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Das S, Hendriks GAGM, van den Noort F, Manzini C, van der Vaart CH, de Korte CL. 3D ultrasound strain imaging of puborectal muscle with and without unilateral avulsion. Int Urogynecol J 2023; 34:2225-2233. [PMID: 37058159 PMCID: PMC10506943 DOI: 10.1007/s00192-023-05498-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/29/2023] [Indexed: 04/15/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The puborectal muscle (PRM), one of the female pelvic floor (PF) muscles, can get damaged during vaginal delivery, leading to disorders such as pelvic organ prolapse. Current diagnosis involves ultrasound (US) imaging of the female PF muscles, but functional information is limited. Previously, we developed a method for strain imaging of the PRM from US images in order to obtain functional information. In this article, we hypothesize that strain in the PRM would differ from intact to the avulsed end. METHODS We calculated strain in PRMs at maximum contraction, along their muscle fiber direction, from US images of two groups of women, which consisted of women with intact (n1 = 8) and avulsed PRMs (unilateral) (n2 = 10). Normalized strain ratios between both ends of the PRM (avulsed or intact) and the mid region were calculated. Subsequently, the difference in ratio between the avulsed and intact PRMs was determined. RESULTS We observe from the obtained results that the contraction/strain pattern of intact and undamaged PRMs is different from PRMs with unilateral avulsion. Normalized strain ratios between avulsed and intact PRMs were statistically significant (p = 0.04). CONCLUSION In this pilot study, we were able to show that US strain imaging of PRMs can show differences between intact PRMs and PRMs with unilateral avulsion.
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Affiliation(s)
- Shreya Das
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10 (767), PO Box 9101 (766), 6500 HB, Nijmegen, The Netherlands
| | - Gijs A G M Hendriks
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10 (767), PO Box 9101 (766), 6500 HB, Nijmegen, The Netherlands
| | - Frieda van den Noort
- Robotics and Mechatronics, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Claudia Manzini
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - C H van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10 (767), PO Box 9101 (766), 6500 HB, Nijmegen, The Netherlands.
- Physics of Fluids, TechMed Center, University of Twente, Enschede, The Netherlands.
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Cernat C, Das S, Hendriks GAGM, Noort FVD, Manzini C, van der Vaart CH, de Korte CL. Tissue Characterization of Puborectalis Muscle From 3-D Ultrasound. Ultrasound Med Biol 2023; 49:527-538. [PMID: 36376156 DOI: 10.1016/j.ultrasmedbio.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Pelvic floor (PF) muscles have the role of preventing pelvic organ descent. The puborectalis muscle (PRM), which is one of the female PF muscles, can be damaged during child delivery. This damage can potentially cause irreversible muscle trauma and even lead to an avulsion, which is disconnection of the muscle from its insertion point, the pubic bone. Ultrasound imaging allows diagnosis of such trauma based on comparison of geometric features of a damaged muscle with the geometric features of a healthy muscle. Although avulsion, which is considered severe damage, can be diagnosed, microdamage within the muscle itself leading to structural changes cannot be diagnosed by visual inspection through imaging only. Therefore, we developed a quantitative ultrasound tissue characterization method to obtain information on the state of the tissue of the PRM and the presence of microdamage in avulsed PRMs. The muscle was segmented as the region of interest (ROI) and further subdivided into six regions of interest (sub-ROIs). Mean echogenicity, entropy and shape parameter of the statistical distribution of gray values were analyzed on two of these sub-ROIs nearest to the bone. The regions nearest to the bones are also the most likely regions to exhibit damage in case of disconnection or avulsion. This analysis was performed for both the muscle at rest and the muscle in contraction. We found that, for PRMs with unilateral avulsion compared with undamaged PRMs, the mean echogenicity (p = 0.02) and shape parameter (p < 0.01) were higher, whereas the entropy was lower (p < 0.01). This method might be applicable to quantification of PRM damage within the muscle.
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Affiliation(s)
- Catalin Cernat
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shreya Das
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gijs A G M Hendriks
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frieda van den Noort
- Robotics and Mechatronics, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Claudia Manzini
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - C Huub van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Center (MUSIC), Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluids, Technical Medical Centre, University of Twente, Enschede, The Netherlands.
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van den Noort F, Manzini C, Hofsteenge M, Sirmacek B, van der Vaart CH, Slump CH. Unsupervised convolutional autoencoders for 4D transperineal ultrasound classification. J Med Imaging (Bellingham) 2023; 10:014004. [PMID: 36785585 PMCID: PMC9921518 DOI: 10.1117/1.jmi.10.1.014004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/23/2023] [Indexed: 02/13/2023] Open
Abstract
Purpose 4D Transperineal ultrasound (TPUS) is used to examine female pelvic floor disorders. Muscle movement, like performing a muscle contraction or a Valsalva maneuver, can be captured on TPUS. Our work investigates the possibility for unsupervised analysis and classification of the TPUS data. Approach An unsupervised 3D-convolutional autoencoder is trained to compress TPUS volume frames into a latent feature vector (LFV) of 128 elements. The (co)variance of the features are analyzed and statistical tests are performed to analyze how features contribute in storing contraction and Valsalva information. Further dimensionality reduction is applied (principal component analysis or a 2D-convolutional autoencoder) to the LFVs of the frames of the TPUS movie to compress the data and analyze the interframe movement. Clustering algorithms ( K -means clustering and Gaussian mixture models) are applied to this representation of the data to investigate the possibilities of unsupervised classification. Results The majority of the features show a significant difference between contraction and Valsalva. The (co)variance of the features from the LFVs was investigated and features most prominent in capturing muscle movement were identified. Furthermore, the first principal component of the frames from a single TPUS movie can be used to identify movement between the frames. The best classification results were obtained after applying principal component analysis and Gaussian mixture models to the LFVs of the TPUS movies, yielding a 91.2% accuracy. Conclusion Unsupervised analysis and classification of TPUS data yields relevant information about the type and amount of muscle movement present.
