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Migliavacca M, Barzaghi F, Fossati C, Rancoita PMV, Gabaldo M, Dionisio F, Giannelli S, Salerio FA, Ferrua F, Tucci F, Calbi V, Gallo V, Recupero S, Consiglieri G, Pajno R, Sambuco M, Priolo A, Ferri C, Garella V, Monti I, Silvani P, Darin S, Casiraghi M, Corti A, Zancan S, Levi M, Cesana D, Carlucci F, Pituch-Noworolska A, AbdElaziz D, Baumann U, Finocchi A, Cancrini C, Ladogana S, Meinhardt A, Meyts I, Montin D, Notarangelo LD, Porta F, Pasquet M, Speckmann C, Stepensky P, Tommasini A, Rabusin M, Karakas Z, Galicchio M, Leonardi L, Duse M, Guner SN, Di Serio C, Ciceri F, Bernardo ME, Aiuti A, Cicalese MP. Long-term and real-world safety and efficacy of retroviral gene therapy for adenosine deaminase deficiency. Nat Med 2024; 30:488-497. [PMID: 38355973 PMCID: PMC7615698 DOI: 10.1038/s41591-023-02789-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 12/21/2023] [Indexed: 02/16/2024]
Abstract
Adenosine deaminase (ADA) deficiency leads to severe combined immunodeficiency (SCID). Previous clinical trials showed that autologous CD34+ cell gene therapy (GT) following busulfan reduced-intensity conditioning is a promising therapeutic approach for ADA-SCID, but long-term data are warranted. Here we report an analysis on long-term safety and efficacy data of 43 patients with ADA-SCID who received retroviral ex vivo bone marrow-derived hematopoietic stem cell GT. Twenty-two individuals (median follow-up 15.4 years) were treated in the context of clinical development or named patient program. Nineteen patients were treated post-marketing authorization (median follow-up 3.2 years), and two additional patients received mobilized peripheral blood CD34+ cell GT. At data cutoff, all 43 patients were alive, with a median follow-up of 5.0 years (interquartile range 2.4-15.4) and 2 years intervention-free survival (no need for long-term enzyme replacement therapy or allogeneic hematopoietic stem cell transplantation) of 88% (95% confidence interval 78.7-98.4%). Most adverse events/reactions were related to disease background, busulfan conditioning or immune reconstitution; the safety profile of the real world experience was in line with premarketing cohort. One patient from the named patient program developed a T cell leukemia related to treatment 4.7 years after GT and is currently in remission. Long-term persistence of multilineage gene-corrected cells, metabolic detoxification, immune reconstitution and decreased infection rates were observed. Estimated mixed-effects models showed that higher dose of CD34+ cells infused and younger age at GT affected positively the plateau of CD3+ transduced cells, lymphocytes and CD4+ CD45RA+ naive T cells, whereas the cell dose positively influenced the final plateau of CD15+ transduced cells. These long-term data suggest that the risk-benefit of GT in ADA remains favorable and warrant for continuing long-term safety monitoring. Clinical trial registration: NCT00598481 , NCT03478670 .
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Affiliation(s)
- Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudia Fossati
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola M V Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | | | - Francesca Dionisio
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Giannelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Andrea Salerio
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vera Gallo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Recupero
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulia Consiglieri
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberta Pajno
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Sambuco
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessio Priolo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Ferri
- Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Ilaria Monti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Darin
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Miriam Casiraghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ambra Corti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | - Daniela Cesana
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Filippo Carlucci
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Dalia AbdElaziz
- Department of Pediatrics, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ulrich Baumann
- Department of Paediatric Pulmonology, Allergy and Neonatology, Hannover Medical School, Hannover, Germany
| | - Andrea Finocchi
- Research Unit of Primary Immunodeficiencies, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Scientific Institute for Research and Healthcare (IRCCS), Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Caterina Cancrini
- Research Unit of Primary Immunodeficiencies, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, Scientific Institute for Research and Healthcare (IRCCS), Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Saverio Ladogana
- Paediatric Onco-haematology Unit, 'Casa Sollievo della Sofferenza' Hospital, IRCCS, San Giovanni Rotondo, Italy
| | - Andrea Meinhardt
- Department of Pediatric Hematology and Oncology, Medical Center, University Hospital Giessen, Giessen, Germany
| | - Isabelle Meyts
- Laboratory of Inborn Errors of Immunity, Department of Microbiology, Immunology and Transplantation, KU Leuven, Childhood Immunology, Department of Pediatrics, UZ Leuven, Leuven, Belgium
| | - Davide Montin
- Department of Pediatric and Public Health Sciences, University of Torino, Turin, Italy
- Regina Margherita Children's Hospital, AOU Città della Salute e della Scienza di Torino, Turin, Italy
| | | | - Fulvio Porta
- Pediatric Oncology-Hematology and BMT Unit, Spedali Civili di Brescia, Brescia, Italy
| | - Marlène Pasquet
- Pediatric Hematology and Immunology, Children's Hospital, Toulouse, France
| | - Carsten Speckmann
- Institute for Immunodeficiency, Center for Chronic Immunodeficiency (CCI), Faculty of Medicine, Medical Center, University of Freiburg, Freiburg, Germany
- Division of Pediatric Hematology and Oncology, Department of Pediatric and Adolescent Medicine, University Medical Center Freiburg, University of Freiburg, Freiburg, Germany
| | - Polina Stepensky
- Department of Bone Marrow Transplantation and Cancer Immunotherapy and Faculty of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Alberto Tommasini
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Marco Rabusin
- Department of Pediatrics, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
| | - Zeynep Karakas
- Department of Pediatrics, Hematology/Oncology Unit, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Miguel Galicchio
- Allergy and Immnunology Service, Hospital de Niños VJ Vilela, Rosario, Argentina
| | - Lucia Leonardi
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Marzia Duse
- Department of Maternal, Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Sukru Nail Guner
- Division of Pediatric Allergy and Immunology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Fabio Ciceri
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
- Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
- Università Vita-Salute San Raffaele, Milan, Italy.
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Università Vita-Salute San Raffaele, Milan, Italy
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Puthettu M, Vandenberghe S, Balafas S, Di Serio C, Singjeli G, Pagnamenta A, Demertzis S. Optimizing CO2 field flooding during sternotomy: In vitro confirmation of the Karolinska studies. PLoS One 2024; 19:e0292669. [PMID: 38194426 PMCID: PMC10775975 DOI: 10.1371/journal.pone.0292669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 09/26/2023] [Indexed: 01/11/2024] Open
Abstract
Although CO2 field-flooding was first used during cardiac surgery more than 60 years ago, its efficacy is still disputed. The invisible nature of the gas and the difficulty in determining the "safe" quantity to protect the patient are two of the main obstacles to overcome for its validation. Moreover, CO2 concentration in the chest cavity is highly sensitive to procedural aspects, such suction and hand movements. Based on our review of the existing literature, we identified four major factors that influence the intra-cavity CO2 concentration during open-heart surgery: type of delivery device (diffuser), delivery CO2 flow rate, diffuser position around the wound cavity, and its orientation inside the cavity. In this initial study, only steady state conditions were considered to establish a basic understanding on the effect of the four above-mentioned factors. Transient factors, such as suction or hand movements, will be reported separately.
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Affiliation(s)
- Mira Puthettu
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Laboratory of Cardiovascular Engineering, Laboratories for Translational Research EOC (LRT-EOC), Bellinzona, Switzerland
| | - Stijn Vandenberghe
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Spyros Balafas
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
| | - Clelia Di Serio
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milano, Italy
- Clinical Trial Unit (CTU), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
| | - Geni Singjeli
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
| | - Alberto Pagnamenta
- Clinical Trial Unit (CTU), Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Department of Intensive Care, Ente Ospedaliero Cantonale (EOC), Lugano, Switzerland
- Division of Pneumology, University of Geneva, Geneva, Switzerland
| | - Stefanos Demertzis
- Department of Cardiac Surgery, Istituto Cardiocentro Ticino, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
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Balafas S, Gagliano V, Di Serio C, Guidugli GA, Saporito A, Gabutti L, Ferrari P. Differential impact of transfusion guidelines on blood transfusion practices within a health network. Sci Rep 2023; 13:6264. [PMID: 37069210 PMCID: PMC10109235 DOI: 10.1038/s41598-023-33549-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/14/2023] [Indexed: 04/19/2023] Open
Abstract
Whether clinical practice guidelines have a significant impact on practice is unclear. The effect of guideline recommendations on clinical practice often a lags behind the date of publication. We evaluated by means of a data-driven approach if and when the guidelines on red blood cell transfusions (RBCTs) issued by Swiss Smarter Medicine in 2016 had an impact on RBCTs practice within a hospital network, where awareness of guidelines was promoted mainly among internal medicine specialties. Data on RBCTs performed in a Swiss hospital network from January 2014 to April 2021 were analyzed by hospital site and specialty to assess whether guidelines led to a decrease in inappropriate RBCTs. RBCTs were defined as "inappropriate" if patients had a hemoglobin level ≥ 70 g/L without or ≥ 80 g/L with significant cardiovascular comorbidities. Changes in the rate of inappropriate transfusions were analyzed with an advanced statistical approach that included generalized additive models. Overall prior to March 2017 there were more inappropriate than appropriate RBCTs, but after October 2017 the opposite could be observed. A change-point in the time trend was estimated from transfusion data to occur in the time interval between March and October 2017. This change was mainly driven by practice changes in the medical wards, while no significant change was observed in the critical care, surgical and oncology wards. Change in practice varied by hospital site. In conclusion, our results show that a significant change in the RBCTs practice at the hospital level occurred approximately 18 months after national guidelines were issued.
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Affiliation(s)
- Spyros Balafas
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
| | - Vanessa Gagliano
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
| | | | - Andrea Saporito
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
- Division of Anesthesiology, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Luca Gabutti
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Paolo Ferrari
- Faculty of Biomedicine, Università Della Svizzera Italiana, Lugano, Switzerland.
- Clinical School, University of New South Wales, Sydney, Australia.
- Department of Nephrology, Ente Ospedaliero Cantonale (EOC), 6900, Lugano, Switzerland.
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Cugnata F, Scarale MG, De Lorenzo R, Simonini M, Citterio L, Querini PR, Castagna A, Di Serio C, Lanzani C. Profiling Covid-19 patients with respect to level of severity: an integrated statistical approach. Sci Rep 2023; 13:5498. [PMID: 37015962 PMCID: PMC10071456 DOI: 10.1038/s41598-023-32089-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
A full understanding of the characteristics of Covid-19 patients with a better chance of experiencing poor vital outcomes is critical for implementing accurate and precise treatments. In this paper, two different advanced data-driven statistical approaches along with standard statistical methods have been implemented to identify groups of patients most at-risk for death or severity of respiratory distress. First, the tree-based analysis allowed to identify profiles of patients with different risk of in-hospital death (by Survival Tree-ST analysis) and severity of respiratory distress (by Classification and Regression Tree-CART analysis), and to unravel the role on risk stratification of highly dependent covariates (i.e., demographic characteristics, admission values and comorbidities). The ST analysis identified as the most at-risk group for in-hospital death the patients with age > 65 years, creatinine [Formula: see text] 1.2 mg/dL, CRP [Formula: see text] 25 mg/L and anti-hypertensive treatment. Based on the CART analysis, the subgroups most at-risk of severity of respiratory distress were defined by patients with creatinine level [Formula: see text] 1.2 mg/dL. Furthermore, to investigate the multivariate dependence structure among the demographic characteristics, the admission values, the comorbidities and the severity of respiratory distress, the Bayesian Network analysis was applied. This analysis confirmed the influence of creatinine and CRP on the severity of respiratory distress.
