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Marini V, Pinto VM, Stella M, Fucile C, Lantieri F, Luci G, Gianesin B, Bacigalupo L, Forni GL, Mattioli F. Effect of Aging on Deferasirox Therapy in Transfusion-dependent Patients. A prospective-retrospective, cohort-study. Curr Drug Metab 2022; 23:CDM-EPUB-128183. [PMID: 36503397 DOI: 10.2174/1389200224666221209144420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 10/24/2022] [Accepted: 11/11/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Iron-chelation therapy is life-saving in patients on a chronic transfusion regimen as it reduces organ damage related to iron deposition in the tissues. Deferasirox, an iron-chelator, is characterized by pharmacokinetics variability, and some patients may discontinue the treatment due to toxicities. OBJECTIVE Understanding whether deferasirox plasma levels are related to patients' specific characteristics could help optimize DFX dosage. METHODS We analyzed deferasirox plasma concentration in 57 transfusion-dependent anemic patients using the HPLC method in this prospective-retrospective cohort study. All outpatients (3 to 98 years) were treated with deferasirox (film-coated tablet) for at least one year (median dose, 16.5 mg/Kg once a day). Deferasirox plasma concentration was normalized for dose/Kg (C/dose) and corrected with a linear regression model that relates C/dose and the time of blood sampling (Cref/dose). RESULTS No significant differences in Cref/dose were found between males and females, either between different types of hemoglobinopathies or depending on the presence of the UGT1A1*28 polymorphism. Cref/dose has a positive and significant correlation with age, creatinine, and direct bilirubin. Cref/dose, instead, has a negative and significant correlation with Liver Iron Concentration (LIC), ferritin, and eGFR. Cref/dose was significantly different between three age categories <18yrs, 18-50yrs, and >50yrs, with Cref/dose median values of 1.0, 1.2, and 1.5, respectively. CONCLUSION The study evidenced that to ensure the efficacy of deferasirox in terms of control over LIC and, at the same time, a lesser influence on renal function, the dose of the drug to be administered to an elderly patient could be reduced.
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Affiliation(s)
- Valeria Marini
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
| | - Valeria Maria Pinto
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Manuela Stella
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
| | - Carmen Fucile
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10. I-56126 Pisa, Italy
| | - Francesca Lantieri
- Health Science Department, Biostatistics Unit, University of Genoa, Via Pastore, n. 1. I-16132 Genoa, Italy
| | - Giacomo Luci
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10. I-56126 Pisa, Italy
| | - Barbara Gianesin
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- ForAnemia Foundation, Via Garibaldi, n. 7. I-16124 Genoa, Italy
| | - Lorenzo Bacigalupo
- Department of Diagnostic Imaging, Radiology and Nuclear Medicine, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Gian Luca Forni
- Centro della Microcitemia, Anemie Congenite e Dismetabolismo del Ferro, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology Unit, EO Ospedali Galliera, Mura delle Cappuccine, n. 14. I-16128 Genoa, Italy
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2. I-16132 Genoa, Italy
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Rucci F, Cigoli MS, Marini V, Fucile C, Mattioli F, Robbiano L, Cavallari U, Scaglione F, Perno CF, Penco S, Marocchi A. Combined evaluation of genotype and phenotype of thiopurine S-methyltransferase (TPMT) in the clinical management of patients in chronic therapy with azathioprine. Drug Metab Pers Ther 2019; 34:dmpt-2018-0037. [PMID: 30840585 DOI: 10.1515/dmpt-2018-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 11/12/2018] [Accepted: 01/29/2019] [Indexed: 06/09/2023]
Abstract
Background The thiopurine S-methyltransferase (TPMT)/azathioprine (AZA) gene-drug pair is one of the most well-known pharmacogenetic markers. Despite this, few studies investigated the implementation of TPMT testing and the combined evaluation of genotype and phenotype in multidisciplinary clinical settings where patients are undergoing chronic therapy with AZA. Methods A total of 356 AZA-treated patients for chronic autoimmune diseases were enrolled. DNA was isolated from whole blood and the samples were analyzed for the c.460G>A and c.719A>G variants by the restriction fragment length polymorphism (RFLP) technique and sequenced for the c.238G>C variant. The TPMT enzyme activity was determined in erythrocytes by a high-performance liquid chromatography (HPLC) assay. Results All the patients enrolled were genotyped while the TPMT enzyme activity was assessed in 41 patients. Clinical information was available on 181 patients. We found no significant difference in the odds of having adverse drug reactions (ADRs) in wild-type patients and variant allele carriers, but the latter had an extra risk of experiencing hematologically adverse events. The enzyme activity was significantly associated to genotype. Conclusions TPMT variant allele carriers have an extra risk of experiencing hematologically adverse events compared to wild-type patients. Interestingly, only two out of 30 (6.6%) patients had discordant results between genotype, phenotype and onset of ADRs.