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Affiliation(s)
- Frieda van den Noort
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
| | - Claudia Manzini
- University Medical Centre Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands
| | - Merijn Hofsteenge
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
| | - Beril Sirmacek
- Saxion University of Applied Sciences, School of Creative Technology, Smart Cities Group, Enschede, The Netherlands
| | - Carl H. van der Vaart
- University Medical Centre Utrecht, Department of Obstetrics and Gynecology, Utrecht, The Netherlands
| | - Cornelis H. Slump
- University of Twente, Technical Medical Centre, Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Enschede, The Netherlands
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van den Noort F, Manzini C, van der Vaart CH, van Limbeek MAJ, Slump CH, Grob ATM. Reply. Ultrasound Obstet Gynecol 2022; 60:589-590. [PMID: 36183346 DOI: 10.1002/uog.26056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Affiliation(s)
- F van den Noort
- Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - C Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - C H van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M A J van Limbeek
- Dynamics of Complex Fluids, Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
| | - C H Slump
- Robotics and Mechatronics, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - A T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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van den Noort F, Manzini C, van der Vaart CH, van Limbeek MAJ, Slump CH, Grob ATM. Automatic identification and segmentation of slice of minimal hiatal dimensions in transperineal ultrasound volumes. Ultrasound Obstet Gynecol 2022; 60:570-576. [PMID: 34767663 PMCID: PMC9828486 DOI: 10.1002/uog.24810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/07/2021] [Accepted: 10/26/2021] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To develop and validate a tool for automatic selection of the slice of minimal hiatal dimensions (SMHD) and segmentation of the urogenital hiatus (UH) in transperineal ultrasound (TPUS) volumes. METHODS Manual selection of the SMHD and segmentation of the UH was performed in TPUS volumes of 116 women with symptomatic pelvic organ prolapse (POP). These data were used to train two deep-learning algorithms. The first algorithm was trained to provide an estimation of the position of the SMHD. Based on this estimation, a slice was selected and fed into the second algorithm, which performed automatic segmentation of the UH. From this segmentation, measurements of the UH area (UHA), anteroposterior diameter (APD) and coronal diameter (CD) were computed automatically. The mean absolute distance between manually and automatically selected SMHD, the overlap (dice similarity index (DSI)) between manual and automatic UH segmentation and the intraclass correlation coefficient (ICC) between manual and automatic UH measurements were assessed on a test set of 30 TPUS volumes. RESULTS The mean absolute distance between manually and automatically selected SMHD was 0.20 cm. All DSI values between manual and automatic UH segmentations were above 0.85. The ICC values between manual and automatic UH measurements were 0.94 (95% CI, 0.87-0.97) for UHA, 0.92 (95% CI, 0.78-0.97) for APD and 0.82 (95% CI, 0.66-0.91) for CD, demonstrating excellent agreement. CONCLUSIONS Our deep-learning algorithms allowed reliable automatic selection of the SMHD and UH segmentation in TPUS volumes of women with symptomatic POP. These algorithms can be implemented in the software of TPUS machines, thus reducing clinical analysis time and simplifying the examination of TPUS data for research and clinical purposes. © 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F. van den Noort
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - C. Manzini
- Department of Obstetrics and GynecologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - C. H. van der Vaart
- Department of Obstetrics and GynecologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | - M. A. J. van Limbeek
- Dynamics of Complex Fluids, Max Planck Institute for Dynamics and Self‐OrganizationGöttingenGermany
| | - C. H. Slump
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical CentreUniversity of TwenteEnschedeThe Netherlands
| | - A. T. M. Grob
- Multi‐Modality Medical Imaging, Faculty of Science and TechnologyTechnical Medical Centre, University of TwenteEnschedeThe Netherlands
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Manzini C, van der Vaart CH, van den Noort F, Grob ATM, Withagen MIJ. Pessary fitting for pelvic organ prolapse: parameters associated with specific reasons for failure. Int Urogynecol J 2022; 33:2037-2046. [DOI: 10.1007/s00192-021-05053-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 11/17/2021] [Indexed: 01/01/2023]
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Manzini C, Morsinkhof LM, van der Vaart CH, Withagen MIJ, Grob ATM. Parameters associated with unsuccessful pessary fitting for pelvic organ prolapse up to three months follow-up: a systematic review and meta-analysis. Int Urogynecol J 2022; 33:1719-1763. [PMID: 35037973 PMCID: PMC9270314 DOI: 10.1007/s00192-021-05015-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
Objectives To clarify which parameters are associated with unsuccessful pessary fitting for pelvic organ prolapse (POP) at up to 3 months follow-up. Methods Embase, PubMed and Cochrane CENTRAL library were searched in May 2020. Inclusion criteria were: (1) pessary fitting attempted in women with symptomatic POP; (2) pessary fitting success among the study outcomes with a maximal follow-up of 3 months; (3) baseline parameters compared between successful and unsuccessful group. A meta-analysis was performed using the random effects model. Main results Twenty-four studies were included in the meta-analysis. Parameters associated with unsuccessful pessary fitting were: age (OR 0.70, 95% CI 0.56–0.86); BMI (OR 1.35, 95% CI 1.08–1.70); menopause (OR 0.65 95% CI 0.47–0.88); de novo stress urinary incontinence (OR 5.59, 95% CI 2.24–13.99); prior surgery, i.e. hysterectomy (OR 1.88, 95% CI 1.48–2.40), POP surgery (OR 2.13, 95% CI 1.34–3.38), pelvic surgery (OR 1.81, 05% CI 1.01–3.26) and incontinence surgery (OR 1.87, 95% CI 1.08–3.25); Colorectal-Anal Distress Inventory-8 scores (OR 1.92, 95% CI 1.22–3.02); solitary predominant posterior compartment POP (OR 1.59, 95% CI 1.08–2.35); total vaginal length (OR 0.56, 95% CI 0.32–0.97); wide introitus (OR 4.85, 95% CI 1.60–14.68); levator ani avulsion (OR 2.47, 95% CI 1.35–4.53) and hiatal area on maximum Valsalva (OR 1.89, 95% CI 1.27–2.80). Conclusion During counselling for pessary treatment a higher risk of failure due to the aforementioned parameters should be discussed and modifiable parameters should be addressed. More research is needed on the association between anatomical parameters and specific reasons for unsuccessful pessary fitting.
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Affiliation(s)
- Claudia Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.,, Utrecht, The Netherlands
| | - Lisan M Morsinkhof
- Magnetic Detection and Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - C Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Mariëlla I J Withagen
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Anique T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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Manzini C, van den Noort F, Grob ATM, Withagen MIJ, Slump CH, van der Vaart CH. Appearance of the levator ani muscle subdivisions on 3D transperineal ultrasound. Insights Imaging 2021; 12:91. [PMID: 34213688 PMCID: PMC8253870 DOI: 10.1186/s13244-021-01037-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The levator ani muscle (LAM) consists of different subdivisions, which play a specific role in the pelvic floor mechanics. The aim of this study is to identify and describe the appearance of these subdivisions on 3-Dimensional (3D) transperineal ultrasound (TPUS). To do so, a study designed in three phases was performed in which twenty 3D TPUS scans of vaginally nulliparous women were assessed. The first phase was aimed at getting acquainted with the anatomy of the LAM subdivisions and its appearance on TPUS: relevant literature was consulted, and the TPUS scan of one patient was analyzed to identify the puborectal, iliococcygeal, puboperineal, pubovaginal, and puboanal muscle. In the second phase, the five LAM subdivisions and the pubic bone and external sphincter, used as reference structures, were manually segmented in volume data obtained from five nulliparous women at rest. In the third phase, intra- and inter-observer reproducibility were assessed on twenty TPUS scans by measuring the Dice Similarity Index (DSI). RESULTS The mean inter-observer and median intra-observer DSI values (with interquartile range) were: puborectal 0.83 (0.13)/0.83 (0.10), puboanal 0.70 (0.16)/0.79 (0.09), iliococcygeal 0.73 (0.14)/0.79 (0.10), puboperineal 0.63 (0.25)/0.75 (0.22), pubovaginal muscle 0.62 (0.22)/0.71 (0.16), and the external sphincter 0.81 (0.12)/0.89 (0.03). CONCLUSION Our results show that the LAM subdivisions of nulliparous women can be reproducibly identified on 3D TPUS data.
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Affiliation(s)
- Claudia Manzini
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Frieda van den Noort
- Robotics and Mechatronics, University of Twente, Enschede, Carre 3.526, Drienerlolaan 5, 7522NB, Enschede, The Netherlands.
