Amabile GA, Bertini E, Santorelli FM. SPG3A: An additional family carrying a new atlastin mutation. Neurology 2002; 59:2002-5. [PMID: 12499504 DOI: 10.1212/01.wnl.0000036902.21438.98] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors report on a novel frameshift mutation (c.1688insA) in the SPG3A gene resulting in premature translation termination of the gene product atlastin. These data add a new variant to the second disease gene in autosomal dominant hereditary spastic paraplegia (ADHSP) and lend definitive support to its causative role. By combining direct testing of SPAST and SPG3A, at least 50% of ADHSP families can now receive appropriate genetic diagnosis.
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Affiliation(s)
- A Tessa
- Molecular Medicine and Neurology, IRCCS-Bambino Gesú Hospital, Rome, Italy
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42
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Patrono C, Dionisi-Vici C, Giannotti A, Bembi B, Digilio MC, Rizzo C, Purificato C, Martini C, Pierini R, Santorelli FM. Two novel mutations of the human Δ7-sterol reductase (DHCR7) gene in children with Smith–Lemli–Opitz syndrome. Mol Cell Probes 2002; 16:315-8. [PMID: 12270273 DOI: 10.1006/mcpr.2002.0426] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We analyzed seven unrelated children with the Smith-Lemli-Opitz syndrome (SLOS) for mutations in the delta7-sterol reductase gene by using SSCP and direct sequencing. We identified two novel mutations (V330M and R363C) in the DHCR7 gene. Reported mutations found in this study were T93M (3/14 alleles), E448K (2/14), and W151X, G244R, P329L, and R446Q (each found in one allele). The so-called common IVS8-1 G --> C was found in three alleles, confirming its relative rarity among Italian SLOS families. By using a scoring system, clinical severity did not seem to correlate with 7DHC levels and type of mutation. Expanding the spectrum of mutations in SLOS, our study does not support direct genotype-phenotype correlation.
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Affiliation(s)
- C Patrono
- Molecular Medicine, Metabolism, and Genetics, IRCCS - Children's Hospital Bambino Gesù, Rome, Italy
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Patrono C, FitzGerald GA. Oxidant stress in cardiovascular disease: an emerging modality or a disproved theory? Ital Heart J 2001; 2:865-6. [PMID: 11838328] [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] [Subscribe] [Scholar Register] [Indexed: 04/17/2023]
Affiliation(s)
- C Patrono
- Department of Pharmacology, La Sapienza University of Rome, Rome, Italy.
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Patrono C. Measurement of cyclooxygenase isozyme inhibition in humans: exploring the clinical relevance of biochemical selectivity. Clin Exp Rheumatol 2001; 19:S45-50. [PMID: 11695252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
Treatment with highly selective cyclooxygenase-2 inhibitors is associated with significantly fewer serious adverse gastrointestinal events than is treatment with non-selective NSAIDs, provided that the drug employed inhibits COX-2 but not COX-1 at therapeutic plasma levels. Several factors might influence the gastrointestinal (GI) safety of a COX-2 inhibitor administered to an individual patient. These factors include pharmacokinetic and pharmacodynamic variables (e.g. COX-2 selectivity), the interaction of these features with preexisting risk factors for drug-dependent adverse effects, as well as the variability in the individual response. Biochemical selectivity is one of the determinants of the risk of experiencing a serious GI complication during long-term NSAID therapy. The wider the separation between the COX-2 and COX-1 dose-response curves of the inhibitor (an index of biochemical selectivity), the lower the probability of experiencing a clinically relevant inhibition of platelet COX-1 due to an unusually high drug level or intense pharmacodynamic response to a normal drug level. The clinical relevance of biochemical selectivity has to be studied in large GI outcome trials with adequate statistical power to detect realistic differences in these relatively rare events.
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Affiliation(s)
- C Patrono
- Department of Medicine and Ageing, Cattedra di Farmacologia, Università di Chieti G. D'Annunzio, Via dei Véstini no. 31, Chieti 66013, Italy.
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Abramson SB, Furst DE, Hochberg MC, Patrono C. Controversies in COX-2 inhibitor therapy: closing remarks. Clin Exp Rheumatol 2001; 19:S77-80. [PMID: 11695257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Affiliation(s)
- S B Abramson
- Department of Rheumatology/Medicine, Hospital for Joint Surgery/NYU School of Medicine, New York, NY, USA
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46
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Santini G, Patrignani P, Sciulli MG, Seta F, Tacconelli S, Panara MR, Ricciotti E, Capone ML, Patrono C. The human pharmacology of monocyte cyclooxygenase 2 inhibition by cortisol and synthetic glucocorticoids. Clin Pharmacol Ther 2001; 70:475-83. [PMID: 11719735 DOI: 10.1067/mcp.2001.119213] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND We studied the concentration dependence of the inhibitory effects of cortisol, 6-methylprednisolone, and dexamethasone on cyclooxygenase-2 (COX-2) expression and activity in human monocytes in response to lipopolysaccharide (LPS) in vitro. Moreover, we characterized the time and dose dependence of the inhibitory effects of 6-methylprednisolone, administered to healthy subjects, on LPS-inducible prostaglandin E2 (PGE2) biosynthesis in whole blood ex vivo. METHODS Heparinized whole-blood samples obtained from healthy subjects and patients with rheumatoid arthritis were incubated with LPS (10 microg/ml) for 24 hours at 37 degrees C, and PGE2 was measured in plasma as an index of monocyte COX-2 activity. Comparative experiments were performed in LPS-stimulated isolated monocytes. The levels of COX-2-like immunoreactivity in monocyte lysates were measured by a specific Western blot technique. PGE2 was evaluated by radioimmunoassay. RESULTS Nanomolar concentrations of cortisol, 6-methylprednisolone, and dexamethasone suppressed LPS-induced PGE2 biosynthesis both in whole blood and in isolated monocytes in vitro with relative potencies similar to those reported for their anti-inflammatory effects in vivo. The administration of single oral doses (4, 8, or 16 mg) of 6-methylprednisolone caused a dose- and time-dependent inhibition of whole-blood COX-2 activity. Whole-blood samples obtained from patients with rheumatoid arthritis treated with comparable maintenance doses of glucocorticoids produced significantly lower levels of LPS-inducible PGE2 than were found in untreated patients. CONCLUSIONS Therapeutic plasma levels of synthetic glucocorticoids down-regulate inducible prostanoid biosynthesis in circulating monocytes. This effect may represent a readily measurable surrogate marker of their clinical efficacy for dose-finding studies.