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Affiliation(s)
- Francesco Rucci
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Piazza Ospedale Maggiore, 3-20162 - Milan, Italy, Tel. +39 0264442803
- University of Milan, Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, Milan, Italy
| | - Maria Sole Cigoli
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
| | - Valeria Marini
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Carmen Fucile
- Department of Internal Medicine, University of Genova, Genova, Italy
| | | | - Luigi Robbiano
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Ugo Cavallari
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
| | - Francesco Scaglione
- University of Milan, Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, Milan, Italy
| | - Carlo F Perno
- Department of Laboratory Medicine, ASST Niguarda Hospital, Milan, Italy
| | - Silvana Penco
- Department of Laboratory Medicine, Medical Genetics, ASST Niguarda Hospital, Milan, Italy
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Fucile C, Mattioli F, Marini V, Gregori M, Sonzogni A, Martelli A, Maximova N. What is known about deferasirox chelation therapy in pediatric HSCT recipients: two case reports of metabolic acidosis. Ther Clin Risk Manag 2018; 14:1649-1655. [PMID: 30237719 PMCID: PMC6136408 DOI: 10.2147/tcrm.s170761] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
To date, in pediatric field, various hematological malignancies are increasingly treated with allogeneic hematopoietic stem cell transplantation (allo-HSCT). Iron overload and systemic siderosis often occur in this particular cohort of patients and are associated with poor prognosis. We describe herein the case of two allo-HSCT patients, on treatment with deferasirox; they showed histopathological elements compatible with venoocclusive disease or vanishing bile duct syndrome in ductopenic evolution before deferasirox started. The first patient developed drug-induced liver damage with metabolic acidosis and the second one a liver impairment with Fanconi syndrome. After withdrawing deferasirox treatment, both patients showed improvement. Measurements of drug plasma concentrations were performed by HPLC assay. The reduction and consequent disappearance of symptoms after the suspension of deferasirox substantiate its role in inducing hepatic damage, probably enabling the diagnosis of drug-induced liver damage. But the difficulties in diagnosing drug-related toxicity must be underlined, especially in compromised subjects. For these reasons, in patients requiring iron-chelating therapy, close and careful drug therapeutic monitoring is strongly recommended.
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Affiliation(s)
- Carmen Fucile
- Pharmacology and Toxicology, Unit, University of Genoa, Genoa, Italy
| | | | - Valeria Marini
- Pharmacology and Toxicology, Unit, University of Genoa, Genoa, Italy
| | - Massimo Gregori
- Department of Pediatric Radiology, Institute for Maternal and Child Health - IRCCS Burlo Garofalo, Trieste, Italy
| | - Aurelio Sonzogni
- Department of Pathology, Ospedale Beato Papa Giovanni XIII, Bergamo, Italy
| | | | - Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofalo, Trieste, Italy,
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Delfino E, Fucile C, Del Bono V, Marchese A, Marini V, Coppo E, Casciaro R, Minicucci L, Giacobbe DR, Martelli A, Viscoli C, Mattioli F. Pharmacokinetics of high-dose extended-infusion meropenem during pulmonary exacerbation in adult cystic fibrosis patients: a case series. New Microbiol 2018; 41:47-51. [PMID: 29313863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 03/05/2018] [Indexed: 06/07/2023]
Abstract
This case series explored the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of meropenem (MEM) in adult cystic fibrosis (CF) patients hospitalized for a pulmonary exacerbation. From January 2015 to June 2016, all adult patients with cystic fibrosis (CF) and chronic pulmonary infection due to meropenem (MEM)-susceptible/intermediate Pseudomonas aeruginosa who received at least 48 h of MEM as an extended 3-hour infusion for treating a pulmonary exacerbation were enrolled. MEM plasma concentrations were determined by high-performance liquid chromatography. Six adult CF patients with a median age of 47 years were included in the study. MEM showed a high Vd (mean 45.98 L, standard deviation [SD] ±34.45). A minimal PK/PD target of 40% T > minimum inhibitory concentration (MIC) with respect to the MEM MIC of P. aeruginosa strains isolated from sputum during exacerbation was achieved in 5/6 patients (83%). MEM failed to achieve this target only in one patient, whose strain showed the highest MEM MIC in our cohort (8 mg/L). In all patients, MEM was well tolerated, and no adverse events were reported. In conclusion, high-dose, extended-infusion MEM during pulmonary exacerbation showed a high Vd in six adult CF patients with high median age, and was well tolerated.