| | - Anique T M Grob
- Multi-Modality Medical Imaging, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mariëlla I J Withagen
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Cornelis H Slump
- Robotics and Mechatronics, University of Twente, Enschede, Carre 3.526, Drienerlolaan 5, 7522NB, Enschede, The Netherlands
| | - C Huub van der Vaart
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
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Manzini C, van den Noort F, Grob ATM, Withagen MIJ, van der Vaart CH. The effect of pessary treatment on puborectalis muscle function. Int Urogynecol J 2021; 32:1409-1417. [PMID: 33847771 PMCID: PMC8042456 DOI: 10.1007/s00192-021-04766-2] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 03/10/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess if puborectalis muscle (PRM) function changes in women with pelvic organ prolapse (POP) undergoing pessary treatment. METHODS This was a prospective cohort study of women with symptomatic POP choosing pessary treatment. An interview, clinical examination and 3D/4D transperineal ultrasound were performed at baseline and at 3-month follow-up. POP was assessed using the Pelvic Organ Prolapse Quantification system (POPQ). Parameters compared between baseline and follow-up were: hiatal area at rest (HArest), maximal contraction (HActx), and maximal Valsalva maneuver (HAVal), displacement in contraction (DISPL-ctx, i.e., relative difference between HArest and HActx), and displacement in Valsalva (DISPL-Val, i.e., relative difference between and HAVal and HArest). Parameters were compared in women with and those without complete avulsion. RESULTS A total of 162 women were assessed and 34 were included. Mean age was 64 years (SD 11.4), and mean BMI 24 kg/m2 (SD 3.1). Thirty-one women had a cystocele, 8 a uterine prolapse, and 12 had a posterior compartment prolapse. Twenty-one women (61.8%) had a POP stage II, and 13 (38.2%) a POP stage III. Ring pessaries were most frequently used (97%). In the entire group a statistically significant increase in DISPL-ctx was observed (mean difference 2.1%, p = 0.017). In the no avulsion group HArest and DISPL-ctx increased significantly (mean difference 4.1%, p = 0.016 and 2.7%, p = 0.016 respectively) and the increase in DISPL-ctx was higher than in the avulsion group (mean difference 2.7% vs 0.2%, p = 0.056). CONCLUSION Our results show that PRM function changes in women with POP undergoing pessary treatment and suggest that such change occurs mainly in the absence of complete avulsion.
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Affiliation(s)
- Claudia Manzini
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Frieda van den Noort
- Robotics and Mechatronics, Faculty of electrical engineering mathematics and computer science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Anique T M Grob
- Multimodality Medical Imaging Group, Faculty of Science and Technology, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Mariëlla I J Withagen
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carl H van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
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Das S, Hansen HHG, Hendriks GAGM, van den Noort F, Manzini C, van der Vaart CH, de Korte CL. 3D Ultrasound Strain Imaging of Puborectalis Muscle. Ultrasound Med Biol 2021; 47:569-581. [PMID: 33358339 DOI: 10.1016/j.ultrasmedbio.2020.11.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 11/09/2020] [Accepted: 11/17/2020] [Indexed: 05/15/2023]
Abstract
The female pelvic floor (PF) muscles provide support to the pelvic organs. During delivery, some of these muscles have to stretch up to three times their original length to allow passage of the baby, leading frequently to damage and consequently later-life PF dysfunction (PFD). Three-dimensional (3D) ultrasound (US) imaging can be used to image these muscles and to diagnose the damage by assessing quantitative, geometric and functional information of the muscles through strain imaging. In this study we developed 3D US strain imaging of the PF muscles and explored its application to the puborectalis muscle (PRM), which is one of the major PF muscles.
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Affiliation(s)
- Shreya Das
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Hendrik H G Hansen
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gijs A G M Hendriks
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frieda van den Noort
- Robotics and Mechatronics, Faculty of Electrical Engineering, Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Claudia Manzini
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - C Huub van der Vaart
- Department of Reproductive Medicine and Gynecology, University Medical Center, Utrecht, The Netherlands
| | - Chris L de Korte
- Medical Ultrasound Imaging Center, Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands; Physics of Fluids, MIRA, University of Twente, Enschede, The Netherlands
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Manzini C, Friedman T, Turel F, Dietz HP. Vaginal laxity: which measure of levator ani distensibility is most predictive? Ultrasound Obstet Gynecol 2020; 55:683-687. [PMID: 31568590 PMCID: PMC7417815 DOI: 10.1002/uog.21873] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess the predictive value of measures of levator hiatal distension at rest and on maximum Valsalva maneuver for symptoms of vaginal laxity. METHODS This was a retrospective study of women seen at a tertiary urogynecological unit. All women underwent a standardized interview, clinical examination and four-dimensional translabial ultrasound examination. Area, anteroposterior diameter (APD) and coronal diameter (CD) of the levator hiatus were measured at rest and on maximum Valsalva maneuver in the plane of minimal hiatal dimensions using the rendered volume technique, by an operator blinded to all clinical data. The association between levator hiatal measurements and vaginal laxity was assessed, and receiver-operating-characteristics (ROC)-curve analysis was used to determine their predictive value. RESULTS Data from 490 patients were analyzed. Mean age was 58 (range, 18-88) years, and vaginal laxity was reported by 111 (23%) women. Measurements obtained on maximum Valsalva were significantly larger in women who reported vaginal laxity than in those who did not, with mean levator hiatal area, APD and CD of 30.45 ± 8.74 cm2 , 7.24 ± 1.16 cm and 5.60 ± 0.89 cm, respectively, in the vaginal-laxity group, compared with 24.84 ± 8.63 cm2 , 6.64 ± 1.22 cm and 5.01 ± 0.97 cm in the no-laxity group (P < 0.001 for all). Measurements obtained at rest were not significantly different between the groups. Multiple logistic regression analysis controlling for age, body mass index, vaginal parity and levator avulsion confirmed these results. The best regression model for the prediction of vaginal laxity included age, vaginal parity and levator hiatal area on maximum Valsalva. ROC-curve analysis of levator hiatal measurements on maximum Valsalva in the prediction of vaginal laxity demonstrated areas under the curve of 0.68 (95% CI, 0.63-0.73) for area, 0.63 (95% CI, 0.57-0.68) for APD and 0.68 (95% CI, 0.62-0.73) for CD. CONCLUSIONS Levator hiatal area on maximum Valsalva seems to be the measure of levator ani distensibility that is most predictive of symptoms of vaginal laxity. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C. Manzini
- Department of Obstetrics and GynecologyUniversity Medical Centre UtrechtUtrechtThe Netherlands
| | | | - F. Turel
- University of SydneySydneyAustralia
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12
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Oliva M, Manzini C, Bontà Pittaluga G, Kozinkova L, De Marchi L, Freitas R, Fabi G, Pretti C. Ficopomatus enigmaticus larval development assay: An application for toxicity assessment of marine sediments. Mar Pollut Bull 2019; 139:189-196. [PMID: 30686418 DOI: 10.1016/j.marpolbul.2018.12.033] [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] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/02/2018] [Accepted: 12/13/2018] [Indexed: 06/09/2023]
Abstract
Ficopomatus enigmaticus is a serpulid polychaete, reef-forming, dioecious gamete spawner throughout different seasons and in different salinity conditions. Due to these characteristics, its candidacy as a model organism to monitor both marine and brackish matrices was assessed. Marine sediments collected in a polluted area near the port of Ancona (Italy) were used as case study. Besides the chemical characterization of sediments, the larval development of F. enigmaticus was adopted as an assay for ecotoxicological assessment of sediments in addition to a regulatory bioassay battery with different organisms and endpoints. The quality of sediments was classified according to the Italian Ministerial Decree for sediment management (Ministerial Decree 173, 2016) by using the SEDI-QUAL-SOFT® (ver. 109.0) software developed by the Italian Environmental Protection Agency (ISPRA). The F. enigmaticus larval development assay showed a quite similar sensitivity to C. gigas larval development assays, indicating its potential use in a regulatory battery of bioassays.
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Affiliation(s)
- M Oliva
- Consorzio per il Centro Interuniversitario di Biologia Marina ed Ecologia Applicata di Livorno "G. Bacci", Viale N. Sauro 4, 57128 Livorno, Italy
| | - C Manzini
- Consorzio per il Centro Interuniversitario di Biologia Marina ed Ecologia Applicata di Livorno "G. Bacci", Viale N. Sauro 4, 57128 Livorno, Italy
| | - G Bontà Pittaluga
- Consorzio per il Centro Interuniversitario di Biologia Marina ed Ecologia Applicata di Livorno "G. Bacci", Viale N. Sauro 4, 57128 Livorno, Italy
| | - L Kozinkova
- Consorzio per il Centro Interuniversitario di Biologia Marina ed Ecologia Applicata di Livorno "G. Bacci", Viale N. Sauro 4, 57128 Livorno, Italy
| | - L De Marchi
- Departamento de Biologia & CESAM, University of Aveiro 3810-193, Portugal
| | - R Freitas
- Departamento de Biologia & CESAM, University of Aveiro 3810-193, Portugal
| | - G Fabi
- National Research Council - ISMAR, largo Fiera della Pesca 1, 60125 Ancona, Italy
| | - C Pretti
- Consorzio per il Centro Interuniversitario di Biologia Marina ed Ecologia Applicata di Livorno "G. Bacci", Viale N. Sauro 4, 57128 Livorno, Italy; Department of Veterinary Sciences, University of Pisa, Via Livornese lato monte, 56122 San Piero a Grado, PI, Italy.