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Affiliation(s)
- Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Giovanna Scarale
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Rebecca De Lorenzo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lorena Citterio
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Rovere Querini
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonella Castagna
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy.
- Biomedical Faculty, Università Della Svizzera Italiana, Lugano, Switzerland.
| | - Chiara Lanzani
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
- Nephrology and Dialysis Unit, Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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5
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Testoni SGG, Petrone MC, Reni M, Di Serio C, Rancoita PM, Rossi G, Balzano G, Linzenbold W, Enderle M, Della-Torre E, De Cobelli F, Falconi M, Capurso G, Arcidiacono PG. EUS-guided ablation with the HybridTherm Probe as second-line treatment in patients with locally advanced pancreatic ductal adenocarcinoma: A case-control study. Endosc Ultrasound 2022; 11:383-392. [PMID: 36255026 PMCID: PMC9688129 DOI: 10.4103/eus-d-21-00200] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and Objectives Data on the clinical efficacy of EUS-guided ablation using the HybridTherm-Probe (EUS-HTP) in locally advanced pancreatic ductal adenocarcinoma (LA-PDAC) are lacking. The aim of the study was to assess the impact of EUS-HTP added to chemotherapy (CT) on overall survival (OS) and progression-free survival (PFS) of LA-PDAC patients with local disease progression (DP) after first-line therapy, compared to CT alone in controls. Methods LA-PDAC cases, prospectively treated by EUS-HTP, were retrospectively compared to matched controls (1:2) receiving standard treatment. Study endpoints were the OS and PFS from local DP after first-line therapy, compared through log-rank test calculating hazard ratios and differences in restricted mean OS/PFS time (RMOST/RMPFST) within prespecified time points (4, 6, and 12 months). Results Thirteen cases and 26 controls were included. Clinical, tumor, and therapy features before and after first-line therapy were case-control balanced. The median OS and PFS were not significantly improved in cases over controls (months: 7 vs. 5 and 5 vs. 3, respectively). At 4 and 6 months, the RMPFST difference was in favor of cases (P = 0.0001 and P = 0.003, respectively). In cases and controls not candidate to further CT (N = 5 and N = 9), the median OS and PFS were not significantly improved in cases over controls (months: 6 vs. 3 and 4 vs. 2, respectively), but the RMPFST difference was in favor of cases at 4 months (P = 0.002). Conclusions In locally progressive PDAC patients experiencing failure of first-line therapy, EUS-HTP achieves a significantly better RMPFST up to 6 months compared to standard treatment, although without a significant impact on OS.
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Affiliation(s)
- Sabrina Gloria Giulia Testoni
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Maria Chiara Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Michele Reni
- Department of Oncology, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Clelia Di Serio
- Vita-Salute San Raffaele University, CUSSB, University Centre for Statistics in the Biomedical Sciences, Milan, Italy
| | - Paola Maria Rancoita
- Vita-Salute San Raffaele University, CUSSB, University Centre for Statistics in the Biomedical Sciences, Milan, Italy
| | - Gemma Rossi
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Gianpaolo Balzano
- Department of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | | | | | - Emanuel Della-Torre
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology and Center for Experimental Imaging, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Massimo Falconi
- Department of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy
| | - Gabriele Capurso
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Hospital, Milan, Italy
| | - Paolo Giorgio Arcidiacono
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, Vita-Salute San Raffaele University, San Raffaele Hospital, Milan, Italy,Address for correspondence Prof. Paolo Giorgio Arcidiacono, Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Vita-Salute San Raffaele University, Via Olgettina 60, 20132, Milan, Italy. E-mail:
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6
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Palmisano A, Vignale D, Boccia E, Nonis A, Gnasso C, Leone R, Montagna M, Nicoletti V, Bianchi AG, Brusamolino S, Dorizza A, Moraschini M, Veettil R, Cereda A, Toselli M, Giannini F, Loffi M, Patelli G, Monello A, Iannopollo G, Ippolito D, Mancini EM, Pontone G, Vignali L, Scarnecchia E, Iannacone M, Baffoni L, Sperandio M, de Carlini CC, Sironi S, Rapezzi C, Antiga L, Jagher V, Di Serio C, Furlanello C, Tacchetti C, Esposito A. AI-SCoRE (artificial intelligence-SARS CoV2 risk evaluation): a fast, objective and fully automated platform to predict the outcome in COVID-19 patients. Radiol Med 2022; 127:960-972. [PMID: 36038790 PMCID: PMC9423702 DOI: 10.1007/s11547-022-01518-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/13/2022] [Indexed: 02/06/2023]
Abstract
Purpose To develop and validate an effective and user-friendly AI platform based on a few unbiased clinical variables integrated with advanced CT automatic analysis for COVID-19 patients’ risk stratification. Material and Methods In total, 1575 consecutive COVID-19 adults admitted to 16 hospitals during wave 1 (February 16-April 29, 2020), submitted to chest CT within 72 h from admission, were retrospectively enrolled. In total, 107 variables were initially collected; 64 extracted from CT. The outcome was survival. A rigorous AI model selection framework was adopted for models selection and automatic CT data extraction. Model performances were compared in terms of AUC. A web–mobile interface was developed using Microsoft PowerApps environment. The platform was externally validated on 213 COVID-19 adults prospectively enrolled during wave 2 (October 14-December 31, 2020). Results The final cohort included 1125 patients (292 non-survivors, 26%) and 24 variables. Logistic showed the best performance on the complete set of variables (AUC = 0.839 ± 0.009) as in models including a limited set of 13 and 5 variables (AUC = 0.840 ± 0.0093 and AUC = 0.834 ± 0.007). For non-inferior performance, the 5 variables model (age, sex, saturation, well-aerated lung parenchyma and cardiothoracic vascular calcium) was selected as the final model and the extraction of CT-derived parameters was fully automatized. The fully automatic model showed AUC = 0.842 (95% CI: 0.816–0.867) on wave 1 and was used to build a 0–100 scale risk score (AI-SCoRE). The predictive performance was confirmed on wave 2 (AUC 0.808; 95% CI: 0.7402–0.8766). Conclusions AI-SCoRE is an effective and reliable platform for automatic risk stratification of COVID-19 patients based on a few unbiased clinical data and CT automatic analysis. Supplementary Information The online version contains supplementary material available at 10.1007/s11547-022-01518-0.
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Affiliation(s)
- Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Edda Boccia
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
| | - Alessandro Nonis
- Centro Universitario Di Statistica Per Le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | - Chiara Gnasso
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Riccardo Leone
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Marco Montagna
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | | | | | | | | | | | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | | | | | | | | | | | | | | | | | | | - Elisa Scarnecchia
- ASST Valtellina and Alto Lario, Eugenio Morelli Hospital, Sondalo, Italy
| | - Mario Iannacone
- San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Lucio Baffoni
- Casa di Cura Villa dei Pini, Civitanova Marche, Italy
| | | | | | | | - Claudio Rapezzi
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
- Cardiologic Centre, University of Ferrara, Ferrara, Italy
| | | | | | - Clelia Di Serio
- Centro Universitario Di Statistica Per Le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Carlo Tacchetti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy.
| | - Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy.
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7
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Serio CD, Malgaroli A, Ferrari P, Kenett RS. The reproducibility of COVID-19 data analysis: paradoxes, pitfalls, and future challenges. PNAS Nexus 2022; 1:pgac125. [PMID: 36741433 PMCID: PMC9896906 DOI: 10.1093/pnasnexus/pgac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 08/08/2022] [Indexed: 02/07/2023]
Abstract
In the midst of the COVID-19 experience, we learned an important scientific lesson: knowledge acquisition and information quality in medicine depends more on "data quality" rather than "data quantity." The large number of COVID-19 reports, published in a very short time, demonstrated that the most advanced statistical and computational tools cannot properly overcome the poor quality of acquired data. The main evidence for this observation comes from the poor reproducibility of results. Indeed, understanding the data generation process is fundamental when investigating scientific questions such as prevalence, immunity, transmissibility, and susceptibility. Most of COVID-19 studies are case reports based on "non probability" sampling and do not adhere to the general principles of controlled experimental designs. Such collected data suffers from many limitations when used to derive clinical conclusions. These include confounding factors, measurement errors and bias selection effects. Each of these elements represents a source of uncertainty, which is often ignored or assumed to provide an unbiased random contribution. Inference retrieved from large data in medicine is also affected by data protection policies that, while protecting patients' privacy, are likely to reduce consistently usefulness of big data in achieving fundamental goals such as effective and efficient data-integration. This limits the degree of generalizability of scientific studies and leads to paradoxical and conflicting conclusions. We provide such examples from assessing the role of risks factors. In conclusion, new paradigms and new designs schemes are needed in order to reach inferential conclusions that are meaningful and informative when dealing with data collected during emergencies like COVID-19.
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Affiliation(s)
- Clelia Di Serio
- Vita-Salute San Raffaele University, UniSR, Milan, Italy
- University Centre of Statistics in the Biomedical Sciences CUSSB, UniSR, Milan, Italy
- Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | | | - Paolo Ferrari
- Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
- Ente Ospedaliero Cantonale, Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, Australia
| | - Ron S Kenett
- KPA,Samuel Neaman Institute, Technion, Haifa, Israel
- University of Turin, Turin, Italy
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8
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Fumagalli F, Calbi V, Natali Sora MG, Sessa M, Baldoli C, Rancoita PMV, Ciotti F, Sarzana M, Fraschini M, Zambon AA, Acquati S, Redaelli D, Attanasio V, Miglietta S, De Mattia F, Barzaghi F, Ferrua F, Migliavacca M, Tucci F, Gallo V, Del Carro U, Canale S, Spiga I, Lorioli L, Recupero S, Fratini ES, Morena F, Silvani P, Calvi MR, Facchini M, Locatelli S, Corti A, Zancan S, Antonioli G, Farinelli G, Gabaldo M, Garcia-Segovia J, Schwab LC, Downey GF, Filippi M, Cicalese MP, Martino S, Di Serio C, Ciceri F, Bernardo ME, Naldini L, Biffi A, Aiuti A. Lentiviral haematopoietic stem-cell gene therapy for early-onset metachromatic leukodystrophy: long-term results from a non-randomised, open-label, phase 1/2 trial and expanded access. Lancet 2022; 399:372-383. [PMID: 35065785 PMCID: PMC8795071 DOI: 10.1016/s0140-6736(21)02017-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 08/12/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Effective treatment for metachromatic leukodystrophy (MLD) remains a substantial unmet medical need. In this study we investigated the safety and efficacy of atidarsagene autotemcel (arsa-cel) in patients with MLD. METHODS This study is an integrated analysis of results from a prospective, non-randomised, phase 1/2 clinical study and expanded-access frameworks. 29 paediatric patients with pre-symptomatic or early-symptomatic early-onset MLD with biochemical and molecular confirmation of diagnosis were treated with arsa-cel, a gene therapy containing an autologous haematopoietic stem and progenitor cell (HSPC) population transduced ex vivo with a lentiviral vector encoding human arylsulfatase A (ARSA) cDNA, and compared with an untreated natural history (NHx) cohort of 31 patients with early-onset MLD, matched by age and disease subtype. Patients were treated and followed up at Ospedale San Raffaele, Milan, Italy. The coprimary efficacy endpoints were an improvement of more than 10% in total gross motor function measure score at 2 years after treatment in treated patients compared with controls, and change from baseline of total peripheral blood mononuclear cell (PBMC) ARSA activity at 2 years after treatment compared with values before treatment. This phase 1/2 study is registered with ClinicalTrials.gov, NCT01560182. FINDINGS At the time of analyses, 26 patients treated with arsa-cel were alive with median follow-up of 3·16 years (range 0·64-7·51). Two patients died due to disease progression and one due to a sudden event deemed unlikely to be related to treatment. After busulfan conditioning, all arsa-cel treated patients showed sustained multilineage engraftment of genetically modified HSPCs. ARSA activity in PBMCs was significantly increased above baseline 2 years after treatment by a mean 18·7-fold (95% CI 8·3-42·2; p<0·0001) in patients with the late-infantile variant and 5·7-fold (2·6-12·4; p<0·0001) in patients with the early-juvenile variant. Mean differences in total scores for gross motor function measure between treated patients and age-matched and disease subtype-matched NHx patients 2 years after treatment were significant for both patients with late-infantile MLD (66% [95% CI 48·9-82·3]) and early-juvenile MLD (42% [12·3-71·8]). Most treated patients progressively acquired motor skills within the predicted range of healthy children or had stabilised motor performance (maintaining the ability to walk). Further, most displayed normal cognitive development and prevention or delay of central and peripheral demyelination and brain atrophy throughout follow-up; treatment benefits were particularly apparent in patients treated before symptom onset. The infusion was well tolerated and there was no evidence of abnormal clonal proliferation or replication-competent lentivirus. All patients had at least one grade 3 or higher adverse event; most were related to conditioning or to background disease. The only adverse event related to arsa-cel was the transient development of anti-ARSA antibodies in four patients, which did not affect clinical outcomes. INTERPRETATION Treatment with arsa-cel resulted in sustained, clinically relevant benefits in children with early-onset MLD by preserving cognitive function and motor development in most patients, and slowing demyelination and brain atrophy. FUNDING Orchard Therapeutics, Fondazione Telethon, and GlaxoSmithKline.