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Affiliation(s)
- Emanuele Delfino
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Carmen Fucile
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Anna Marchese
- Microbiology Unit, University of Genoa (DISC) and San Martino Hospital, Genoa, Italy
| | - Valeria Marini
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Erika Coppo
- Microbiology Unit, University of Genoa (DISC) and San Martino Hospital, Genoa, Italy
| | - Rosaria Casciaro
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Laura Minicucci
- Cystic Fibrosis Centre, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Daniele Roberto Giacobbe
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Antonietta Martelli
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
| | - Claudio Viscoli
- Infectious Diseases Division, University of Genoa (DISSAL) and San Martino Hospital, Genoa, Italy
| | - Francesca Mattioli
- Clinical Pharmacology and Toxicology Unit, University of Genoa (DIMI), Genoa, Italy
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Maximova N, Gregori M, Simeone R, Sonzogni A, Boz G, Fucile C, Marini V, Martelli A, Mattioli F. Safety and tolerability of deferasirox in pediatric hematopoietic stem cell transplant recipients: one facility's five years' experience of chelation treatment. Oncotarget 2017; 8:63177-63186. [PMID: 28968980 PMCID: PMC5609912 DOI: 10.18632/oncotarget.18725] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 05/23/2017] [Indexed: 01/19/2023] Open
Abstract
42 pediatric patients with iron overload, who underwent liver biopsy and DFX treatment after hematopoietic stem cell transplantation were included in the study group. The patients were divided into two groups diversified according to deferasirox trough plasma concentrations (DFX Ctrough) with cut-off equal to10 mcg/mL. The average dose of DFX was 25.9 mg/kg in the DFX Ctrough < 10 mcg/mL group versus 19.2 mg/kg in the DFX Ctrough > 10 mcg/mL group (p=0,0003). The mean duration of DFX treatment was 135.7 days in the DFX Ctrough < 10 mcg/mL group versus 41.8 days in the DFX Ctrough > 10 mcg/mL group (p<0.0001). The mean tissue iron concentration in the DFX Ctrough < 10 mcg/mL group was 261.9 μmol/g versus 133.4 μmol/g in the DFX Ctrough > 10 mcg/mL group (p < 0.0001). 21 patients (100%) in the DFX Ctrough > 10 mcg/mL group had ductopenia which was complete in 47.6% of them and severe in 52.4%. All patients with particularly high Ctrough (> 25 mcg/mL) were found to have total ductopenia. 90.5% of all deferasirox-related adverse events and 100% of major adverse events occurred in the DFX Ctrough > 10 mcg/mL group. In the DFX Ctrough < 10 mcg/mL group only one patient interrupted chelation therapy versus 16 (84.2%) patients in the DFX Ctrough > 10 mcg/mL group. We would recommend a close monitoring in pediatric hematopoietic transplant recipients subjected to deferasirox-based therapy because we have observed a high incidence of adverse events and discontinuation of chelation treatment.
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Affiliation(s)
- Natalia Maximova
- Bone Marrow Transplant Unit, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | - Massimo Gregori
- Department of Pediatric Radiology, Institute for Maternal and Child Health - IRCCS Burlo Garofolo, Trieste, Italy
| | | | - Aurelio Sonzogni
- Department of Pathology, Ospedale Beato Papa Giovanni XIII, Bergamo, Italy
| | - Giulia Boz
- University of Cagliari, Faculty of Medicine, Cagliari, Italy
| | - Carmen Fucile
- Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
| | - Valeria Marini
- Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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Del Bono V, Giacobbe DR, Marchese A, Parisini A, Fucile C, Coppo E, Marini V, Arena A, Molin A, Martelli A, Gratarola A, Viscoli C, Pelosi P, Mattioli F. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox? Virulence 2017; 8:66-73. [PMID: 27430122 PMCID: PMC5963200 DOI: 10.1080/21505594.2016.1213476] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [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: 03/11/2016] [Revised: 06/14/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022] Open
Abstract
The objective of this study was to assess the achievement of pharmacokinetic/pharmacodynamic (PK/PD) targets of meropenem (MEM) in critically-ill patients with bloodstream infections (BSI) due to Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) with MEM minimum inhibitory concentrations (MICs) ≥16 mg/L. Nineteen critically-ill patients with KPC-Kp BSI were given combination therapy including MEM, tigecycline, plus colistin or gentamicin (according to susceptibility testing). MEM was administered as an extended 3-hour infusion of 2 g every 8 hours, or adjusted according to renal function. MEM plasma concentrations were determined by high-performance liquid chromatography. PK/PD targets for MEM were defined as T > 40% 1×MIC and T > 40% 4×MIC. Possible synergisms between MEM and coadministered agents were assessed by time-kill assays based on plasma levels for MEM and on fixed plasma concentrations for the other agents. In none of 19 patients MEM reached any PK/PD target. The actual MEM MICs were 256, 512, and 1024 mg/L in 1, 3, and 15 isolates, respectively. However, theoretically, the PK/PD target of T > 40% 1×MIC could have been achieved in 95%, 68%, 32% and 0% of the isolates for MIC equal to 8, 16, 32, and 64 mg/L, respectively. No synergisms were observed between MEM and coadministered agents. In conclusion, high-dose MEM failed to reach PK/PD targets in 19 patients with BSI due to KPC-Kp with very high MEM MICs. On a theoretical basis, our results suggest a possible usefulness of MEM against resistant blood isolates with MICs up to 32 mg/L.