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13
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Parodi M, Raggi F, Cangelosi D, Manzini C, Balsamo M, Blengio F, Eva A, Varesio L, Pietra G, Moretta L, Mingari MC, Vitale M, Bosco MC. Hypoxia Modifies the Transcriptome of Human NK Cells, Modulates Their Immunoregulatory Profile, and Influences NK Cell Subset Migration. Front Immunol 2018; 9:2358. [PMID: 30459756 PMCID: PMC6232835 DOI: 10.3389/fimmu.2018.02358] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 09/24/2018] [Indexed: 12/29/2022] Open
Abstract
Hypoxia, which characterizes most tumor tissues, can alter the function of different immune cell types, favoring tumor escape mechanisms. In this study, we show that hypoxia profoundly acts on NK cells by influencing their transcriptome, affecting their immunoregulatory functions, and changing the chemotactic responses of different NK cell subsets. Exposure of human peripheral blood NK cells to hypoxia for 16 or 96 h caused significant changes in the expression of 729 or 1,100 genes, respectively. Gene Set Enrichment Analysis demonstrated that these changes followed a consensus hypoxia transcriptional profile. As assessed by Gene Ontology annotation, hypoxia-targeted genes were implicated in several biological processes: metabolism, cell cycle, differentiation, apoptosis, cell stress, and cytoskeleton organization. The hypoxic transcriptome also showed changes in genes with immunological relevance including those coding for proinflammatory cytokines, chemokines, and chemokine-receptors. Quantitative RT-PCR analysis confirmed the modulation of several immune-related genes, prompting further immunophenotypic and functional studies. Multiplex ELISA demonstrated that hypoxia could variably reduce NK cell ability to release IFNγ, TNFα, GM-CSF, CCL3, and CCL5 following PMA+Ionomycin or IL15+IL18 stimulation, while it poorly affected the response to IL12+IL18. Cytofluorimetric analysis showed that hypoxia could influence NK chemokine receptor pattern by sustaining the expression of CCR7 and CXCR4. Remarkably, this effect occurred selectively (CCR7) or preferentially (CXCR4) on CD56bright NK cells, which indeed showed higher chemotaxis to CCL19, CCL21, or CXCL12. Collectively, our data suggest that the hypoxic environment may profoundly influence the nature of the NK cell infiltrate and its effects on immune-mediated responses within tumor tissues.
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Affiliation(s)
- Monica Parodi
- UOC Immunologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Federica Raggi
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Davide Cangelosi
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Claudia Manzini
- Laboratorio di Immunologia Clinica e Sperimentale, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Mirna Balsamo
- Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy
| | - Fabiola Blengio
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Alessandra Eva
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Luigi Varesio
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Gabriella Pietra
- UOC Immunologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy
| | - Lorenzo Moretta
- Immunology Area, Ospedale Pediatrico Bambin Gesù, Rome, Italy
| | - Maria Cristina Mingari
- UOC Immunologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy.,Center of Excellence for Biomedical Research, University of Genoa, Genova, Italy
| | - Massimo Vitale
- UOC Immunologia, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Carla Bosco
- Laboratorio di Biologia Molecolare, IRCCS Istituto Giannina Gaslini, Genova, Italy
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Manzini C, Venè R, Cossu I, Gualco M, Zupo S, Dono M, Spagnolo F, Queirolo P, Moretta L, Mingari MC, Pietra G. Cytokines can counteract the inhibitory effect of MEK-i on NK-cell function. Oncotarget 2018; 7:60858-60871. [PMID: 27563819 PMCID: PMC5308621 DOI: 10.18632/oncotarget.11504] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 04/19/2016] [Accepted: 08/03/2016] [Indexed: 01/23/2023] Open
Abstract
Oncogene-targeted therapies based on mutated BRAF- and/or MEK-specific inhibitors have been developed for melanoma treatment. Although these drugs induce tumor regression in a high percentage of patients, clinical responses are frequently limited in time and tumors often recur. Recent studies suggested that the combination of BRAF/MEK inhibition with immunotherapy could represent a promising strategy for the cure of melanoma. NK cells are suitable effectors for tumor immunotherapy. Here we show that PLX4032 (a mutant BRAFV600 inhibitor) had no effect on the functional properties of NK cells cultured in the presence of IL-2 or IL-15. In contrast, PD0325901 (a MEK inhibitor) induced the down-regulation of the main activating NK receptors and inhibited NK cell function. Importantly, PD0325901 did not affect the anti-tumor activity of NK cells that had been exposed to a combination of IL-15 and IL-18. In addition, both PLX4032 and PD0325901 did not exert any inhibitory effect on in vitro IL-2 or IL-15 pre-activated NK cells. Our data may provide a rationale for future clinical protocols that combine IL-15/IL-18 cytokine administration with MEK inhibitors. In addition, they suggest that oncogene-targeting drugs are compatible with NK-based adoptive therapy.
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Affiliation(s)
| | - Roberta Venè
- Oncologia Molecolare e Angiogenesi, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Irene Cossu
- IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Marina Gualco
- Anatomia Patologica, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Simonetta Zupo
- Diagnostica Molecolare, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Mariella Dono
- Diagnostica Molecolare, IRCCS AOU San Martino-IST, Genoa, Italy
| | | | - Paola Queirolo
- Oncologia Medica 2, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Lorenzo Moretta
- Department of Experimental Medicine, University of Genoa, Genoa, Italy
| | - Maria Cristina Mingari
- Immunologia, IRCCS AOU San Martino-IST, Genoa, Italy.,Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
| | - Gabriella Pietra
- Immunologia, IRCCS AOU San Martino-IST, Genoa, Italy.,Center of Excellence for Biomedical Research, University of Genoa, Genoa, Italy
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Benazzo F, Perticarini L, Padolino A, Castelli A, Gifuni P, Lovato M, Manzini C, Giordan N. A multi-centre, open label, long-term follow-up study to evaluate the benefits of a new viscoelastic hydrogel (Hymovis®) in the treatment of knee osteoarthritis. Eur Rev Med Pharmacol Sci 2016; 20:959-968. [PMID: 27010157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To evaluate the long-term efficacy and safety of Hymovis® in the symptomatic treatment of knee osteoarthritis (OA). PATIENTS AND METHODS This is a prospective, multi-center, open label, phase III clinical study. Two intra-articular injections (3 mL) of Hymovis® (8 mg/mL HYADD® 4) were administered 1 week apart at the beginning of the study on day 0 and day 7 and after 6 months from baseline, on day 182 and 189. Follow-up assessment were conducted for 52 weeks. 50 subjects, > 40 years old, with knee OA, with clinical and radiological confirm, complain pain in the target knee were enrolled. The variables considered were: WOMAC questionnaire, Joint Space Width (JSW), OMERACT OARSI responder criteria, EQ-5D questionnaire, rescue medication consumption. RESULTS After the injections of Hymovis®, pain perceived by the patient when walking on a flat surface (WOMAC A1 score) significantly improves at the end of the study respect to the baseline. WOMAC stiffness, physical function and total score significantly improve during the study since 3 months after treatment, and it is maintained up to the end of the study (p < 0.001). By the x-ray analysis of knee, a radiological progression of OA was observed in the 26% of patients at the end of the study, while 88% of patients result to be responder to the therapy classified as per OMERACT-OARSI criteria. The EQ-5D weighted index increased significantly, against baseline, at each study time point (p < 0.001). Investigator's and patient's global assessment of the disease measured by the VAS both show a marked improvement in patient's health conditions. CONCLUSIONS Results from this study confirm that Hymovis® alleviate the knee pain since the first treatment cycle. The patients treated with two cycles of intra-articular injections of Hymovis® have a progressive pain reduction that is maintained up to one year after the treatment start with improve of all the scores considered in this study. Hymovis® is effective and safe in symptomatic treatment of painful knee OA.