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Affiliation(s)
- Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Neurology, ASST Papa Giovanni XXIII Bergamo, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paola Maria V Rancoita
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesca Ciotti
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Fraschini
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Andrea Zambon
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Acquati
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Redaelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vanessa Attanasio
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Simona Miglietta
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabiola De Mattia
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Barzaghi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Tucci
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vera Gallo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Specialistic Neurological Rehabilitation, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Ivana Spiga
- Clinical Molecular Biology Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Elena Sophia Fratini
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Morena
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Locatelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ambra Corti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano Zancan
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gigliola Antonioli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Gabaldo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy; Unit of Neurorehabilitation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabata Martino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | - Fabio Ciceri
- Unit of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria Ester Bernardo
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Padua University and Padua University Hospital, Padua, Italy; Gene Therapy Program, Dana Farber/Boston Children's Cancer and Blood Disorders Center, Boston, MA, USA
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
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9
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Siracusano G, Brombin C, Pastori C, Cugnata F, Noviello M, Tassi E, Princi D, Cantoni D, Malnati MS, Maugeri N, Bozzi C, Saretto G, Clementi N, Mancini N, Uberti-Foppa C, Temperton N, Bonini C, Di Serio C, Lopalco L. Profiling Antibody Response Patterns in COVID-19: Spike S1-Reactive IgA Signature in the Evolution of SARS-CoV-2 Infection. Front Immunol 2021; 12:772239. [PMID: 34804064 PMCID: PMC8595940 DOI: 10.3389/fimmu.2021.772239] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/14/2021] [Indexed: 11/27/2022] Open
Abstract
This contribution explores in a new statistical perspective the antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 141 coronavirus disease 2019 (COVID-19) patients exhibiting a broad range of clinical manifestations. This cohort accurately reflects the characteristics of the first wave of the SARS-CoV-2 pandemic in Italy. We determined the IgM, IgA, and IgG levels towards SARS-CoV-2 S1, S2, and NP antigens, evaluating their neutralizing activity and relationship with clinical signatures. Moreover, we longitudinally followed 72 patients up to 9 months postsymptoms onset to study the persistence of the levels of antibodies. Our results showed that the majority of COVID-19 patients developed an early virus-specific antibody response. The magnitude and the neutralizing properties of the response were heterogeneous regardless of the severity of the disease. Antibody levels dropped over time, even though spike reactive IgG and IgA were still detectable up to 9 months. Early baseline antibody levels were key drivers of the subsequent antibody production and the long-lasting protection against SARS-CoV-2. Importantly, we identified anti-S1 IgA as a good surrogate marker to predict the clinical course of COVID-19. Characterizing the antibody response after SARS-CoV-2 infection is relevant for the early clinical management of patients as soon as they are diagnosed and for implementing the current vaccination strategies.
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Affiliation(s)
- Gabriel Siracusano
- Division of Immunology, Transplantation and Infectious Disease, Immunobiology of HIV Group, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Claudia Pastori
- Division of Immunology, Transplantation and Infectious Disease, Immunobiology of HIV Group, San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Maddalena Noviello
- Experimental Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Elena Tassi
- Experimental Hematology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Denise Princi
- Division of Immunology, Transplantation and Infectious Disease, Immunobiology of HIV Group, San Raffaele Scientific Institute, Milan, Italy
| | - Diego Cantoni
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham, United Kingdom
| | - Mauro S. Malnati
- Viral Evolution and Transmission Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Norma Maugeri
- Autoimmunity and Vascular Inflammation Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Nicola Clementi
- Laboratory of Medical Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
| | - Nicasio Mancini
- Laboratory of Medical Microbiology and Virology, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Nigel Temperton
- Viral Pseudotype Unit, Medway School of Pharmacy, Universities of Kent and Greenwich, Chatham, United Kingdom
| | - Chiara Bonini
- Experimental Hematology Unit, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
- Biomedical Faculty, Università della Svizzera Italiana, Lugano, Switzerland
| | - Lucia Lopalco
- Division of Immunology, Transplantation and Infectious Disease, Immunobiology of HIV Group, San Raffaele Scientific Institute, Milan, Italy
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10
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Saluzzo F, Mantegani P, Poletti de Chaurand V, Cugnata F, Rovere-Querini P, Cilla M, Erba PP, Racca S, Tresoldi C, Uberti-Foppa C, Di Serio C, Cirillo DM. Saliva molecular testing for SARS-CoV-2: simplifying the diagnosis without losing accuracy. Eur Respir J 2021; 58:13993003.02099-2021. [PMID: 34649973 PMCID: PMC8859976 DOI: 10.1183/13993003.02099-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/22/2021] [Indexed: 11/08/2022]
Abstract
The possibility to rely on rapid and accurate diagnostic techniques has proved itself crucial during the past year to contain the spread of SARS-CoV-2 infection [1]. Even if quantitative RT-PCR (RT-qPCR) on nasopharyngeal swab (NPS) is still considered the standard for coronavirus disease 2019 (COVID-19) diagnosis, saliva has been evaluated in several studies as a possible alternative to NPS and is currently extensively utilised in South Korea, Germany and Japan [2, 3]. Nonetheless, the use of saliva is still debated, and a rigorous standardisation of the analysis protocol is greatly needed [4–6]. The application of point-of-care technologies on saliva, able to rapidly perform highly specific and sensitive molecular testing, could prove invaluable to allow the diagnosis also in challenging and remote settings by simplifying and speeding up the diagnostic process [1]. This study demonstrated that the use of point of care technologies on saliva represents a valid and highly specific solution to simplify, speed up and broadly distribute the diagnostic process for the control of the COVID-19 epidemichttps://bit.ly/3oh4bds
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Affiliation(s)
- Francesca Saluzzo
- Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Mantegani
- Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | - Federica Cugnata
- CUSSB-University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Marta Cilla
- IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Patrizia Paola Erba
- IRCCS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Sara Racca
- Laboratorio Microbiologia/Virologia, SMEL, IRCSS Ospedale San Raffaele, Milan, Italy
| | - Cristina Tresoldi
- Molecular Hematology Unit, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Caterina Uberti-Foppa
- Division of Infectious Diseases, IRCSS Ospedale San Raffaele and Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- CUSSB-University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Daniela Maria Cirillo
- Division of Immunology, Transplantation and Infectious Disease, IRCCS Ospedale San Raffaele, Milan, Italy
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11
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Amodio G, Mandelli A, Curto R, Rancoita PMV, Stabilini A, Bonfanti R, de Pellegrin M, Bosi E, Di Serio C, Battaglia M, Gregori S. Altered Frequency and Phenotype of HLA-G-Expressing DC-10 in Type 1 Diabetes Patients at Onset and in Subjects at Risk to Develop the Disease. Front Immunol 2021; 12:750162. [PMID: 34659254 PMCID: PMC8517474 DOI: 10.3389/fimmu.2021.750162] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/06/2021] [Indexed: 01/21/2023] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune disease resulting in progressive destruction of β-cells. Several factors affecting lymphocyte and antigen-presenting cells, including dendritic cells (DCs), contribute to defective maintenance of tolerance in T1D. DC-10 are a subset of human DCs involved in IL-10-mediated tolerance. A precise monitoring of DC-10 in the peripheral blood is possible thanks to the discovery of specific biomarkers. DC-10, being cells that naturally express HLA-G, may be used for the appropriate staging of the disease. By enumerating and phenotypically characterizing DC-10 in the peripheral blood of subjects at different stages of T1D development-first-degree relatives (FDRs) of T1D patients, without (Abneg) or with (Abpos) autoantibodies, T1D patients at onset, and age-matched healthy controls (HCs)-we showed that DC-10 contain a high proportion of HLA-G-expressing cells as compared with monocytes. We reported that a low frequency of DC-10 during disease development is paralleled with the increased proportion of pro-inflammatory cDC2 cells. Moreover, DC-10 number and phenotype differ from Abneg FDRs, Abpos FDRs, and T1D patients compared with HCs, and DC-10 from T1D patients express low levels of CD83. Finally, multiple regression analysis, considering DC-10 and HLA-G-related parameters, showed that Abneg FDRs are more similar to subjects with autoimmunity than to HCs. This is the first demonstration that impairment in DC-10 number and phenotype, specifically CD83 expression, is associated with risk of developing T1D, suggesting a possible use of CD83+ DC-10 to stratify individuals at risk of T1D in conjunction with classical prognostic factors.