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Affiliation(s)
- Valerio Del Bono
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Daniele Roberto Giacobbe
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Anna Marchese
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Andrea Parisini
- Centro ortopedico di Quadrante, Ospedale Madonna del Popolo, Omegna, Italy
| | - Carmen Fucile
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Erika Coppo
- Unità di Microbiologia, DIPSE, DISC, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Valeria Marini
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Antonio Arena
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Alexandre Molin
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Antonietta Martelli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
| | - Angelo Gratarola
- U.O. Anestesia e Rianimazione, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
| | - Claudio Viscoli
- Clinica Malattie Infettive, DIPMI, DISSAL, IRCCS AOU San Martino-IST, Università di Genova, Genova, Italy
| | - Paolo Pelosi
- U.O. Anestesia e Terapia Intensiva, DIPEA, IRCCS AOU San Martino-IST, Genova, Italy
- Anestesia e Terapia Intensiva, DISC, Università di Genova, Genova, Italy
| | - Francesca Mattioli
- Unità di Farmacologia Clinica e Tossicologia, DIMI, Università di Genova, Genova, Italy
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Mattioli F, Fucile C, Del Bono V, Marini V, Parisini A, Molin A, Zuccoli ML, Milano G, Danesi R, Marchese A, Polillo M, Viscoli C, Pelosi P, Martelli A, Di Paolo A. Population pharmacokinetics and probability of target attainment of meropenem in critically ill patients. Eur J Clin Pharmacol 2016; 72:839-48. [PMID: 27048201 DOI: 10.1007/s00228-016-2053-x] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 03/23/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Patients admitted to intensive care unit (ICU) with Klebsiella pneumoniae infections are characterized by high mortality. The aims of the present study were to investigate the population pharmacokinetics parameters and to assess the probability of target attainment of meropenem in critically ill patients to provide information for more effective regimens. METHODS Twenty-seven consecutive patients were included in the study. Meropenem was administered as 3-h intravenous (i.v.) infusions at doses of 1-2 g every 8 or 12 h. Meropenem plasma concentrations were measured by a high-performance liquid chromatography (HPLC) method, and a population pharmacokinetics analysis was performed using NONMEM software. Meropenem plasma disposition was simulated for extended (3 h; 5 h) or continuous i.v. infusions, and the following parameters were calculated: time during which free drug concentrations were above minimum inhibitory concentration (MIC) (fT > MIC), free minimum plasma concentrations above 4× MIC (fCmin > 4× MIC), probability of target attainment (PTA), and cumulative fraction of response (CFR). RESULTS Gender and severity of sepsis affected meropenem clearance, whose typical population values ranged from 6.22 up to 12.04 L/h (mean ± standard deviation (SD) value, 9.38 ± 4.47 L/h). Mean C min value was 7.90 ± 7.91 mg/L, suggesting a high interindividual variability. The simulation confirmed that 88 and 97.5 % of patients achieved effective C min > 4× MIC values after 3- and 5-h i.v. infusions of meropenem 2 g × 3/day, respectively. On the contrary, the same total daily doses reached the target C min > 4× MIC values in 100 % of patients when administered as continuous i.v. infusions. CONCLUSIONS Several factors may influence meropenem pharmacokinetics in ICU patients. Continuous i.v. infusions of meropenem seem to be more effective than standard regimens to achieve optimal therapeutic targets.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy.
| | - Carmen Fucile
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Valerio Del Bono
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Valeria Marini
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Andrea Parisini
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Alexandre Molin
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Maria Laura Zuccoli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Giulia Milano
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Romano Danesi
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Anna Marchese
- Section of Microbiology-DISC, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Marialuisa Polillo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
| | - Claudio Viscoli
- Infectious Diseases Clinics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Paolo Pelosi
- Anesthesia and Intensive Care, Department Surgical Sciences and Integrated Diagnostics, IRCCS A.O.U San Martino-IST, University of Genoa, Largo R. Benzi, n. 10, 16132, Genoa, Italy
| | - Antonietta Martelli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, 16132, Genoa, Italy
| | - Antonello Di Paolo
- Department of Clinical and Experimental Medicine, University of Pisa, Via Savi, n.10, 56126, Pisa, Italy
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Barbieri F, Thellung S, Ratto A, Carra E, Marini V, Fucile C, Bajetto A, Pattarozzi A, Würth R, Gatti M, Campanella C, Vito G, Mattioli F, Pagano A, Daga A, Ferrari A, Florio T. In vitro and in vivo antiproliferative activity of metformin on stem-like cells isolated from spontaneous canine mammary carcinomas: translational implications for human tumors. BMC Cancer 2015; 15:228. [PMID: 25884842 PMCID: PMC4397725 DOI: 10.1186/s12885-015-1235-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 03/20/2015] [Indexed: 12/21/2022] Open
Abstract
Background Cancer stem cells (CSCs) are considered the cell subpopulation responsible for breast cancer (BC) initiation, growth, and relapse. CSCs are identified as self-renewing and tumor-initiating cells, conferring resistance to chemo- and radio-therapy to several neoplasias. Nowadays, th (about 10mM)e pharmacological targeting of CSCs is considered an ineludible therapeutic goal. The antidiabetic drug metformin was reported to suppress in vitro and in vivo CSC survival in different tumors and, in particular, in BC preclinical models. However, few studies are available on primary CSC cultures derived from human postsurgical BC samples, likely because of the limited amount of tissue available after surgery. In this context, comparative oncology is acquiring a relevant role in cancer research, allowing the analysis of larger samples from spontaneous pet tumors that represent optimal models for human cancer. Methods Isolation of primary canine mammary carcinoma (CMC) cells and enrichment in stem-like cell was carried out from fresh tumor specimens by culturing cells in stem-permissive conditions. Phenotypic and functional characterization of CMC-derived stem cells was performed in vitro, by assessment of self-renewal, long-lasting proliferation, marker expression, and drug sensitivity, and in vivo, by tumorigenicity experiments. Corresponding cultures of differentiated CMC cells were used as internal reference. Metformin efficacy on CMC stem cell viability was analyzed both in vitro and in vivo. Results We identified a subpopulation of CMC cells showing human breast CSC features, including expression of specific markers (i.e. CD44, CXCR4), growth as mammospheres, and tumor-initiation in mice. These cells show resistance to doxorubicin but were highly sensitive to metformin in vitro. Finally, in vivo metformin administration significantly impaired CMC growth in NOD-SCID mice, associated with a significant depletion of CSCs. Conclusions Similarly to the human counterpart, CMCs contain stem-like subpopulations representing, in a comparative oncology context, a valuable translational model for human BC, and, in particular, to predict the efficacy of antitumor drugs. Moreover, metformin represents a potential CSC-selective drug for BC, as effective (neo-)adjuvant therapy to eradicate CSC in mammary carcinomas of humans and animals. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1235-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Federica Barbieri
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy. .,Centro di Eccellenza per la Ricerca Biomedica (CEBR), University of Genova, Genoa, Italy.