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Affiliation(s)
- F Benazzo
- Clinica Ortopedica e Traumatologica, Università degli Studi di Pavia - Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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16
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Balsamo M, Manzini C, Pietra G, Raggi F, Blengio F, Mingari MC, Varesio L, Moretta L, Bosco MC, Vitale M. Hypoxia downregulates the expression of activating receptors involved in NK-cell-mediated target cell killing without affecting ADCC. Eur J Immunol 2013; 43:2756-64. [PMID: 23913266 DOI: 10.1002/eji.201343448] [Citation(s) in RCA: 189] [Impact Index Per Article: 17.2] [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: 02/13/2013] [Revised: 06/03/2013] [Accepted: 07/05/2013] [Indexed: 12/21/2022]
Abstract
In certain infection sites or tumor tissues, the disruption of homeostasis can give rise to a hypoxic microenvironment, which, in turn, can alter the function of different immune cell types and favor the progression of the disease. Natural killer (NK) cells are directly involved in the elimination of virus-infected or transformed cells, however it is unknown whether their function is affected by hypoxia or not. In this study, we show that NK cells adapt to a hypoxic environment by upregulating the hypoxia-inducible factor 1α. However, NK cells lose their ability to upregulate the surface expression of the major activating NK-cell receptors (NKp46, NKp30, NKp44, and NKG2D) in response to IL-2 (or other activating cytokines, including IL-15, IL-12, and IL-21). These altered phenotypic features correlate with reduced responses to triggering signals resulting in impaired capability of killing infected or tumor target cells. Remarkably, hypoxia does not significantly alter the surface density and the triggering function of the Fc-γ receptor CD16, thus allowing NK cells to maintain their capability of killing target cells via antibody-dependent cellular cytotoxicity. This finding offers an important clue for exploitation of NK cell in antibody-based immunotherapy of cancer.
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Affiliation(s)
- Mirna Balsamo
- Dipartimento di Medicina Sperimentale, Università di Genova, Genova, Italy
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17
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Affiliation(s)
- Gabriella Pietra
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
| | - Massimo Vitale
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
| | - Claudia Manzini
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
| | - Mirna Balsamo
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
| | - Lorenzo Moretta
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
| | - Maria Cristina Mingari
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
- Authors' Affiliations: 1Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova; 2IRCCS AOU San Martino - IST; and 3Istituto Giannina Gaslini, Genova, Italy
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18
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Balsamo M, Vermi W, Parodi M, Pietra G, Manzini C, Queirolo P, Lonardi S, Augugliaro R, Moretta A, Facchetti F, Moretta L, Mingari MC, Vitale M. Melanoma cells become resistant to NK-cell-mediated killing when exposed to NK-cell numbers compatible with NK-cell infiltration in the tumor. Eur J Immunol 2012; 42:1833-42. [DOI: 10.1002/eji.201142179] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Revised: 02/21/2012] [Accepted: 03/20/2012] [Indexed: 01/17/2023]
Affiliation(s)
| | - William Vermi
- Servizio di Anatomia Patologica; Spedali Civili di Brescia; Brescia; Italy
| | - Monica Parodi
- Dipartimento di Medicina Sperimentale; Università di Genova; Genova; Italy
| | - Gabriella Pietra
- Dipartimento di Medicina Sperimentale; Università di Genova; Genova; Italy
| | - Claudia Manzini
- Dipartimento di Medicina Sperimentale; Università di Genova; Genova; Italy
| | - Paola Queirolo
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST; Istituto Nazionale per la Ricerca sul Cancro; Genova; Italy
| | - Silvia Lonardi
- Servizio di Anatomia Patologica; Spedali Civili di Brescia; Brescia; Italy
| | - Raffaella Augugliaro
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST; Istituto Nazionale per la Ricerca sul Cancro; Genova; Italy
| | | | - Fabio Facchetti
- Servizio di Anatomia Patologica; Spedali Civili di Brescia; Brescia; Italy
| | | | | | - Massimo Vitale
- IRCCS Azienda Ospedaliera Universitaria San Martino - IST; Istituto Nazionale per la Ricerca sul Cancro; Genova; Italy
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19
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Pietra G, Manzini C, Rivara S, Vitale M, Cantoni C, Petretto A, Balsamo M, Conte R, Benelli R, Minghelli S, Solari N, Gualco M, Queirolo P, Moretta L, Mingari MC. Melanoma cells inhibit natural killer cell function by modulating the expression of activating receptors and cytolytic activity. Cancer Res 2012; 72:1407-15. [PMID: 22258454 DOI: 10.1158/0008-5472.can-11-2544] [Citation(s) in RCA: 226] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Natural killer (NK) cells play a key role in tumor immune surveillance. However, adoptive immunotherapy protocols using NK cells have shown limited clinical efficacy to date, possibly due to tumor escape mechanisms that inhibit NK cell function. In this study, we analyzed the effect of coculturing melanoma cells and NK cells on their phenotype and function. We found that melanoma cells inhibited the expression of major NK receptors that trigger their immune function, including NKp30, NKp44, and NKG2D, with consequent impairment of NK cell-mediated cytolytic activity against various melanoma cell lines. This inhibitory effect was primarily mediated by indoleamine 2,3-dioxygenase (IDO) and prostaglandin E2 (PGE2). Together, our findings suggest that immunosuppressive barriers erected by tumors greatly hamper the antitumor activity of human NK cells, thereby favoring tumor outgrowth and progression.
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Affiliation(s)
- Gabriella Pietra
- Dipartimento di Medicina Sperimentale and Centro di Eccellenza per la Ricerca Biomedica Università degli Studi di Genova, Genova, Italy
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20
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Pietra G, Romagnani C, Manzini C, Moretta L, Mingari MC. The emerging role of HLA-E-restricted CD8+ T lymphocytes in the adaptive immune response to pathogens and tumors. J Biomed Biotechnol 2010; 2010:907092. [PMID: 20634877 PMCID: PMC2896910 DOI: 10.1155/2010/907092] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2010] [Accepted: 05/04/2010] [Indexed: 11/18/2022] Open
Abstract
Human leukocyte antigen (HLA)-E is a nonclassical major histocompatibility complex (MHC) class I molecule of limited sequence variability that is expressed by most tissues albeit at low levels. HLA-E has been first described as the ligand of CD94/NKG2 receptors expressed mainly by natural killer (NK) cells, thus confining its role to the regulation of NK-cell function. However, recent evidences obtained by our and other groups indicate that HLA-E complexed with peptides can interact with alphabeta T-cell receptor (TCR) expressed on CD8(+) T cells. Although, HLA-E displays a selective preference for nonameric peptides, derived from the leader sequence of various HLA class I alleles, several reports indicate that it can present also "noncanonical" peptides derived from both stress-related and pathogen-associated proteins. Because HLA-E displays binding specificity for innate CD94/NKG2 receptors, as well as all the features of an antigen-presenting molecule, its role in both natural and acquired immune responses has recently been re-evaluated.