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Affiliation(s)
- Giada Amodio
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Mandelli
- Immune-Mediated Diseases Unit: From Pathogenesis to Treatment, Diabetes Research Institute (DRI), Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rosalia Curto
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
| | - Paola M. V. Rancoita
- University Center for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Angela Stabilini
- Immune-Mediated Diseases Unit: From Pathogenesis to Treatment, Diabetes Research Institute (DRI), Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Bonfanti
- Immune-Mediated Diseases Unit: From Pathogenesis to Treatment, Diabetes Research Institute (DRI), Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Pediatrics and Neonatology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Emanuele Bosi
- Immune-Mediated Diseases Unit: From Pathogenesis to Treatment, Diabetes Research Institute (DRI), Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Internal Medicine, IRCCS San Raffaele Hospital, Milan, Italy
- TrialNet Clinical Center, IRCCS San Raffaele Hospital, Milan, Italy
| | - Clelia Di Serio
- University Center for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Manuela Battaglia
- Immune-Mediated Diseases Unit: From Pathogenesis to Treatment, Diabetes Research Institute (DRI), Division of Immunology, Transplantation, and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Gregori
- Mechanisms of Peripheral Tolerance Unit, San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Scientific Institute, Milan, Italy
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12
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Fumagalli F, Zambon AA, Rancoita PMV, Baldoli C, Canale S, Spiga I, Medaglini S, Penati R, Facchini M, Ciotti F, Sarzana M, Lorioli L, Cesani M, Natali Sora MG, Del Carro U, Cugnata F, Antonioli G, Recupero S, Calbi V, Di Serio C, Aiuti A, Biffi A, Sessa M. Metachromatic leukodystrophy: A single-center longitudinal study of 45 patients. J Inherit Metab Dis 2021; 44:1151-1164. [PMID: 33855715 DOI: 10.1002/jimd.12388] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 11/10/2022]
Abstract
In this study, we characterize the natural course of metachromatic leukodystrophy (MLD), explore intra/inter group differences, and identify biomarkers to monitor disease progression. This is a longitudinal observational study. Genotype and characteristics at disease onset were recorded. Time-to-event analyses were performed to assess time to major disease-related milestones in different subgroups. Longitudinal trajectories of nerve conduction velocities (NCV), brain MRI score, and brainstem auditory evoked responses (BAERs) were described. We recruited 22 late-infantile, 14 early-juvenile, 5 late-juvenile, and 4 adult MLD patients. Thirty-four were prospectively evaluated (median FU time 43 months). In late-infantile patients, the attainment of independent walking was associated with a later age at dysphagia. In early-juvenile, the presence of isolated cognitive impairment at onset was not a favorable prognostic factor. Late-infantile and early-juvenile subjects showed similar rapid loss of ambulation and onset of seizures, but late-infantile displayed earlier loss of trunk control, dysphagia, and death. We found significant differences in all major disease-related milestones (except death) between early-juvenile and late-juvenile patients. Late-juvenile and adult patients both presented with a predominant cognitive impairment, mild/no peripheral neuropathy, lower brain MRI score at plateau compared to LI/EJ, and later cerebellar involvement. NCV and BAER were consistently severely abnormal in late-infantile but not in older subjects, in whom both NCV and BAER were variably affected, with no deterioration over time in some cases. This study clarifies intra/inter group differences between MLD subtypes and provides additional indications regarding reliable clinical and instrumental tools to monitor disease progression and to serve as areference to evaluate the efficacy of future therapeutic interventions inthe different MLD variants.
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Affiliation(s)
- Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto A Zambon
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Specialistic Neurological Rehabilitation, IRCCS Multimedica, Sesto San Giovanni, Italy
| | - Ivana Spiga
- Clinical Molecular Biology Laboratory, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefania Medaglini
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rachele Penati
- Vita-Salute San Raffaele University, Milan, Italy
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Marcella Facchini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Ciotti
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marina Sarzana
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Martina Cesani
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- AGC Biologics S.p.a, Bresso (MI), Italy
| | | | - Ubaldo Del Carro
- Department of Neurology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Gigliola Antonioli
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Salvatore Recupero
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Valeria Calbi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pediatric Immunohematology Unit and BMT Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Division of Pediatric Hematology, Oncology and Stem Cell Transplant, Department of Women and Child Health, University of Padova, Padova, Italy
| | - Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCCS San Raffaele Scientific Institute, Milan, Italy
- Department of Neurology, ASST Papa Giovanni XXIII, Bergamo, Italy
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13
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Esposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV, Leone R, Nicoletti V, Gnasso C, Monello A, Biagi A, Turchio P, Landoni G, Gallone G, Monti G, Casella G, Iannopollo G, Nannini T, Patelli G, Di Mare L, Loffi M, Sergio P, Ippolito D, Sironi S, Pontone G, Andreini D, Mancini EM, Di Serio C, De Cobelli F, Ciceri F, Zangrillo A, Colombo A, Tacchetti C, Giannini F. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy. Eur Radiol 2021; 31:4031-4041. [PMID: 33355697 PMCID: PMC7755582 DOI: 10.1007/s00330-020-07622-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/06/2020] [Accepted: 12/10/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. METHODS This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox's regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. RESULTS In the derivation cohort, the median age was 69 (IQR, 58-77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59-77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253-2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154-2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796-0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758-0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). CONCLUSION Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19. KEY POINTS • Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. • Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. • The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy.
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy.
| | - Anna Palmisano
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Marco Toselli
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Davide Vignale
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Alberto Cereda
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Paola Maria Vittoria Rancoita
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Centro Universitario di Statistica per le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Leone
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Valeria Nicoletti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Chiara Gnasso
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | | | | | | | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Guglielmo Gallone
- Division of Cardiology, Department of Internal Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Giacomo Monti
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | | | | | | | | | | | | | | | | | - Clelia Di Serio
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Centro Universitario di Statistica per le Scienze Biomediche, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Department of Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
- Anesthesia and Intensive Care Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Antonio Colombo
- GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy
| | - Carlo Tacchetti
- Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milan, Italy
- School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, Italy
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14
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Esposito A, Palmisano A, Cao R, Rancoita P, Landoni G, Grippaldi D, Boccia E, Cosenza M, Messina A, La Marca S, Palumbo D, Di Serio C, Spessot M, Tresoldi M, Scarpellini P, Ciceri F, Zangrillo A, De Cobelli F. Quantitative assessment of lung involvement on chest CT at admission: Impact on hypoxia and outcome in COVID-19 patients. Clin Imaging 2021; 77:194-201. [PMID: 33984670 PMCID: PMC8081746 DOI: 10.1016/j.clinimag.2021.04.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 04/14/2021] [Accepted: 04/18/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND The aim of this study was to quantify COVID-19 pneumonia features using CT performed at time of admission to emergency department in order to predict patients' hypoxia during the hospitalization and outcome. METHODS Consecutive chest CT performed in the emergency department between March 1st and April 7th 2020 for COVID-19 pneumonia were analyzed. The three features of pneumonia (GGO, semi-consolidation and consolidation) and the percentage of well-aerated lung were quantified using a HU threshold based software. ROC curves identified the optimal cut-off values of CT parameters to predict hypoxia worsening and hospital discharge. Multiple Cox proportional hazards regression was used to analyze the capability of CT quantitative features, demographic and clinical variables to predict the time to hospital discharge. RESULTS Seventy-seven patients (median age 56-years-old, 51 men) with COVID-19 pneumonia at CT were enrolled. The quantitative features of COVID-19 pneumonia were not associated to age, sex and time-from-symptoms onset, whereas higher number of comorbidities was correlated to lower well-aerated parenchyma ratio (rho = -0.234, p = 0.04) and increased semi-consolidation ratio (rho = -0.303, p = 0.008). Well-aerated lung (≤57%), semi-consolidation (≥17%) and consolidation (≥9%) predicted worst hypoxemia during hospitalization, with moderate areas under curves (AUC 0.76, 0.75, 0.77, respectively). Multiple Cox regression identified younger age (p < 0.01), female sex (p < 0.001), longer time-from-symptoms onset (p = 0.049), semi-consolidation ≤17% (p < 0.01) and consolidation ≤13% (p = 0.03) as independent predictors of shorter time to hospital discharge. CONCLUSION Quantification of pneumonia features on admitting chest CT predicted hypoxia worsening during hospitalization and time to hospital discharge in COVID-19 patients.
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Affiliation(s)
- Antonio Esposito
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy.
| | - Anna Palmisano
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta Cao
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Rancoita
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Giovanni Landoni
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniele Grippaldi
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Edda Boccia
- Imaging analysis and post-processing, Experimental Imaging Center, IRCCS San Raffaele Hospital, Milan, Italy
| | - Michele Cosenza
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Messina
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Salvatore La Marca
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Diego Palumbo
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Marzia Spessot
- Emergency Medicine, Emergency Department, IRCCS San Raffaele Hospital, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Scarpellini
- Infectious Diseases Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Ciceri
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Hematology and Bone Marrow Transplantation, IRCCS San Raffaele Scientific Institute, Italy
| | - Alberto Zangrillo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Experimental Imaging Center, Radiology Unit, IRCCS San Raffaele Hospital, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Milan, Italy
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15
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Cippà PE, Cugnata F, Ferrari P, Brombin C, Ruinelli L, Bianchi G, Beria N, Schulz L, Bernasconi E, Merlani P, Ceschi A, Di Serio C. A data-driven approach to identify risk profiles and protective drugs in COVID-19. Proc Natl Acad Sci U S A 2021; 118:e2016877118. [PMID: 33303654 PMCID: PMC7817222 DOI: 10.1073/pnas.2016877118] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 11/12/2020] [Indexed: 01/08/2023] Open
Abstract
As the COVID-19 pandemic is spreading around the world, increasing evidence highlights the role of cardiometabolic risk factors in determining the susceptibility to the disease. The fragmented data collected during the initial emergency limited the possibility of investigating the effect of highly correlated covariates and of modeling the interplay between risk factors and medication. The present study is based on comprehensive monitoring of 576 COVID-19 patients. Different statistical approaches were applied to gain a comprehensive insight in terms of both the identification of risk factors and the analysis of dependency structure among clinical and demographic characteristics. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus enters host cells by binding to the angiotensin-converting enzyme 2 (ACE2), but whether or not renin-angiotensin-aldosterone system inhibitors (RAASi) would be beneficial to COVID-19 cases remains controversial. The survival tree approach was applied to define a multilayer risk stratification and better profile patient survival with respect to drug regimens, showing a significant protective effect of RAASi with a reduced risk of in-hospital death. Bayesian networks were estimated, to uncover complex interrelationships and confounding effects. The results confirmed the role of RAASi in reducing the risk of death in COVID-19 patients. De novo treatment with RAASi in patients hospitalized with COVID-19 should be prospectively investigated in a randomized controlled trial to ascertain the extent of risk reduction for in-hospital death in COVID-19.