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Affiliation(s)
- G Santini
- Division of Pharmacology, Department of Medicine and Aging, G. D'Annunzio University of Chieti School of Medicine, Italy
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Patrono C, Malliani A. [Antithrombotic treatment of acute coronary syndromes]. Recenti Prog Med 2001; 92:3A-7A. [PMID: 11822106] [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] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- C Patrono
- Cattedra di Farmacologia, Università G. D'Annunzio, Chieti
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Patrono C. Efficacy and safety of aspirin in the long-term management of atherothrombosis. Haematologica 2001; 86:19-21. [PMID: 11926767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Affiliation(s)
- C Patrono
- University of Rome La Sapienza, Rome, Italy
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49
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Davì G, Di Minno G, Coppola A, Andria G, Cerbone AM, Madonna P, Tufano A, Falco A, Marchesani P, Ciabattoni G, Patrono C. Oxidative stress and platelet activation in homozygous homocystinuria. Circulation 2001; 104:1124-8. [PMID: 11535567 DOI: 10.1161/hc3501.095287] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Severe hyperhomocysteinemia due to cystathionine beta-synthase deficiency (CbetaSD) is associated with early atherothrombotic vascular disease. Homocysteine may exert its effects by promoting oxidative damage. In the present study, we investigated whether in vivo formation of 8-iso-prostaglandin (PG) F(2alpha), a platelet-active product of arachidonic acid peroxidation, is enhanced in CbetaSD and whether it correlates with in vivo platelet activation, as reflected by thromboxane (TX) metabolite excretion. METHODS AND RESULTS Urine and blood samples were obtained from patients with homozygous CbetaSD (n=13) and age-matched healthy subjects. Urinary 8-iso-PGF(2alpha) excretion was significantly higher in CbetaSD patients than in control subjects (640+/-384 versus 213+/-43 pg/mg creatinine; P=0.0015) and correlated with plasma homocysteine (rho=0.398, P=0.0076). Similarly, urinary 11-dehydro-TXB(2) excretion was enhanced in CbetaSD (1166+/-415 versus 324+/-72 pg/mg creatinine; P=0.0015) and correlated with urinary 8-iso-PGF(2alpha) (rho=0.362, P=0.0153). Vitamin E supplementation (600 mg/d for 2 weeks) was associated with a statistically significant increase in its plasma levels (from 16.6+/-4.6 to 40.4+/-8.7 micromol/L, P=0.0002) and with reductions in 8-iso-PGF(2alpha) (from 790+/-159 to 559+/-111 pg/mg creatinine, P=0.018) and 11-dehydro-TXB(2) (from 1273+/-383 to 913+/-336 pg/mg creatinine, P=0.028). A statistically significant inverse correlation was found between urinary 8-iso-PGF(2alpha) and plasma vitamin E levels (rho=-0.745, P=0.0135). CONCLUSIONS The results of the present study suggest that enhanced peroxidation of arachidonic acid to form bioactive F(2)-isoprostanes may represent an important mechanism linking hyperhomocysteinemia and platelet activation in CbetaSD patients. Moreover, they provide a rationale for dose-finding studies of vitamin E supplementation in this setting.
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Affiliation(s)
- G Davì
- Center of Excellence on Aging, Department of Biomedical Sciences, University of Chieti G. D'Annunzio, Chieti, Italy.
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Piemonte F, Casali C, Carrozzo R, Schägger H, Patrono C, Tessa A, Tozzi G, Cricchi F, Di Capua M, Siciliano G, Amabile GA, Morocutti C, Bertini E, Santorelli FM. Respiratory chain defects in hereditary spastic paraplegias. Neuromuscul Disord 2001; 11:565-9. [PMID: 11525886 DOI: 10.1016/s0960-8966(01)00214-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hereditary Spastic Paraplegias (HSPs) are heterogeneous neurodegenerative disorders whose etiopathogenesis is still unclear. The identification of pathogenic mutations in a gene (SPG7) encoding a mitochondrial metalloprotease suggested that oxidative phosphorylation (OXPHOS) alterations might underlie HSP in a subgroup of patients. We performed clinical, morphological, biochemical, and molecular genetic studies in six HSP patients and in six sporadic patients to investigate OXPHOS in muscle biopsies. Complicated and pure forms were included in our study. Morphological alterations of the type seen in OXPHOS-related disorders were found in three patients. Five patients showed an isolated defect of complex I activity. No mutations in the SPG7 gene were detected. Our results suggest that OXPHOS defects in HSP patients are more common than previously believed.
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Affiliation(s)
- F Piemonte
- Molecular Medicine and Neurology, IRCCS-Ospedale Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy
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