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Affiliation(s)
- Gabriella Pietra
- Dipartimento di Medicina Sperimentale and Centro di Eccellenza per le Ricerche Biomediche, Università degli Studi di Genova, 16132 Genova, Italy
| | - Chiara Romagnani
- Clinical Immunology Group, German Rheumatism Research Centre, 10117 Berlin, Germany
| | - Claudia Manzini
- Dipartimento di Medicina Sperimentale and Centro di Eccellenza per le Ricerche Biomediche, Università degli Studi di Genova, 16132 Genova, Italy
| | - Lorenzo Moretta
- Dipartimento di Medicina Sperimentale and Centro di Eccellenza per le Ricerche Biomediche, Università degli Studi di Genova, 16132 Genova, Italy
- Istituto Giannina Gaslini, 16147 Genova, Italy
| | - Maria Cristina Mingari
- Dipartimento di Medicina Sperimentale and Centro di Eccellenza per le Ricerche Biomediche, Università degli Studi di Genova, 16132 Genova, Italy
- Istituto Nazionale per la Ricerca sul Cancro, 16132 Genova, Italy
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Balsamo M, Scordamaglia F, Pietra G, Manzini C, Cantoni C, Boitano M, Queirolo P, Vermi W, Facchetti F, Moretta A, Moretta L, Mingari MC, Vitale M. Effect of Melanoma-derived Fibroblasts on NK Cell Phenotype and Functions. Clin Immunol 2010. [DOI: 10.1016/j.clim.2010.03.143] [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: 10/19/2022]
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Balsamo M, Scordamaglia F, Pietra G, Manzini C, Cantoni C, Boitano M, Queirolo P, Vermi W, Facchetti F, Moretta A, Moretta L, Mingari MC, Vitale M. Melanoma-associated fibroblasts modulate NK cell phenotype and antitumor cytotoxicity. Proc Natl Acad Sci U S A 2009; 106:20847-52. [PMID: 19934056 PMCID: PMC2791633 DOI: 10.1073/pnas.0906481106] [Citation(s) in RCA: 251] [Impact Index Per Article: 16.7] [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: 06/12/2009] [Indexed: 12/21/2022] Open
Abstract
Although the role of the tumor microenvironment in the process of cancer progression has been extensively investigated, the contribution of different stromal components to tumor growth and/or evasion from immune surveillance is still only partially defined. In this study we analyzed fibroblasts derived from metastatic melanomas and provide evidence for their strong immunosuppressive activity. In coculture experiments, melanoma-derived fibroblasts sharply interfered with NK cell functions including cytotoxicity and cytokine production. Thus, both the IL-2-induced up-regulation of the surface expression of NKp44, NKp30, and DNAM-1 triggering receptors and the acquisition of cytolytic granules were inhibited in NK cells. This resulted in an impairment of the NK cell-mediated killing of melanoma target cells. Transwell cocultures and the use of specific inhibitors suggested that cell-to-cell contact was required for inducing DNAM-1 modulation. In contrast, modulation of NKp44 and NKp30 was due to PGE(2) released by fibroblasts during coculture. Normal skin fibroblasts could also partially affect NK cell phenotype and function. However, the inhibitory effect of tumor-derived fibroblasts was far stronger and directly correlated with their ability to produce PGE(2) either constitutively or upon induction by NK cells.
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Affiliation(s)
- Mirna Balsamo
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
| | - Francesca Scordamaglia
- Clinica Malattie dell'Apparato Respiratorio e Allergologia, Dipartimento di Medicina Interna, Università di Genova, 16132 Genova, Italy
| | - Gabriella Pietra
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
| | - Claudia Manzini
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
| | - Claudia Cantoni
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
- Istituto Giannina Gaslini 16147 Genova Italy
| | - Monica Boitano
- Istituto Nazionale per la Ricerca sul Cancro (IST) 16132 Genova, Italy; and
| | - Paola Queirolo
- Istituto Nazionale per la Ricerca sul Cancro (IST) 16132 Genova, Italy; and
| | - William Vermi
- Servizio di Anatomia Patologica, Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Fabio Facchetti
- Servizio di Anatomia Patologica, Spedali Civili di Brescia, 25123, Brescia, Italy
| | - Alessandro Moretta
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
| | - Lorenzo Moretta
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
- Istituto Giannina Gaslini 16147 Genova Italy
| | - Maria Cristina Mingari
- Dipartimento di Medicina Sperimentale (DIMES), Università di Genova, 16132 Genova and Centro di Eccellenza per la Ricerca Biomedica 16132 Genova, Italy
- Istituto Nazionale per la Ricerca sul Cancro (IST) 16132 Genova, Italy; and
| | - Massimo Vitale
- Istituto Nazionale per la Ricerca sul Cancro (IST) 16132 Genova, Italy; and
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Pietra G, Manzini C, Vitale M, Balsamo M, Ognio E, Boitano M, Queirolo P, Moretta L, Mingari MC. Natural killer cells kill human melanoma cells with characteristics of cancer stem cells. Int Immunol 2009; 21:793-801. [DOI: 10.1093/intimm/dxp047] [Citation(s) in RCA: 118] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
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24
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Daoust R, Beaulieu P, Manzini C, Lavigne G. Estimation of Pain Intensity in Emergency Medicine: A Validation Study. Acad Emerg Med 2007. [DOI: 10.1197/j.aem.2007.03.862] [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: 11/10/2022]
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25
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Dubé C, Rompré PH, Manzini C, Guitard F, de Grandmont P, Lavigne GJ. Quantitative polygraphic controlled study on efficacy and safety of oral splint devices in tooth-grinding subjects. J Dent Res 2004; 83:398-403. [PMID: 15111632 DOI: 10.1177/154405910408300509] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.5] [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: 02/06/2023] Open
Abstract
The efficacy of occlusal splints in diminishing muscle activity and tooth-grinding damage remains controversial. The objective of this study was to compare the efficacy and safety of an occlusal splint (OS) vs. a palatal control device (PCD). Nine subjects with sleep bruxism (SB) participated in this randomized study. Sleep laboratory recordings were made on the second night to establish baseline data. Patients then wore each of the splints in the sleep laboratory for recording nights three and four, two weeks apart, according to a crossover design. A statistically significant reduction in the number of SB episodes per hour (decrease of 41%, p = 0.05) and SB bursts per hour (decrease of 40%, p < 0.05) was observed with the two devices. Both oral devices also showed 50% fewer episodes with grinding noise (p = 0.06). No difference was observed between the devices. Moreover, no changes in respiratory variables were observed. Both devices reduced muscle activity associated with SB.
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Affiliation(s)
- C Dubé
- Département de Restauration, Prosthodontics Postgraduate Program, Faculté de médecine dentaire, Université de Montréal, Québec, Canada
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26
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Lavigne GJ, Soucy JP, Lobbezoo F, Manzini C, Blanchet PJ, Montplaisir JY. Double-blind, crossover, placebo-controlled trial of bromocriptine in patients with sleep bruxism. Clin Neuropharmacol 2001; 24:145-9. [PMID: 11391125 DOI: 10.1097/00002826-200105000-00005] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [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: 11/25/2022]
Abstract
This study was designed to assess the effects of bromocriptine, a dopamine D2 receptor agonist, on sleep bruxism. Seven otherwise healthy patients with severe and frequent sleep bruxism participated in this randomized, double-blind, placebo-controlled study. The study used a crossover design that included 2 weeks of active treatment or placebo with a washout period of 1 week. To further evaluate whether bromocriptine influences striatal D2 receptor binding, we used iodine-123-iodobenzamide single photon emission computed tomography (SPECT) under both placebo and bromocriptine regimens. Bromocriptine did not reduce the frequency of episodes of bruxism during sleep (mean +/- SEM, 9.0 +/- 1.0 and 9.6 +/- 1.5 bruxism episodes per hour for placebo and bromocriptine, respectively) or the amplitude of masseter muscle contractions (root mean square values, 48.2 +/- 15.5 microV and 46.9 +/- 12.7 microV for placebo and bromocriptine, respectively). SPECT also failed to reveal that either treatment had any influence on striatal D2 binding (values for total binding in counts/pixel, 1.80 [1.72-1.93] and 1.79 [1.56-1.87] for placebo and bromocriptine, respectively). This study shows that a nightly dose of bromocriptine does not exacerbate or reduce sleep bruxism motor activity.