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Affiliation(s)
- Pietro E Cippà
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland;
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Federica Cugnata
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy
| | - Paolo Ferrari
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Clinical School, University of New South Wales, Sydney, NSW 2052, Australia
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy
| | - Lorenzo Ruinelli
- ICT (Informatica e Tecnologia della Comunicazione), Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Giorgia Bianchi
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Nicola Beria
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Lukas Schulz
- Department of Medicine, Division of Nephrology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Enos Bernasconi
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Department of Medicine, Division of Infectious Diseases, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Paolo Merlani
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Critical Care Medicine, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
| | - Alessandro Ceschi
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
- Institute of Pharmacology and Toxicology, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland
- Department of Clinical Pharmacology and Toxicology, University Hospital Zurich, 8091 Zurich, Switzerland
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, 20132 Milan, Italy;
- Biomedical Faculty, Università della Svizzera Italiana, 6900 Lugano, Switzerland
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16
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Partelli S, Ricci C, Rancoita PMV, Montorsi R, Andreasi V, Ingaldi C, Arru G, Pecorelli N, Crippa S, Alberici L, Di Serio C, Casadei R, Falconi M. Preoperative predictive factors of laparoscopic distal pancreatectomy difficulty. HPB (Oxford) 2020; 22:1766-1774. [PMID: 32340858 DOI: 10.1016/j.hpb.2020.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 10/01/2019] [Revised: 03/29/2020] [Accepted: 04/02/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic distal pancreatectomy (LDP) is a challenging operation due to technical complexity and tumor-related factors. Aim of this study was to identify preoperative risk factors affecting LDP difficulty. METHODS Consecutive patients who underwent LDP between 2015 and 2018 at San Raffaele Hospital and Policlinico S.Orsola-Malpighi Hospital were enrolled retrospectively. Three variables were used to define surgical difficulty: conversion to open, duration of surgery >3rd quartile and intraoperative blood loss >3rd quartile. The presence of ≥1 of these 3 variables was considered as another measure of difficulty. RESULTS Overall, 191 patients were included. Conversion to open was required in 25 patients (13%). At multiple regression analysis, tumor proximity to major vessels was the only independent predictor of conversion from laparoscopic to open (p < 0.001). No variables independently predicted an excessive duration of surgery. Male gender (p = 0.033) and increasing parenchymal thickness at resection line (p = 0.018) were independent predictors of excessive blood loss. Increasing parenchymal thickness at resection line (p = 0.014) and tumor proximity to major vessels (p = 0.002) were significant risk factors for the presence of ≥1 outcome of surgical difficulty. CONCLUSION Male gender, increasing parenchymal thickness at resection line and tumor proximity to major vessels represent preoperative risk factors of LDP difficulty.
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Affiliation(s)
- Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy
| | - Claudio Ricci
- Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi, Bologna, Italy
| | - Paola M V Rancoita
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, Milan, Italy
| | - Roberto Montorsi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy
| | - Valentina Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy
| | - Carlo Ingaldi
- Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi, Bologna, Italy
| | - Giaime Arru
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy
| | - Nicolò Pecorelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy
| | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy
| | - Laura Alberici
- Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi, Bologna, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, "Vita-Salute San Raffaele" University, Milan, Italy
| | - Riccardo Casadei
- Department of Internal Medicine and Surgery, Alma Mater Studiorum, University of Bologna, S. Orsola-Malpighi, Bologna, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute IRCCS, Milan, Italy; "Vita-Salute San Raffaele" University, Milan, Italy.
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Jofra Hernández R, Calabria A, Sanvito F, De Mattia F, Farinelli G, Scala S, Visigalli I, Carriglio N, De Simone M, Vezzoli M, Cecere F, Migliavacca M, Basso-Ricci L, Omrani M, Benedicenti F, Norata R, Rancoita PMV, Di Serio C, Albertini P, Cristofori P, Naldini L, Gentner B, Montini E, Aiuti A, Mortellaro A. Hematopoietic Tumors in a Mouse Model of X-linked Chronic Granulomatous Disease after Lentiviral Vector-Mediated Gene Therapy. Mol Ther 2020; 29:86-102. [PMID: 33010230 PMCID: PMC7791081 DOI: 10.1016/j.ymthe.2020.09.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 04/10/2020] [Revised: 08/03/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a rare inherited disorder due to loss-of-function mutations in genes encoding the NADPH oxidase subunits. Hematopoietic stem and progenitor cell (HSPC) gene therapy (GT) using regulated lentiviral vectors (LVs) has emerged as a promising therapeutic option for CGD patients. We performed non-clinical Good Laboratory Practice (GLP) and laboratory-grade studies to assess the safety and genotoxicity of LV targeting myeloid-specific Gp91phox expression in X-linked chronic granulomatous disease (XCGD) mice. We found persistence of gene-corrected cells for up to 1 year, restoration of Gp91phox expression and NADPH oxidase activity in XCGD phagocytes, and reduced tissue inflammation after LV-mediated HSPC GT. Although most of the mice showed no hematological or biochemical toxicity, a small subset of XCGD GT mice developed T cell lymphoblastic lymphoma (2.94%) and myeloid leukemia (5.88%). No hematological malignancies were identified in C57BL/6 mice transplanted with transduced XCGD HSPCs. Integration pattern analysis revealed an oligoclonal composition with rare dominant clones harboring vector insertions near oncogenes in mice with tumors. Collectively, our data support the long-term efficacy of LV-mediated HSPC GT in XCGD mice and provide a safety warning because the chronic inflammatory XCGD background may contribute to oncogenesis.
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Affiliation(s)
- Raisa Jofra Hernández
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Calabria
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Sanvito
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pathology Unit, Department of Experimental Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabiola De Mattia
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Scala
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ilaria Visigalli
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Carriglio
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maura De Simone
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Michela Vezzoli
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Cecere
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luca Basso-Ricci
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maryam Omrani
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Benedicenti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Norata
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Albertini
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Patrizia Cristofori
- GLP Test Facility, San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Non-Clinical Safety In Vivo Translation Research, Glaxo Smith Kline, Ware, UK
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Medical School, Vita-Salute San Raffaele University, Milan, Italy
| | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Hematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugenio Montini
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplantation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Medical School, Vita-Salute San Raffaele University, Milan, Italy.
| | - Alessandra Mortellaro
- San Raffaele Telethon Institute for Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Di Serio C, Scala S, Vicard P. Bayesian networks for cell differentiation process assessment. Stat (Int Stat Inst) 2020. [DOI: 10.1002/sta4.287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences Vita‐Salute San Raffaele University Milan 20132 Italy
| | - Serena Scala
- San Raffaele Telethon Institute for Gene Therapy (TIGET) Milan 20132 Italy
| | - Paola Vicard
- Department of Economics University Roma Tre Rome 00154 Italy
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Deantoni CL, Fodor A, Cozzarini C, Fiorino C, Brombin C, Di Serio C, Calandrino R, Di Muzio N. Prostate cancer with low burden skeletal disease at diagnosis: outcome of concomitant radiotherapy on primary tumor and metastases. Br J Radiol 2020; 93:20190353. [PMID: 31971828 DOI: 10.1259/bjr.20190353] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate toxicity and clinical outcome in synchronous bone only oligometastatic (≤2 lesions) prostate cancer patients, simultaneously irradiated to prostate/prostatic bed, lymph nodes and bone metastases. METHODS From 2/2009 to 6/2015, 39 bone only prostate cancer patients underwent radiotherapy (RT) at "radical" doses to bone metastases (median 2 Gy equivalent dose, EQD2>40Gy, α/β = 1,5), nodes, and prostate/prostatic bed, within the same RT course, in association with androgen deprivation therapy (ADT).Biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were evaluated. RESULTS After a median follow-up of 46.5 (1.2-103.6) months, 5 patients died from disease progression, 10 experienced biochemical relapse, 19, still in ADT, presented undetectable prostate-specific antigen (PSA) at the last follow-up. Five patients who discontinued ADT after a median of 34 months (5.8-41) are free from biochemical relapse.The 4 year Kaplan-Meier estimates of biochemical relapse-free survival, clinical relapse-free survival, freedom from distant metastases and overall survival were 53.3%, 65.7%, 73.4% and 82.4% respectively.No Grade > 2 acute events and only two severe late urinary events were recorded, not due to the concomitant treatment of primary and metastatic disease. CONCLUSION Our results suggest that "radical" and synchronous irradiation of primitive tumor and metastatic disease may be a valid approach in synchronous bone only prostate cancer patients, showing mild toxicity profile and promising survival results. ADVANCES IN KNOWLEDGE To the best of our knowledge, this is the first analysis of clinical outcome in synchronous bone-only metastasis (neither nodal nor visceral) patients at diagnosis, treated with radical RT to all disease, associated to ADT.
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Affiliation(s)
| | - Andrei Fodor
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Riccardo Calandrino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nadia Di Muzio
- Department of Radiation Oncology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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20
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Partelli S, Andreasi V, Rancoita PMV, Perez-Sanchez E, Muffatti F, Balzano G, Crippa S, Di Serio C, Falconi M. Outcomes after distal pancreatectomy for neuroendocrine neoplasms: a retrospective comparison between minimally invasive and open approach using propensity score weighting. Surg Endosc 2020; 35:165-173. [PMID: 31953734 DOI: 10.1007/s00464-020-07375-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic neuroendocrine neoplasms (PanNEN) are ideal entities for minimally invasive surgery. The advantage of the laparoscopic approach in terms of complications, length of stay (LOS) and cosmetic results has been previously demonstrated. However, scarce data are available on long-term oncological outcomes. Aim of this study was to compare short-term postoperative outcomes, pathological findings and long-term oncological results of minimally invasive distal pancreatectomy (MIDP) and open distal pancreatectomy (ODP) for PanNEN. METHODS Patients who underwent ODP or MIDP for nonfunctioning PanNEN (NF-PanNEN) were retrospectively analyzed. Inverse probability of treatment weighting using propensity score was performed to compare the outcomes of MIDP and ODP. RESULTS Overall, 124 patients were included in the study: 84 underwent OPD, whereas 40 were submitted to MIDP. The rate of high-grade postoperative complications was significantly lower in the MIDP group (p = 0.005, grade of complication with highest estimated probability 0 vs 2) and the postoperative LOS was significantly shorter after MIDP (p < 0.001, estimated days 8 versus 10). The number of examined lymph nodes (ELN) in the ODP group was significantly higher (p = 0.0036, estimated number of ELN 13 vs 10). Similar disease-free survival and overall survival were reported for the two groups (p = 0.234 and p = 0.666, respectively). CONCLUSIONS Although MIDP for PanNEN seems to be associated with a lower number of ELN, long-term survival is not influenced by the type of surgical approach. MIDP is advantageous in terms of postoperative complications and LOS, but prospective studies are needed to confirm the overall oncological quality of resection in this group of neoplasms.
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Affiliation(s)
- Stefano Partelli
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Valentina Andreasi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Paola Maria Vittoria Rancoita
- Vita-Salute San Raffaele University, Milan, Italy
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Eduardo Perez-Sanchez
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Francesca Muffatti
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Gianpaolo Balzano
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
| | - Stefano Crippa
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Falconi
- Pancreatic Surgery Unit, Pancreas Translational and Clinical Research Center, ENETS Center of Excellence, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
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Cillo A, Bonetti M, Burro G, Di Serio C, De Filippis R, Martoni RM. Neurocognitive assessment in obsessive compulsive disorder patients: Adherence to behavioral decision models. PLoS One 2019; 14:e0211856. [PMID: 30768599 PMCID: PMC6377126 DOI: 10.1371/journal.pone.0211856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 01/23/2019] [Indexed: 01/07/2023] Open
Abstract
In economics, models of decision-making under risk are widely investigated. Since many empirical studies have shown patterns in choice behavior that classical models fail to predict, several descriptive theories have been developed. Due to an evident phenotypic heterogeneity, obsessive compulsive disorder (OCD) patients have shown a general deficit in decision making when compared to healthy control subjects (HCs). However, the direction for impairment in decision-making in OCD patients is still unclear. Hence, bridging decision-making models widely used in the economic literature with mental health research may improve the understanding of preference relations in severe patients, and may enhance intervention designs. We investigate the behavior of OCD patients with respect to HCs by means of decision making economic models within a typical neuropsychological setting, such as the Cambridge Gambling Task. In this task subjects have to decide the amount of their initial wealth to invest in each risky decision. To account for heterogenous preferences, we have analyzed the micro-level data for a more informative analysis of the choices made by the subjects. We consider two influential models in economics: the expected value (EV), which assumes risk neutrality, and a multiple reference points model, an alternative formulation of Disappointment theory. We find evidence that (medicated) OCD patients are more consistent with EV than HCs. The former appear to be more risk neutral, namely, less sensitive to risk than HCs. They also seem to base their decisions on disappointment avoidance less than HCs.