| | - Stefano Thellung
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy. .,Centro di Eccellenza per la Ricerca Biomedica (CEBR), University of Genova, Genoa, Italy.
| | - Alessandra Ratto
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, and National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Genoa, Italy.
| | - Elisa Carra
- Dipartimento di Medicina Sperimentale, University of Genova, Genoa, Italy.
| | - Valeria Marini
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Carmen Fucile
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Adriana Bajetto
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Alessandra Pattarozzi
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Roberto Würth
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Monica Gatti
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Chiara Campanella
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, and National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Genoa, Italy.
| | - Guendalina Vito
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, and National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Genoa, Italy.
| | - Francesca Mattioli
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy.
| | - Aldo Pagano
- Dipartimento di Medicina Sperimentale, University of Genova, Genoa, Italy. .,IRCCS AOU San Martino - IST, Genoa, Italy.
| | | | - Angelo Ferrari
- Istituto Zooprofilattico Sperimentale del Piemonte, Liguria e Valle D'Aosta, and National Reference Center of Veterinary and Comparative Oncology (CEROVEC), Genoa, Italy.
| | - Tullio Florio
- Dipartimento di Medicina Interna, Sezione di Farmacologia, University of Genova, Genoa, Italy. .,Centro di Eccellenza per la Ricerca Biomedica (CEBR), University of Genova, Genoa, Italy.
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9
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Zuccoli ML, Muscella A, Fucile C, Carrozzino R, Mattioli F, Martelli A, Orengo S. Paliperidone for the treatment of ketamine-induced psychosis: a case report. Int J Psychiatry Med 2015; 48:103-8. [PMID: 25377151 DOI: 10.2190/pm.48.2.c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Ketamine is an anaesthetic and analgesic drug synthesized in the 1960s from phencyclidine. The recreational use of ketamine increased among the dance culture of techno and house music, in particular in clubs, discotheques, and rave parties. The psychotropic effects of ketamine are now well known and they range from dissociation to positive, negative, and cognitive schizophrenia-like symptoms. We report a case of a chronic oral consumption of ketamine which induced agitation, behavioral abnormalities, and loss of contact with reality in a poly-drug abuser; these symptoms persisted more than two weeks after the drug consumption had stopped. Antipsychotic treatment with paliperidone led to a successful management of the psychosis, getting a complete resolution of the clinical picture. Paliperidone has proven to be very effective in the treatment of ketamine-induced disorders. Moreover, the pharmacological action and metabolism of paliperidone are poorly dependent from the activity of liver enzymes, so that it seems to be one of the best second generation antipsychotics for the treatment of smokers and alcohol abusers.