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Affiliation(s)
- G J Lavigne
- Center d'étude du sommeil, Hôpital du Sacré-Coeur de Montréal, Québec, Canada
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27
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Lavigne GJ, Zucconi M, Castronovo V, Manzini C, Veglia F, Smirne S, Ferini-Strambi L. Heart rate changes during sleep in response to experimental thermal (nociceptive) stimulations in healthy subjects. Clin Neurophysiol 2001; 112:532-5. [PMID: 11222976 DOI: 10.1016/s1388-2457(00)00558-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [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: 11/24/2022]
Abstract
OBJECTIVE During wakefulness, nociceptive thermal stimulation can trigger a rapid and transient rise in heart rate (HR). During sleep, HR variations are different across sleep stages; HR is more variable in stage 2 and in REM than in stages 3 and 4. The aim of this study was to assess the HR response to experimental thermal stimulation during different sleep stages. METHODS Eight young subjects free of sleep and pain problems, underwent a night of polysomnographic recording during which experimental thermal stimulations were applied. During all sleep stages (St), a series of cold, warm/control and heat pain stimulations were applied over the shoulder skin by means of a water-driven system. Variation of HR interval was measured for 6 s before and for 6 s during the thermal stimulation. RESULTS In comparison to control warm stimulation, experimental nociceptive thermal stimulation induced a significant rise in HR during sleep; HR increased by 7% in St 2, 5.4% in St 3&4, and by 4.3% in REM sleep. CONCLUSION The brief increase in cardiac activity with experimental nociceptive stimulation suggests that during sleep, the autonomic-cardiac nervous system remains reactive to external sensory inputs and is part of the physiological response to preserve body safety and sleep integrity in the face of potentially harmful stimulation.
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Affiliation(s)
- G J Lavigne
- Sleep studies Centre/Hôpital du Sacré-Coeur and Faculty of Dental Medicine, Université de Montréal, C.P. 6128, Succursale Centre-ville, Québec H3C 3J7, Montréal, Canada.
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Lavigne G, Zucconi M, Castronovo C, Manzini C, Marchettini P, Smirne S. Sleep arousal response to experimental thermal stimulation during sleep in human subjects free of pain and sleep problems. Pain 2000; 84:283-90. [PMID: 10666533 DOI: 10.1016/s0304-3959(99)00213-4] [Citation(s) in RCA: 116] [Impact Index Per Article: 4.8] [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: 11/24/2022]
Abstract
Although the interaction between sleep and pain is generating considerable interest (NIH Technology Assessment Panel, 1996), it is still unknown if chronic pain is the cause or effect of poor sleep. To further this understanding, subjects free of pain and sleep problems need to be studied in order to assess their response to pain during sleep, defined as a behavioral and a physiological state in which sensory processing is altered. (For example, while auditory perception remains active, other sensory inputs are facilitated, attenuated, or suppressed (Velluti, 199746 degrees C) was statistically greater in the lighter sleep stage 2 (48.3%) than in the deeper stages 3&4 (27.9%). A nocifensive behavioral-motor response was associated with only 2.5% of the 351 heat pain stimuli. Two other markers of sleep quality-sleep stage shift and awakening-were not influenced by the thermal stimuli. None of the subjects demonstrated any burns in the morning following the thermal stimulations applied during sleep. We conclude that the processing of nociceptive inputs is attenuated across sleep stages.
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Affiliation(s)
- G Lavigne
- Faculté de médecine dentaire, Université de Montréal and Centre de Recherche Fernand Séguin, Hôpital Louis-H. Lafontaine, Montréal, Canada.
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29
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Bione S, Sala C, Manzini C, Arrigo G, Zuffardi O, Banfi S, Borsani G, Jonveaux P, Philippe C, Zuccotti M, Ballabio A, Toniolo D. A human homologue of the Drosophila melanogaster diaphanous gene is disrupted in a patient with premature ovarian failure: evidence for conserved function in oogenesis and implications for human sterility. Am J Hum Genet 1998; 62:533-41. [PMID: 9497258 PMCID: PMC1376955 DOI: 10.1086/301761] [Citation(s) in RCA: 194] [Impact Index Per Article: 7.5] [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] [Indexed: 11/03/2022] Open
Abstract
Premature ovarian failure (POF) is a defect of ovarian development and is characterized by primary or secondary amenorrhea, with elevated levels of serum gonadotropins, or by early menopause. The disorder has been attributed to various causes, including rearrangements of a large "critical region" in the long arm of the X chromosome. Here we report identification, in a family with POF, of a gene that is disrupted by a breakpoint. The gene is the human homologue of the Drosophila melanogaster diaphanous gene; mutated alleles of this gene affect spermatogenesis or oogenesis and lead to sterility. The protein (DIA) encoded by the human gene (DIA) is the first human member of the growing FH1/FH2 protein family. Members of this protein family affect cytokinesis and other actin-mediated morphogenetic processes that are required in early steps of development. We propose that the human DIA gene is one of the genes responsible for POF and that it affects the cell divisions that lead to ovarian follicle formation.
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Affiliation(s)
- S Bione
- Institute of Genetics, Biochemistry and Evolution, Consiglio Nationale delle Ricerche, University of Pavia, Pavia, Italy
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Vanzulli A, Manzini C, Villa G, Bonato C, Lanzi F, Del Maschio A. [Accuracy of magnetic resonance (0.5 T) in traumatic lesions of the knee. Controlled 87 cases]. Radiol Med 1992; 83:585-91. [PMID: 1631333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
In this study the authors investigated the diagnostic accuracy of Magnetic Resonance (MR) imaging as a method to recognise traumatic disorders of the knee; in particular its capability to identify meniscal and cruciate ligaments tears was examined. The results have been compared with those from arthroscopy and/or surgery, which were considered the gold standard of the study. Eighty-seven consecutive patients with suspected traumatic injury of the knee were prospectively studied. All patients underwent MR examination (0.5 Tesla magnet, gradient echo sequences, slices thickness = 5 mm) and, within 15 days/1 month, arthroscopy or surgery. The high diagnostic accuracy (internal meniscus = 87.5%; external meniscus = 88.5%; anterior cruciate ligament = 93.1%; posterior cruciate ligament = 96.5%) has confirmed the good diagnostic capabilities of MR in assessing traumatic lesions of the knee.
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Affiliation(s)
- A Vanzulli
- Istituto Scientifico Ospedale S. Raffaele, Milano
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31
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Millington WR, Dybdal NO, Dawson R, Manzini C, Mueller GP. Equine Cushing's disease: differential regulation of beta-endorphin processing in tumors of the intermediate pituitary. Endocrinology 1988; 123:1598-604. [PMID: 2456916 DOI: 10.1210/endo-123-3-1598] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Equine Cushing's disease is caused by an adenomatous hyperplasia of the intermediate pituitary which secretes high levels of beta-endorphin, ACTH, and other peptide derivatives of POMC. In the present study we found that plasma and cerebrospinal fluid immunoreactive beta-endorphin (i beta-endorphin) levels were 60- and 120-fold higher than control values in horses with Cushing's disease. There were no significant differences in intermediate lobe i beta-endorphin concentrations, although anterior lobe i beta-endorphin was significantly reduced in Cushing's horses, presumably because high levels of circulating glucocorticoids inhibit POMC biosynthesis in corticotrophs. Although the i beta-endorphin concentration of the tumors was not different from that in normal tissue, the posttranslational processing of beta-endorphin in the two tissues differed significantly. In controls, beta-endorphin-(1-31) was extensively processed to N-acetyl-beta-endorphin-(1-31), -(1-27), and -(1-26) and des-acetyl beta-endorphin-(1-27). N-Acetyl-beta-endorphin-(1-27) was the predominant form, constituting 57% of the total i beta-endorphin, whereas beta-endorphin-(1-31) was quantitatively minor (less than 7% of the total immunoreactivity. In adenomatous pituitaries, the processing of beta-endorphin was restricted, significantly increasing the proportions of beta-endorphin-(1-31) and N-acetyl-beta-endorphin-(1-31) and lowering the amounts of N-acetyl-beta-endorphin-(1-27) and -(1-26). These changes in peptide processing were associated with markedly reduced levels of dopamine, suggesting that the dopaminergic neurons that normally control intermediate lobe secretion no longer innervate the hyperplastic tissue. These findings are consistent with evidence that the dopaminergic innervation of the intermediate pituitary regulates the posttranslational processing and release of beta-endorphin.