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Affiliation(s)
- Alessandra Cillo
- Department of Decision Sciences and IGIER, Bocconi University, Milan, Italy
| | - Marco Bonetti
- Department of Social and Political Sciences and Dondena Research Center, Bocconi University, Milan, Italy
- * E-mail:
| | - Giovanni Burro
- Department of Statistics, University of Warwick, Coventry, United Kingdom
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Roberta De Filippis
- Department of Clinical Neurosciences, IRCCS San Raffaele Turro, Milan, Italy
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Martoni RM, Rancoita PMV, De Filippis R, Di Serio C, Brombin C. Exploring and integrating discrete and dimensional approaches while inducing negative emotional states. J Gen Psychol 2018; 145:238-265. [PMID: 30198836 DOI: 10.1080/00221309.2018.1468313] [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] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Selecting visual stimuli for inducing specific emotional states is very challenging, since the choice relies on specific conceptualization of emotions. In this work, we present a set of 55 stimuli, realized integrating discrete and dimensional theories of emotions, and specifically selected to investigate anger, fear, and disgust reactions in non-clinical and clinical contexts. Our set of stimuli presents several aspects of novelty since (1) a large and heterogeneous sample of subjects from the general population was involved in the labelling task, and (2) bivariate and multivariate statistical techniques were applied to integrate emotion models. The proposed set of stimuli could be useful for researchers and other professionals in the affective sciences to address negative emotion recognition issues within a broader perspective both in general population and in psychiatric samples. The obtained comprehensive characterization of the stimuli allowed us to confirm the sexual dimorphism in emotional processing.
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Morsica G, Bagaglio S, Spagnuolo V, Castagna A, Di Serio C, Galli A, Della Torre L, Andolina A, Pramov A, Uberti-Foppa C. Immune response to hepatitis B vaccination in HIV-positive individuals with isolated antibodies against hepatitis B core antigen: Results of a prospective Italian study. PLoS One 2017; 12:e0184128. [PMID: 28863182 PMCID: PMC5581175 DOI: 10.1371/journal.pone.0184128] [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] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/18/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND AND AIM Antibodies against hepatitis B core antigen (anti-HBc) are found in 14-44% of patients with HIV infection, but it is still unclear whether hepatitis B virus (HBV) vaccination should be recommended for HIV-positive subjects with isolated anti-HBc (IAHBc). We examined the rate of anamnestic and primary responses (ARs and PRs) and associated factors in a group of HIV-infected patients with an IAHBc profile. METHODS This prospective study recruited 25 HIV-positive patients with anti-HBc alone who were vaccinated against HBV infection. Those without an AR (anti-hepatitis B envelope antigen [anti-HBs] levels of <10 U/L) or who were hypo-responsiveness (anti-HBs levels of >10 but <100 U/L) four weeks after the first dose of vaccine underwent a full course of vaccinations. Their clinical and virological data, including the presence of occult hepatitis B infection (OBI), were evaluated in accordance with the vaccination schedule. RESULTS Six of the 25 patients (24%) showed an AR, four of whom had anti-HBs levels of <100 U/L. Ten of 19 (52.6%) remaining patients became seroprotected after the third dose. OBI was detected in four of the six patients with an AR, two of the 10 patients with a PR, and none of the nine patients who did not respond. Multivariate analysis showed that an AR was associated with the presence of OBI (P = 0.0162), and a PR was associated with HCV antibody status. (P = 0.0191). CONCLUSIONS Our data suggest that testing for anti-HBc alone may not be a reliable means of assessing protection from HBV infection in HIV-positive patients. OBI-positive patients may benefit from a single vaccine dose. Anti-HCV serostatus may affect PRs.
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Affiliation(s)
- Giulia Morsica
- Division of Infectious Diseases, IRCCS, Ospedale San Raffaele, Milan, Italy
- * E-mail:
| | - Sabrina Bagaglio
- Division of Infectious Diseases, IRCCS, Ospedale San Raffaele, Milan, Italy
| | | | | | - Clelia Di Serio
- Vita-Salute San Raffaele University, CUSSB (University Centre for Statistics in the Biomedical Sciences), Milan, Italy
| | - Andrea Galli
- Division of Infectious Diseases, IRCCS, Ospedale San Raffaele, Milan, Italy
| | | | - Andrea Andolina
- Division of Infectious Diseases, IRCCS, Ospedale San Raffaele, Milan, Italy
| | - Alexander Pramov
- Vita-Salute San Raffaele University, CUSSB (University Centre for Statistics in the Biomedical Sciences), Milan, Italy
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Martoni RM, Rancoita PMV, Di Serio C, Brombin C. Validating the Italian Version of the Disgust and Propensity Scale-Revised. Front Psychol 2017; 8:765. [PMID: 28553252 PMCID: PMC5427091 DOI: 10.3389/fpsyg.2017.00765] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
The aim of this work is to evaluate the factor structure and psychometric properties of the Italian version of the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R, 16 items) in two samples taken from the general population. In the first study, 285 participants completed the DPSS-R questionnaire through a web-based survey. Exploratory factor analysis for ordinal Likert-type data supported the existence of four underlying factors, reflecting self-focused disgust, disgust propensity, somatic anxiety and disgust sensitivity. In the second study, an independent sample of 293 participants was enrolled as a test set to validate the factor structure obtained in the exploratory phase. The factor solution was confirmed, but showed quite highly correlated latent factors. We fitted the model and tested whether or not the bifactor structure was better than the previous one (four correlated factors). Actually, we had evidence supporting the presence of a general factor, providing a measure of disgust susceptibility, along with the four specific factors previously defined. This result could be useful also from the clinical perspective since the DPSS-R questionnaire will be used in clinical context, where underlying factors may be related to different and specific psychopathological profiles. Finally, we examined and visualized the interrelationships among the four DPSS-R factors and the external scales (Anxiety Sensitivity, Disgust Scale and Padua) using a graphical model approach.
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Affiliation(s)
- Riccardo M Martoni
- Department of Clinical Neurosciences, IRCCS San Raffaele TurroMilan, Italy
| | - Paola M V Rancoita
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Clelia Di Serio
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Chiara Brombin
- University Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele UniversityMilan, Italy
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Scaini S, Ogliari A, De Carolis L, Bellodi L, Di Serio C, Brombin C. Evaluation of Mother-Child Agreement and Factorial Structures of the SCARED Questionnaire in an Italian Clinical Sample. Front Psychol 2017; 8:242. [PMID: 28286488 PMCID: PMC5323378 DOI: 10.3389/fpsyg.2017.00242] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/07/2017] [Indexed: 11/28/2022] Open
Abstract
Background: A great part of the literature has confirmed the importance of both child and parents reports as source of factual information, especially for childhood emotional syndromes. In our study we aimed at: (i) calculating mother-child agreement and (ii) evaluating factorial structure of the Screen for Child Anxiety Related Emotional Disorders (SCARED) questionnaire in an Italian clinical sample. The novelty of this contribution is two-fold: first, from a clinical point of view, we investigated the parent-child agreement level and examined separately the factorial structures of both parent and child versions of the SCARED for the first time in an Italian clinical sample. Second, unlike previous studies, we used statistical approaches specifically suited to account for the ordinal nature of the collected variables. Method: In a clinical sample of 171 children and adolescents aged 8–18 and their mothers we evaluated inter-rater agreement using weighted kappa indices to assess agreement for each item belonging to a certain SCARED subscale. Exploratory factor analysis for ordinal data was then performed on the polychoric correlation matrix calculated on SCARED items. Differences in the numbers of symptoms reported by children and parents were evaluated as well. Results and Conclusions: Our results reveal moderate to strong mother-child agreement. A significant age effect is present. Two different factorial solutions emerged for parent and child SCARED versions (a 5 factor structure for parents and a 6 factor solution in the child version, including a new factor “Worry about Parents”). This study confirmed the importance of evaluating both child and parent reports in assessment protocols for anxiety disorders. Our findings could help clinicians to determine which information, and from which rater, must be accounted for in evaluating treatment decisions. Moreover, we find that patients characteristics, such as gender and age, should be taken into account when assessing agreement.
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Affiliation(s)
- Simona Scaini
- Faculty of Psychology, Sigmund Freud UniversityMilan, Italy; Developmental Psychopathology Unit, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Anna Ogliari
- Developmental Psychopathology Unit, Vita-Salute San Raffaele UniversityMilan, Italy; Department of Clinical Neuroscience, San Raffaele Scientific InstituteMilan, Italy
| | | | - Laura Bellodi
- Department of Clinical Neuroscience, San Raffaele Scientific InstituteMilan, Italy; Faculty of Psychology, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Clelia Di Serio
- Faculty of Psychology, Vita-Salute San Raffaele UniversityMilan, Italy; University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele UniversityMilan, Italy
| | - Chiara Brombin
- Faculty of Psychology, Vita-Salute San Raffaele UniversityMilan, Italy; University Centre of Statistics in the Biomedical Sciences, Vita-Salute San Raffaele UniversityMilan, Italy
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Abstract
Background In biomedical research a relevant issue is to identify time intervals or portions of a n-dimensional support where a particular event of interest is more likely to occur than expected. Algorithms that require to specify a-priori number/dimension/length of clusters assumed for the data suffer from a high degree of arbitrariness whenever no precise information are available, and this may strongly affect final estimation on parameters. Within this framework, spatial scan-statistics have been proposed in the literature, representing a valid non-parametric alternative. Results We adapt the so called Bernoulli-model scan statistic to the genomic field and we propose a multivariate extension, named Relative Scan Statistics, for the comparison of two series of Bernoulli r.v. defined over a common support, with the final goal of highlighting unshared event rate variations. Using a probabilistic approach based on success probability estimates and comparison (likelihood based), we can exploit an hypothesis testing procedure to identify clusters and relative clusters. Both the univariate and the novel multivariate extension of the scan statistic confirm previously published findings. Conclusion The method described in the paper represents a challenging application of scan statistics framework to problem related to genomic data. From a biological perspective, these tools offer the possibility to clinicians and researcher to improve their knowledge on viral vectors integrations process, allowing to focus their attention to restricted over-targeted portion of the genome. Electronic supplementary material The online version of this article (doi:10.1186/s12859-016-1173-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Danilo Pellin
- University Center of Statistics for the Biomedical Sciences, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy. .,Johann Bernoulli Institute, University of Groningen, Nijenborgh 9, Groningen, 9747 AG, Netherlands.