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Affiliation(s)
| | | | | | - R Carrozzino
- Correctional Health Service ASL2 Savonese, Savona, Italy
| | | | | | - S Orengo
- "San Paolo" Hospital, Savona, Italy
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10
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Macri A, Marini V, Sangalli G, Fucile C, Iester M, Mattioli F. An Artificial Aqueous Humor as a Standard Matrix to Assess Drug Concentration in the Anterior Chamber by High Performance Liquid Chromatography Methods. Clin Lab 2015; 61:47-52. [DOI: 10.7754/clin.lab.2014.140309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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11
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Mattioli F, Puntoni M, Marini V, Fucile C, Milano G, Robbiano L, Perrotta S, Pinto V, Martelli A, Forni GL. Determination of deferasirox plasma concentrations: do gender, physical and genetic differences affect chelation efficacy? Eur J Haematol 2014; 94:310-7. [PMID: 25081908 DOI: 10.1111/ejh.12419] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2014] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Bioavailability of deferasirox (DFX) is significantly affected by the timing of administration relative to times and to composition of meals. Its elimination half-life is also highly variable - in some patients as a result of gene polymorphisms. Understanding whether deferasirox plasma levels are related to specific characteristics of patients could help physicians to devise a drug regimen tailored the individual patient. METHODS We analyzed deferasirox plasma concentrations (CDFX ) in 80 patients with transfusion-dependent anemias, such as thalassemia, by a high performance liquid chromatography (HPLC) assay. We used a multivariate linear regression model to find significant associations between CDFX and clinical/demographical characteristics of patients. All patients were genotyped for UGT1A1. RESULTS Fifty-six patients were female, 24 were male, the great majority (88%) affected by β-thalassemia, and 15 were children and adolescents. No statistical correlation was detectable between CDFX and DFX dose (P = 0.6). Age, time from last drug intake to blood sampling, and ferritin levels in the 6 months before study initiation were significantly and inversely associated with CDFX in univariate analysis. In the multivariate analysis, the only two factors independently and inversely associated with CDFX levels were time from last drug intake to blood sampling and ferritin levels (P = 0.006). A significant inverse correlation (P = 0.03) was observed between CDFX and UGT1A1*28 gene polymorphism, but only in patients with levels of lean body mass (LBM) below the median (P for interaction = 0.05). CONCLUSIONS The results could indicate that a higher plasma DFX concentration could be associated with greater chelation efficacy. As a correlation between dose and CDFX was not demonstrated, it seems useful to monitor the concentrations to optimize and determine the most appropriate dose for each patient. Interesting results emerged from the analysis of genetic and physical characteristics of patients: LBM was a borderline significant effect modifier of the relationship between UGT1A1 polymorphisms and CDFX . Individual patient-tailored dosing of DFX should help to improve iron chelation efficacy and to reduce dose-dependent drug toxicity.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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12
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Milano G, Leone S, Fucile C, Zuccoli ML, Stimamiglio A, Martelli A, Mattioli F. Uncommon serum creatine phosphokinase and lactic dehydrogenase increase during diosmin therapy: two case reports. J Med Case Rep 2014; 8:194. [PMID: 24934505 PMCID: PMC4070635 DOI: 10.1186/1752-1947-8-194] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Accepted: 04/01/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Short-term administration of diosmin is usually considered safe, with only minor side effects (stomach and abdominal pain, diarrhea, dermatological disorders, and headache) occasionally observed. Within a 4-year period, a general practitioner noticed 17 cases of mild, diosmin-induced side effects, two of which showed particular interest. CASES PRESENTATION Case 1: A 55-year-old Caucasian woman presented with chronic leg venous insufficiency. She was prescribed diosmin 450 mg twice a day. After 5 days of therapy, she developed pain in the legs (myalgia), and diosmin therapy was suspended. She made a spontaneous attempt of drug rechallenge and her leg pain reappeared. Thus, she underwent blood analysis, which showed elevation of creatine phosphokinase levels. Creatine phosphokinase values normalized only after prolonged discontinuation of the therapy. Case 2: A 79-year-old Caucasian man, who was diagnosed with acute hemorrhoidal syndrome. After 21 days of continuous diosmin treatment, increased levels of serum lactic dehydrogenase were detected. In both cases a comprehensive analysis of all possible causes for enzyme elevation was made. CONCLUSIONS A feasible hypothesis to explain these rare effects could be that exaggerated adrenergic activity occurred on microcirculation, leading to an excessive peripheral vasoconstriction and subsequent ischemic damage. An individual predisposition is strongly suggested. A concurrence of events was probably responsible for the elevation of nonspecific tissue necrosis markers. Physicians and patients must be aware of these rare, but possible, adverse drug reactions.
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Affiliation(s)
| | | | | | | | | | | | - Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV 2, Genoa I-16132, Italy.
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13
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Zuccoli ML, Milano G, Leone S, Fucile C, Brasesco PC, Martelli A, Mattioli F. A case report on escitalopram-induced hyperglycaemia in a diabetic patient. Int J Psychiatry Med 2014; 46:195-201. [PMID: 24552042 DOI: 10.2190/pm.46.2.f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The incidence of depression in diabetic patients is quite high; moreover, it has been suggested that the presence of depression itself may increase the risk of diabetes mellitus. Hence, it follows that the simultaneous use of antidiabetic and antidepressant drugs is common. Some clinical evidence indicates that selective serotonin re-uptake inhibitors (SSRIs) could be very useful in treating overweight patients, both with and without diabetes. However, recent deregulation of glucidic metabolism was tested in diabetic subjects treated with antidepressants. Several cases of hyperglycaemia and hypoglycaemia associated with other SSRIs have been published, whereas only one case of escitalopram inducing hyperglycaemia has been noted. The exact mechanism of glucose control impairment in patients taking SSRIs--escitalopram in particular--still remains unclear. We describe a diabetic 83-year-old woman with good glycaemic control (as evinced by glycaemic and glycosylated haemoglobin assay--HbA1c--values) before escitalopram initiation in response to therapy with glibenclamide. Escitalopram resulted in a significantly increased glycaemia values 5 days following administration. Glycaemia values returned to normality only after suspension of escitalopram, despite antidiabetic dosage increase. We report this case to draw attention to escitalopram as a possible cause of glycaemic control loss.