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Affiliation(s)
- W R Millington
- Department of Physiology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814
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32
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Bichet DG, Kortas C, Mettauer B, Manzini C, Marc-Aurèle J, Rouleau JL, Schrier RW. Modulation of plasma and platelet vasopressin by cardiac function in patients with heart failure. Kidney Int 1986; 29:1188-96. [PMID: 3528612 DOI: 10.1038/ki.1986.126] [Citation(s) in RCA: 68] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two groups of patients with congestive heart failure were studied, one with elevated (Group I) and another (Group II) with suppressed plasma concentrations of vasopressin. The mean plasma arginine vasopressin (AVP) concentration in the 17 patients in group I was 3.1 +/- 0.4 pg/mliter whereas the eight patients in group II had plasma concentration less than 0.5 pg/mliter. Platelet AVP concentrations were also higher in the Group I than Group II patients (7.8 +/- 1.5 vs. 2.2 +/- 0.7 pg/mliter, P less than 0.001). Plasma effective osmolality (262 vs. 268 mOsm/kg H2O, P less than 0.05) and plasma sodium concentration (134 vs. 137 mEq/liter, P less than 0.05) were lower in Group I. The Group I patients had a lower cardiac index (CI, 1.9 vs. 2.5 liter/min/m2, P less than 0.05) and higher pulmonary capillary wedge pressure (PCWP, 30 vs. 22 mm Hg, P less than 0.02), plasma renin activity (4.4 vs. 2.0 ng/mliter/hr, P less than 0.01), and plasma aldosterone (74 vs. 10 ng/dliter, P less than 0.001) than the Group II patients. The Group I patients also excreted a smaller percentage of a 15 mliter/kg waterload (31 vs. 57%, P less than 0.005). Group I patients then were treated with agents to decrease cardiac afterload, either captopril or prazosin. CI increased (1.9 to 2.1 liter/min/m2, P less than 0.001) and PCWP decreased (30 to 27 mm Hg, P less than 0.001). This improved cardiac performance was associated with enhanced water excretion (31 vs. 52%, P less than 0.001) and decreased minimal urinary osmolality (375 vs. 208 mOsm/kg H2O, P less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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Mettauer B, Rouleau JL, Bichet D, Kortas C, Manzini C, Tremblay G, Chatterjee K. Differential long-term intrarenal and neurohormonal effects of captopril and prazosin in patients with chronic congestive heart failure: importance of initial plasma renin activity. Circulation 1986; 73:492-502. [PMID: 3512121 DOI: 10.1161/01.cir.73.3.492] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Fifty patients with congestive heart failure received, by infusion, 15 ml/kg body weight water load, and systemic hemodynamic, renal function, and neurohumoral parameters values were measured before, 2 days, and 1 month after randomly allocating patients to prazosin or captopril therapy. Both prazosin and captopril caused similar and persistent hemodynamic changes, but important differences existed between their renal and neurohumoral effects. After 1 month of continuous therapy, captopril increased creatinine clearance from 71 to 84 ml/min/1.73(2) (p less than .05), increased the water load excreted in 5 hr from 50% to 71% (p less than .005), and increased 5 hr sodium excreted from 6.8 to 14.7 meq (p less than .005), Captopril also caused a decrease in plasma norepinephrine from 568 to 448 pg/ml (p less than .005), in plasma epinephrine from 94 to 73 pg/ml (p less than .05), and in plasma aldosterone from 57 to 28 ng/dl (p less than .005), without changing plasma vasopressin. These beneficial effects were greater after 1 month of therapy than after 2 days. The only beneficial effect of prazosin was to increase water excretion from 49% to 59% (p less than .05). The long-term response to captopril was similar in patients with higher (greater than 2.5 ng/ml/hr) and lower renin levels. However, in patients with lower renin levels, prazosin decreased pulmonary capillary wedge pressure (24.8 to 21.8 mm Hg, p less than .05), decreased plasma arginine vasopressin (1.16 to 0.75 pg/ml, p less than .05), increased water excretion (62% to 85%, p less than .005), and decreased plasma epinephrine (81 to 46 pg/ml, p less than .05), while in patients with higher renin levels none of these beneficial effects were noted. We conclude that captopril produces long-term beneficial renal and neurohumoral effects that prazosin does not despite similar hemodynamic changes with the two drugs, that these effects are at least partially dependent on the initial neurohumoral and hemodynamic status of the patient, and that through hemodynamic improvement vasodilators may chronically interrupt vasopressin overstimulation.
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Bichet DG, Kortas C, Manzini C, Barjon JN. A specific antibody to vasopressin in a man with concomitant resistance to treatment with Pitressin. Clin Chem 1986; 32:211-2. [PMID: 3940717] [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: 01/08/2023]
Abstract
A 26-year-old man with complete neurogenic diabetes insipidus since age nine was initially treated with vasopressin (Pitressin Tannate in oil). At age 13, its dosages were progressively increased to control the patient's polyuria; minor allergic symptoms occurred after every such treatment. We incubated serial dilutions of the patient's plasma with 125I-labeled arginine-vasopressin and obtained a 50% specific binding for the plasma at a final dilution of 625-fold. Cross-reactivity studies showed that lysine-vasopressin was better recognized by the antibody than arginine-vasopressin. These results were attributed to large concentrations of lysine-vasopressin (pork vasopressin) in the Pitressin.
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35
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Bichet DG, Kortas C, Manzini C, Barjon JN. A specific antibody to vasopressin in a man with concomitant resistance to treatment with Pitressin. Clin Chem 1986. [DOI: 10.1093/clinchem/32.1.211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A 26-year-old man with complete neurogenic diabetes insipidus since age nine was initially treated with vasopressin (Pitressin Tannate in oil). At age 13, its dosages were progressively increased to control the patient's polyuria; minor allergic symptoms occurred after every such treatment. We incubated serial dilutions of the patient's plasma with 125I-labeled arginine-vasopressin and obtained a 50% specific binding for the plasma at a final dilution of 625-fold. Cross-reactivity studies showed that lysine-vasopressin was better recognized by the antibody than arginine-vasopressin. These results were attributed to large concentrations of lysine-vasopressin (pork vasopressin) in the Pitressin.
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Martelli A, Malaguti P, Manzini C, Migliori V. [Clinico-statistical considerations on the recent influenza epidemic (1969-70)]. Acta Gerontol (Milano) 1970; 20:93-122. [PMID: 5532161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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37
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Manzini C, Fraulini B, Bisceglia L. [Voluminous mesothelial "spring water" cysts of the ovary, simulating peritoneal exudate]. Bull Sci Med (Bologna) 1966; 138:192-204. [PMID: 5919272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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38
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Manzini C. [Urastrat as a specific routine method of determination of urea in the blood. Clinico-statistical data]. Minerva Med 1966; 57:385-90. [PMID: 5909144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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