| | - Clelia Di Serio
- University Center of Statistics for the Biomedical Sciences, Vita-Salute San Raffaele University, Via Olgettina 58, Milan, 20132, Italy
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Sessa M, Lorioli L, Fumagalli F, Acquati S, Redaelli D, Baldoli C, Canale S, Lopez ID, Morena F, Calabria A, Fiori R, Silvani P, Rancoita PMV, Gabaldo M, Benedicenti F, Antonioli G, Assanelli A, Cicalese MP, Del Carro U, Sora MGN, Martino S, Quattrini A, Montini E, Di Serio C, Ciceri F, Roncarolo MG, Aiuti A, Naldini L, Biffi A. Lentiviral haemopoietic stem-cell gene therapy in early-onset metachromatic leukodystrophy: an ad-hoc analysis of a non-randomised, open-label, phase 1/2 trial. Lancet 2016; 388:476-87. [PMID: 27289174 DOI: 10.1016/s0140-6736(16)30374-9] [Citation(s) in RCA: 327] [Impact Index Per Article: 40.9] [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: 12/21/2022]
Abstract
BACKGROUND Metachromatic leukodystrophy (a deficiency of arylsulfatase A [ARSA]) is a fatal demyelinating lysosomal disease with no approved treatment. We aimed to assess the long-term outcomes in a cohort of patients with early-onset metachromatic leukodystrophy who underwent haemopoietic stem-cell gene therapy (HSC-GT). METHODS This is an ad-hoc analysis of data from an ongoing, non-randomised, open-label, single-arm phase 1/2 trial, in which we enrolled patients with a molecular and biochemical diagnosis of metachromatic leukodystrophy (presymptomatic late-infantile or early-juvenile disease or early-symptomatic early-juvenile disease) at the Paediatric Clinical Research Unit, Ospedale San Raffaele, in Milan. Trial participants received HSC-GT, which consisted of the infusion of autologous HSCs transduced with a lentiviral vector encoding ARSA cDNA, after exposure-targeted busulfan conditioning. The primary endpoints of the trial are safety (toxicity, absence of engraftment failure or delayed haematological reconstitution, and safety of lentiviral vector-tranduced cell infusion) and efficacy (improvement in Gross Motor Function Measure [GMFM] score relative to untreated historical controls, and ARSA activity, 24 months post-treatment) of HSC-GT. For this ad-hoc analysis, we assessed safety and efficacy outcomes in all patients who had received treatment and been followed up for at least 18 months post-treatment on June 1, 2015. This trial is registered with ClinicalTrials.gov, number NCT01560182. FINDINGS Between April, 2010, and February, 2013, we had enrolled nine children with a diagnosis of early-onset disease (six had late-infantile disease, two had early-juvenile disease, and one had early-onset disease that could not be definitively classified). At the time of analysis all children had survived, with a median follow-up of 36 months (range 18-54). The most commonly reported adverse events were cytopenia (reported in all patients) and mucositis of different grades of severity (in five of nine patients [grade 3 in four of five patients]). No serious adverse events related to the medicinal product were reported. Stable, sustained engraftment of gene-corrected HSCs was observed (a median of 60·4% [range 14·0-95·6] lentiviral vector-positive colony-forming cells across follow-up) and the engraftment level was stable during follow-up; engraftment determinants included the duration of absolute neutropenia and the vector copy number of the medicinal product. A progressive reconstitution of ARSA activity in circulating haemopoietic cells and in the cerebrospinal fluid was documented in all patients in association with a reduction of the storage material in peripheral nerve samples in six of seven patients. Eight patients, seven of whom received treatment when presymptomatic, had prevention of disease onset or halted disease progression as per clinical and instrumental assessment, compared with historical untreated control patients with early-onset disease. GMFM scores for six patients up to the last follow-up showed that gross motor performance was similar to that of normally developing children. The extent of benefit appeared to be influenced by the interval between HSC-GT and the expected time of disease onset. Treatment resulted in protection from CNS demyelination in eight patients and, in at least three patients, amelioration of peripheral nervous system abnormalities, with signs of remyelination at both sites. INTERPRETATION Our ad-hoc findings provide preliminary evidence of safety and therapeutic benefit of HSC-GT in patients with early-onset metachromatic leukodystrophy who received treatment in the presymptomatic or very early-symptomatic stage. The results of this trial will be reported when all 20 patients have achieved 3 years of follow-up. FUNDING Italian Telethon Foundation and GlaxoSmithKline.
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Affiliation(s)
- Maria Sessa
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Lorioli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Francesca Fumagalli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Serena Acquati
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Daniela Redaelli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Baldoli
- Neuroradiology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sabrina Canale
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ignazio D Lopez
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Morena
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Andrea Calabria
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Rossana Fiori
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Silvani
- Department of Anesthesia and Critical Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Michela Gabaldo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabrizio Benedicenti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gigliola Antonioli
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Assanelli
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Pia Cicalese
- Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Ubaldo Del Carro
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Sabata Martino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Perugia, Italy
| | - Angelo Quattrini
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Eugenio Montini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Fabio Ciceri
- Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Grazia Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy
| | - Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, IRCCS San Raffaele Scientific Institute, Milan, Italy; Pediatric Immunohematology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Bone Marrow Transplantation Program, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita Salute San Raffaele University, Milan, Italy.
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Farinelli G, Jofra Hernandez R, Rossi A, Ranucci S, Sanvito F, Migliavacca M, Brombin C, Pramov A, Di Serio C, Bovolenta C, Gentner B, Bragonzi A, Aiuti A. Lentiviral Vector Gene Therapy Protects XCGD Mice From Acute Staphylococcus aureus Pneumonia and Inflammatory Response. Mol Ther 2016; 24:1873-1880. [PMID: 27456061 DOI: 10.1038/mt.2016.150] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 07/17/2016] [Indexed: 12/27/2022] Open
Abstract
Chronic granulomatous disease (CGD) is a primary immunodeficiency due to a deficiency in one of the subunits of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. CGD patients are characterized by an increased susceptibility to bacterial and fungal infections, and to granuloma formation due to the excessive inflammatory responses. Several gene therapy approaches with lentiviral vectors have been proposed but there is a lack of in vivo data on the ability to control infections and inflammation. We set up a mouse model of acute infection that closely mimic the airway infection in CGD patients. It involved an intratracheal injection of a methicillin-sensitive reference strain of S. aureus. Gene therapy, with hematopoietic stem cells transduced with regulated lentiviral vectors, restored the functional activity of NADPH oxidase complex (with 20-98% of dihydrorhodamine positive granulocytes and monocytes) and saved mice from death caused by S. aureus, significantly reducing the bacterial load and lung damage, similarly to WT mice even at low vector copy number. When challenged, gene therapy-treated XCGD mice showed correction of proinflammatory cytokines and chemokine imbalance at levels that were comparable to WT. Examined together, our results support the clinical development of gene therapy protocols using lentiviral vectors for the protection against infections and inflammation.
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Affiliation(s)
- Giada Farinelli
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), San Raffaele Scientific Institute, Milan, Italy
| | - Raisa Jofra Hernandez
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), San Raffaele Scientific Institute, Milan, Italy
| | - Alice Rossi
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Serena Ranucci
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | | | - Maddalena Migliavacca
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), San Raffaele Scientific Institute, Milan, Italy.,Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Chiara Brombin
- CUSSB-University Center Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Aleksandar Pramov
- CUSSB-University Center Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | - Clelia Di Serio
- CUSSB-University Center Center for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Bernhard Gentner
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), San Raffaele Scientific Institute, Milan, Italy.,Haematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Bragonzi
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), San Raffaele Scientific Institute, Milan, Italy.,Pediatric Immunohematology and Bone Marrow Transplantation Unit, San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy, Italy
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Rancoita PMV, Valberg M, Demicheli R, Biganzoli E, Di Serio C. Tumor dormancy and frailty models: A novel approach. Biometrics 2016; 73:260-270. [PMID: 27398936 DOI: 10.1111/biom.12559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 04/01/2016] [Accepted: 04/01/2016] [Indexed: 12/17/2022]
Abstract
Frailty models are here proposed in the tumor dormancy framework, in order to account for possible unobservable dependence mechanisms in cancer studies where a non-negligible proportion of cancer patients relapses years or decades after surgical removal of the primary tumor. Relapses do not seem to follow a memory-less process, since their timing distribution leads to multimodal hazards. From a biomedical perspective, this behavior may be explained by tumor dormancy, i.e., for some patients microscopic tumor foci may remain asymptomatic for a prolonged time interval and, when they escape from dormancy, micrometastatic growth results in a clinical disease appearance. The activation of the growth phase at different metastatic states would explain the occurrence of metastatic recurrences and mortality at different times (multimodal hazard). We propose a new frailty model which includes in the risk function a random source of heterogeneity (frailty variable) affecting the components of the hazard function. Thus, the individual hazard rate results as the product of a random frailty variable and the sum of basic hazard rates. In tumor dormancy, the basic hazard rates correspond to micrometastatic developments starting from different initial states. The frailty variable represents the heterogeneity among patients with respect to relapse, which might be related to unknown mechanisms that regulate tumor dormancy. We use our model to estimate the overall survival in a large breast cancer dataset, showing how this improves the understanding of the underlying biological process.
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Affiliation(s)
- Paola M V Rancoita
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Morten Valberg
- Department of Biostatistics, Oslo Center for Biostatistics and Epidemiology, Institute of Basic Medical Sciences, University of Oslo, Norway
| | - Romano Demicheli
- Scientific Directorate Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elia Biganzoli
- Unit of Medical Statistics, Biometry and Bioinformatics "Giulio A. Maccacaro" Campus Cascina Rosa, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
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Barcellini L, Borroni E, Brown J, Brunetti E, Campisi D, Castellotti PF, Codecasa LR, Cugnata F, Di Serio C, Ferrarese M, Goletti D, Lipman M, Rancoita PM, Russo G, Tadolini M, Vanino E, Cirillo DM. First evaluation of QuantiFERON-TB Gold Plus performance in contact screening. Eur Respir J 2016; 48:1411-1419. [DOI: 10.1183/13993003.00510-2016] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 05/23/2016] [Indexed: 01/25/2023]
Abstract
Identifying latently infected individuals is crucial for the elimination of tuberculosis (TB). We evaluated for the first time the performance of a new type of interferon-γ release assay, QuantiFERON-TB Plus (QFT-Plus), which includes an additional antigen tube (TB2), stimulating both CD4+ and CD8+ T-cells in contacts of TB patients.Contacts were screened for latent TB infection by tuberculin skin test, QFT-Plus and QuantiFERON-TB Gold in Tube (QFT-GIT).In 119 TB contacts, the overall agreement between QFT-Plus and QFT-GIT was high, with a Cohen's κ of 0.8. Discordant results were found in 12 subjects with negative QFT-GIT and positive QFT-Plus results. In analyses of markers of TB exposure and test results, the average time spent with the index case was the strongest risk factor for positivity in each of these tests. The difference in interferon-γ production between the two antigen tubes (TB2−TB1) was used as an estimate of CD8+ stimulation provided by the TB2. TB2−TB1 values >0.6 IU·mL−1 were significantly associated with proximity to the index case and European origin.QFT-Plus has a stronger association with surrogate measures of TB exposure than QFT-GIT in adults screened for latent TB infection. Interferon-γ response in the new antigen tube used an indirect estimate of specific CD8+ response correlates with increased Mycobacterium tuberculosis exposure, suggesting a possible role in identifying individuals with recent infection.