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Affiliation(s)
- M L Zuccoli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - G Milano
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - S Leone
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - C Fucile
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - P C Brasesco
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - A Martelli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
| | - F Mattioli
- Department of Internal Medicine, Pharmacology and Toxicology UnitUniversity of Genoa, Italy
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14
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Fucile C, Marini V, Zuccoli ML, Leone S, Robbiano L, Martelli A, Mattioli F. HPLC determination of malondialdehyde as biomarker for oxidative stress: application in patients with alcohol dependence. Clin Lab 2013; 59:837-41. [PMID: 24133914 DOI: 10.7754/clin.lab.2012.120730] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Chronic and excess ethanol exposure causes an increase in generation of free radicals which attack the polyunsaturated fatty acids in membranes to create lipid peroxides such as malondialdehyde (MDA) which is widely used as an indirect biomarker of oxidative stress. METHODS In this study a sensitive and reproducible high performance liquid chromatography (HPLC) method for measurement of MDA was applied in a group of alcohol dependent patients who underwent detoxification treatment. RESULTS Compared to the control group, mean MDA concentrations at baseline were significantly higher in alcohol dependent patients (1.28 +/- 0.58 microM vs. 0.9 +/- 0.21 microM; p < 0.02). However, MDA levels remained almost unchanged after three weeks of detoxification treatment (1.28 +/- 0.58 microM vs. 1.38 +/- 0.61 microM; p > 0.05). Among alcoholic patients, the MDA plasma concentration in smokers was higher than in non smokers both at baseline and after three weeks. CONCLUSIONS The failure to reduce the levels of MDA after 3 weeks of detoxification treatment suggests that patients with chronic alcohol dependence have difficulty in compensating for alcohol-induced excessive production of free radicals. Furthermore, the possibility of cigarette smoke affecting the MDA plasma concentration cannot be ruled out.
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Affiliation(s)
- Carmen Fucile
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Italy.
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15
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Marini V, Fucile C, Zuccoli ML, Testino G, Sumberaz A, Robbiano L, Martelli A, Mattioli F. Involvement of the mu-opioid receptor gene polymorphism A118G in the efficacy of detoxification of alcohol dependent patients. Addict Behav 2013; 38:1669-71. [PMID: 23254216 DOI: 10.1016/j.addbeh.2012.09.015] [Citation(s) in RCA: 8] [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] [Received: 08/28/2012] [Revised: 09/13/2012] [Accepted: 09/17/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The A118G (rs 1799971) polymorphism in the mu-opioid receptor gene (OPRM1) has been reported to be associated with alcohol addiction. METHODS In this study 109 patients diagnosed with alcohol dependence in accordance with DMS-IV criteria and 95 healthy subjects were enrolled and everyone has been genotyped. RESULTS The percentage of alcoholic patients with higher than normal gamma-glutamyl transferase (GGT) levels significantly decreased after six months of standard detoxification treatment, both in patients with A/A genotype and in the other ones with A/G genotype. However, the percentage of alcohol dependent patients with the A/A genotype recorded a slight decrease of the GGT and the mean corpuscolar volume of erythrocytes (MCV) combination marker after six months of therapy (30% vs 12%), while subjects with the A/G genotype showed no variation. CONCLUSION This finding suggests that alcohol dependent patients with the A/A genotype could have a faster restoration of their liver function than those ones with the A/G genotype: it might be possible that the presence of G allele confers on these patients a reduced ability in abstaining from drinking alcohol.
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Affiliation(s)
- Valeria Marini
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Viale Benedetto XV, n. 2, I-16132, Genoa, Italy
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Leone S, Zuccoli ML, Fucile C, Storace S, Martelli A, Mattioli F. Heparin-induced acute adverse reaction--case report of a patient with acute trauma and a genetic predisposition to thrombotic events: a concurrence of events. J Clin Pharm Ther 2012; 37:733-5. [PMID: 22646290 DOI: 10.1111/j.1365-2710.2012.01360.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The most common complication of heparin therapy is bleeding. Allergic reactions to heparin are rare, and the mechanisms are poorly understood. We report on a case of acute systemic reaction after subcutaneous injections of a low-molecular-weight heparin (LMWH) in a patient with a genetic predisposition to thrombotic events and review the literature on heparin-induced acute adverse reaction. CASE SUMMARY A 57-year-old diabetic, hypertriglyceridemic and hypercholesterolemic man was admitted with a fractured right malleolus sustained while driving. He was prescribed parnaparin sodium 4250 IU subcutaneously once a day. During the third injection, the patient developed widespread pain, sickness and facial rash, followed by a state of stupor (Glasgow Coma Scale 8) and was hospitalized in Neurological Unit. He was found to be a carrier of two genetic mutations (i.e. prothrombin G20210A and MTHFR mutation) associated with an increased risk of thrombotic events. Discontinuation of parnaparin and supportive care led to a sufficient recovery of the patient to be discharged 6 days after admission. WHAT IS NEW AND CONCLUSION Treatment for heparin-related hypersensitivity reactions is largely supportive and symptomatic. Clinicians should be aware of these rare but potentially serious adverse events. Prothrombin gene mutations are quite common, and guidelines on anticoagulant therapy for affected patients are needed.
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Affiliation(s)
- S Leone
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Genoa, Italy
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17
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Marini V, Michelazzi L, Cioé A, Fucile C, Spigno F, Robbiano L. Exposure to asbestos: correlation between blood levels of mesothelin and frequency of micronuclei in peripheral blood lymphocytes. Mutat Res 2011; 721:114-7. [PMID: 21238604 DOI: 10.1016/j.mrgentox.2010.12.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Revised: 12/13/2010] [Accepted: 12/27/2010] [Indexed: 11/26/2022]
Abstract
Inhalation of asbestos, a mineral extensively used in a variety of applications, is strongly associated with malignant mesothelioma (MM), a fatal cancer of the pleura. Soluble mesothelin-related peptides (SMRP) are a promising biomarker suggested for the screening of MM in healthy asbestos-exposed subjects. In the present study a comparison of micronucleus (Mn) frequencies in peripheral blood lymphocytes (PBL) between 44 asbestos-exposed and 22 control individuals has been performed, and the correlation with serum SMRP has been examined. SMRP levels were found to be significantly higher in subjects exposed to asbestos and in their various subgroups than in controls. Concerning micronucleated lymphocytes, a statistically significant difference from controls was seen in the percentages of both micronucleated mononucleated lymphocytes (MnMNL) and micronucleated binucleated lymphocytes (MnBNL), but the difference was markedly higher for the percentage of micronucleated polynucleated lymphocytes (MnPNL). With respect to the correlation between the frequency of the three types of micronucleated lymphocytes and serum-SMRP values of asbestos-exposed subjects, it was statistically significant for MnMNL, but not for MnBNL and MnPNL.
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Affiliation(s)
- Valeria Marini
- Department of Internal Medicine, Division of Clinical Pharmacology and Toxicology, University of Genoa, Viale Benedetto XV, 2, I-16132 Genoa, Italy
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Mattioli F, Fucile C, Marini V, Isola L, Montanaro F, Savarino V, Martelli A. Assessment of intestinal permeability using sugar probes: influence of urinary volume. Clin Lab 2011; 57:909-918. [PMID: 22239021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND As the accuracy of the "Sugar Test" is currently debated, this study was conducted to focus on how urine volumes may impact the test results. METHODS Fifty-five subjects, 23 healthy and 32 with Irritable Bowel Syndrome (IBS), were enrolled. Lactulose and D-mannitol dissolved in water were administered to all the participating subjects; the urine excreted was collected and the total urine volume was measured. The urine samples were analyzed by High Performance Liquid Chromatography (HPLC). The results were expressed as percentage of urine recovery of lactulose and D-mannitol and lactulose/D-mannitol ratio (LMR). RESULTS All subjects were divided into two groups: subjects with urine volume < 500 mL and subjects with urine volume > or = 500 mL. Urine analysis showed that the mean LMR was significantly lower in subjects with urine volume > or = 500 mL than in subjects with urine volume < 500 mL (0.02 +/- 0.02 vs 0.04 +/- 0.04; p < 0.05). A significant increase in D-mannitol recovery was found to be associated with greater urine volumes (p < 0.001). CONCLUSIONS The urine volume may influence urinary excretion of sugar probes. Intake of liquids should therefore be carefully monitored before and during the test and the volume of urine produced over the period of collection should be precisely measured.
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Affiliation(s)
- Francesca Mattioli
- Department of Internal Medicine, Clinical Pharmacology and Toxicology Unit, University of Genoa, Italy.
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Mezi S, Gerace D, Felici A, Carcioppolo O, Tomao S, Pallotta M, Muratori L, Brescia A, Fucile C, Modesti M. [The use of mammary echotomography in the diagnosis and monitoring of the pregnant and puerperal breast. 3 cases of galactocele]. G Chir 1990; 11:238-42. [PMID: 2223516] [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: 12/30/2022]
Abstract
Three cases of galactocele appeared as breast nodule during lactation are reported. From our experience and the recent literature, ultrasound shows a good reliability for the diagnosis of breast diseases during pregnancy and lactation in spite of oedema and breast turgidity, distinctive of these periods.
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Affiliation(s)
- S Mezi
- Dipartimento di Medicina Sperimentale, Università degli Studi La Sapienza, Roma
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20
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Tomao S, Sciarretta F, Atlante M, Cardi G, Fucile C, Polito ML, Modesti M. [Carcinoma of the endometrium in young women]. G Chir 1989; 10:582-5. [PMID: 2518298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Eighteen cases of endometrial cancer under 45 years were clinically and pathologically reviewed. Epidemiological analysis confirmed obesity as an effective risk factor for this neoplasia. In only three cases the association of adenomatous hyperplasia with endometrial cancer was discovered. These data support the theory that in young women endometrial cancer is not an endocrine related neoplasia.
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Modesti M, Mezi S, Guglielmi P, Gerace D, Mastrantoni M, Aloise G, Fucile C, Gatti F, Muratori L, Tomao S. [Breast secretions]. G Chir 1989; 10:185-90. [PMID: 2518553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Nipple discharge, a rare clinical sign, is more frequently determined by benign breast diseases, but it can be associated to breast cancer; for this reason such clinical sign shouldn't be ignored. Cytologic examination together with breast examination and thermography are the correct oncologic approach for nipple discharge, because such way it is possible to select the patients for whom mammography or galactography are recommended as well as and breast biopsy depending on the galactographic data.
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