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Biasco L, Pellin D, Scala S, Dionisio F, Basso-Ricci L, Leonardelli L, Scaramuzza S, Baricordi C, Ferrua F, Cicalese MP, Giannelli S, Neduva V, Dow DJ, Schmidt M, Von Kalle C, Roncarolo MG, Ciceri F, Vicard P, Wit E, Di Serio C, Naldini L, Aiuti A. In Vivo Tracking of Human Hematopoiesis Reveals Patterns of Clonal Dynamics during Early and Steady-State Reconstitution Phases. Cell Stem Cell 2016; 19:107-19. [PMID: 27237736 PMCID: PMC4942697 DOI: 10.1016/j.stem.2016.04.016] [Citation(s) in RCA: 163] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/11/2016] [Accepted: 04/28/2016] [Indexed: 12/31/2022]
Abstract
Hematopoietic stem/progenitor cells (HSPCs) are capable of supporting the lifelong production of blood cells exerting a wide spectrum of functions. Lentiviral vector HSPC gene therapy generates a human hematopoietic system stably marked at the clonal level by vector integration sites (ISs). Using IS analysis, we longitudinally tracked >89,000 clones from 15 distinct bone marrow and peripheral blood lineages purified up to 4 years after transplant in four Wiskott-Aldrich syndrome patients treated with HSPC gene therapy. We measured at the clonal level repopulating waves, populations' sizes and dynamics, activity of distinct HSPC subtypes, contribution of various progenitor classes during the early and late post-transplant phases, and hierarchical relationships among lineages. We discovered that in-vitro-manipulated HSPCs retain the ability to return to latency after transplant and can be physiologically reactivated, sustaining a stable hematopoietic output. This study constitutes in vivo comprehensive tracking in humans of hematopoietic clonal dynamics during the early and late post-transplant phases. Hematopoietic reconstitution occurs in two distinct clonal waves A few thousand HSPC clones stably sustain multilineage blood cell production Steady-state hematopoiesis after transplant is maintained by both HSCs and MPPs Natural killer clones have closer relationships to myeloid cells than to lymphoid cells
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Affiliation(s)
- Luca Biasco
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy.
| | | | - Serena Scala
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Francesca Dionisio
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Luca Basso-Ricci
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Lorena Leonardelli
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Samantha Scaramuzza
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Cristina Baricordi
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Francesca Ferrua
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Maria Pia Cicalese
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Stefania Giannelli
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy
| | - Victor Neduva
- Target Sciences, GlaxoSmithKline R&D, Stevenage, Herts SG1 2NY, UK
| | - David J Dow
- Target Sciences, GlaxoSmithKline R&D, Stevenage, Herts SG1 2NY, UK
| | - Manfred Schmidt
- National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69121 Heidelberg, Germany
| | - Christof Von Kalle
- National Center for Tumor Diseases (NCT), German Cancer Research Center (DKFZ), 69121 Heidelberg, Germany
| | - Maria Grazia Roncarolo
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy; Division of Stem Cell Transplantation and Regenerative Medicine, Department of Pediatrics, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Fabio Ciceri
- Pediatric Immunohematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Paola Vicard
- Department of Economy, University Roma Tre, 00154 Rome, Italy
| | - Ernst Wit
- Johann Bernoulli Institute, University of Groningen, 9700 AB Groningen, the Netherlands
| | - Clelia Di Serio
- CUSSB, Vita-Salute University, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Luigi Naldini
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy (TIGET), 20132 Milan, Italy; Pediatric Immunohematology and Bone Marrow Transplant Unit, San Raffaele Scientific Institute, 20132 Milan, Italy; Vita-Salute San Raffaele University, 20132 Milan, Italy.
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Farinelli G, Hernandez RJ, Rossi A, Ranucci S, Sanvito F, Migliavacca M, Brombin C, Pramov A, Di Serio C, Gentner B, Bragonzi A, Aiuti A. 226. Lentiviral Vector Gene Therapy Protects XCGD Mice from Acute Staphylococcus aureus Pneumonia and Inflammatory Response. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33035-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Leonardelli L, Pellin D, Scala S, Dionisio F, Ricci LB, Cittaro D, Di Serio C, Aiuti A, Biasco L. 531. Computational Pipeline for the Identification of Integration Sites and Novel Method for the Quantification of Clone Sizes in Clonal Tracking Studies. Mol Ther 2016. [DOI: 10.1016/s1525-0016(16)33340-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Barcellini L, Borroni E, Brown J, Brunetti E, Codecasa L, Cugnata F, Dal Monte P, Di Serio C, Goletti D, Lombardi G, Lipman M, Rancoita PM, Tadolini M, Cirillo DM. First independent evaluation of QuantiFERON-TB Plus performance. Eur Respir J 2016; 47:1587-90. [DOI: 10.1183/13993003.02033-2015] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 01/01/2016] [Indexed: 12/22/2022]
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Bagaglio S, Uberti-Foppa C, Di Serio C, Trentini F, Andolina A, Hasson H, Messina E, Merli M, Porrino L, Lazzarin A, Morsica G. Dynamic of Mixed HCV Infection in Plasma and PBMC of HIV/HCV Patients Under Treatment With Peg-IFN/Ribavirin. Medicine (Baltimore) 2015; 94:e1876. [PMID: 26512601 PMCID: PMC4985415 DOI: 10.1097/md.0000000000001876] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 09/25/2015] [Accepted: 09/29/2015] [Indexed: 02/07/2023] Open
Abstract
The extent of mixed hepatitis C virus (HCV) genotype in different compartments (plasma and peripheral blood mononuclear cell, PBMC) and possible association with treatment efficacy in HIV/HCV coinfected patients remains to be unknown.The objective of this study was to elucidate the frequency of mixed genotype infection (MG), its profile in different compartments during anti-HCV treatment, and the possible influence of different genotypes on the response rate.The compartmentalization of HCV population was investigated by next-generation sequencing in 19 HIV/HCV coinfected patients under anti-HCV treatment with peginterferon/ribavirin (P-R). Ten individuals were nonresponder (NR) or relapser (RE) to P-R treatment and 9 had a sustained virological response (SVR).Eleven/nineteen (58%) patients had MG in plasma compartment. Ten or 12 patients infected by a difficult to treat genotype (DTG) 1 or 4 as dominant strain, had an MG, whereas only 1/7 individuals infected by easy to treat genotype (ETG) harbored a mixed genotype, P = 0.006. HCV-RNA was more frequently detected in PBMC of NR (10/10) than in those of SVR (5/9), P = 0.032. Mixed genotype infection was detected in 6/15 (40%) PBMC-positive cases and was not associated with P-R treatment response. By multivariate analysis, MG in plasma samples was the most important viral factor affecting the treatment response (P = 0.0237).Detection of MG in plasma of HIV/HCV coinfected patients seems to represent the major determinant of response to P-R treatment. This finding may have important clinical implication in light of the new therapeutic approach in HIV/HCV coinfected individuals suggesting that combination treatment with direct acting antivirals could be less effective in MG.
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Affiliation(s)
- Sabrina Bagaglio
- Infectious Diseases Department, Scientific Institute Ospedale San Raffaele, Via Stamira d'Ancona 20, 20127 Milan, Italy (SB, CU-F, AA, HH, EM, MM, AL, GM); Vita-Salute University Via Olgettina 58, 20132 Milan, Italy (SB, AL); University Centre for Statistics in the Biomedical Sciences (CUSSB) Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy (CDS, FT); L. Bocconi University, Via R. Sarfatti 25, 20136 Milan, Italy (FT); Mol Med Spa, Via Olgettina 58, 20132 Milan, Italy (LP)
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Biasco L, Dionisio F, Pellin D, Scala S, Basso Ricci L, Scaramuzza S, Baricordi C, Calabria A, Giannelli S, Neduva V, Dow DJ, Montini E, Di Serio C, Naldini L, Aiuti A. 476. Clonal Tracking of Engineered Hematopoiesis In Vivo in Humans By Insertional Barcoding. Mol Ther 2015. [DOI: 10.1016/s1525-0016(16)34085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Baldan R, Rancoita PMV, Di Serio C, Mazzotti M, Cichero P, Ossi C, Biancardi A, Nizzero P, Saracco A, Scarpellini P, Cirillo DM. Epidemic MRSA clone ST22-IV is more resistant to multiple host- and environment-related stresses compared with ST228-I. J Antimicrob Chemother 2014; 70:757-65. [PMID: 25428923 DOI: 10.1093/jac/dku467] [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] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND ST22-IV is a successful hospital-associated MRSA clone. Due to its known ability to replace other MRSA clones in hospitals, it became a dominant clone in Europe and beyond. So far, there are no studies investigating the relationship between the epidemiological success of MRSA clones and their capacity to withstand commonly encountered stresses. METHODS We investigated the fitness of ST22-IV in comparison with the replaced clone ST228-I, evaluating its resistance to oxidative stress, autolytic activity, growth at high osmolarity and in acid and alkaline environments and survival under desiccation and heat shock. We also compared their phenotypic characteristics and examined the impact of antibiotic consumption on epidemiological success. RESULTS Here we demonstrate that the dominance of ST22-IV is linked neither to changes in antibiotic consumption nor to acquisition of additional resistances over time. Strong α-haemolysin activity, the production of β-haemolysin and the presence of an active agr could partly explain the virulence of ST22-IV previously observed in a murine model of pneumonia. Most importantly, we show that ST22-IV compared with ST228-I, besides retaining susceptibility to most antibiotics over time, has a superior capacity to survive under all stress conditions tested, which bacteria commonly face during their life cycle. CONCLUSIONS Our results support our hypothesis that ST22-IV has a fitness advantage over ST228-I. This fitness advantage could have allowed ST22-IV to displace ST228-I without acquiring additional resistances and could help explain its epidemic success in hospital settings and its spread in Europe and beyond.
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Affiliation(s)
- Rossella Baldan
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Maria Mazzotti
- Department of Pharmacy, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Paola Cichero
- Department of Microbiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Cristina Ossi
- Department of Microbiology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | | | - Paolo Scarpellini
- Department of Infectious Diseases, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Daniela Maria Cirillo
- Emerging Bacterial Pathogens Unit, Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Gagliani N, Magnani CF, Huber S, Gianolini ME, Pala M, Licona-Limon P, Guo B, Herbert DR, Bulfone A, Trentini F, Di Serio C, Bacchetta R, Andreani M, Brockmann L, Gregori S, Flavell RA, Roncarolo MG. Erratum: Corrigendum: Coexpression of CD49b and LAG-3 identifies human and mouse T regulatory type 1 cells. Nat Med 2014. [DOI: 10.1038/nm1014-1217c] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Ciampi P, Scotti C, Nonis A, Vitali M, Di Serio C, Peretti GM, Fraschini G. The benefit of synthetic versus biological patch augmentation in the repair of posterosuperior massive rotator cuff tears: a 3-year follow-up study. Am J Sports Med 2014; 42:1169-75. [PMID: 24634447 DOI: 10.1177/0363546514525592] [Citation(s) in RCA: 130] [Impact Index Per Article: 13.0] [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: 01/31/2023]
Abstract
BACKGROUND Rotator cuff repair typically results in a satisfactory, although variable, clinical outcome. However, anatomic failure of the repaired tendon often occurs. HYPOTHESIS Patch augmentation can improve the results of open rotator cuff repair by supporting the healing process, protecting the suture, and reducing friction in the subacromial space. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 152 patients with a posterosuperior massive rotator cuff tear were treated by open repair only (control group; n = 51; mean age, 67.06 ± 4.42 years), open repair together with collagen patch augmentation (collagen group; n = 49; mean age, 66.53 ± 5.17 years), or open repair together with polypropylene patch augmentation (polypropylene group; n = 52; mean age, 66.17 ± 5.44 years) and were retrospectively studied. Patients were evaluated preoperatively and after 36 months with a visual analog scale (VAS) and the University of California, Los Angeles (UCLA) shoulder rating scale and by measuring elevation of the scapular plane and strength with a dynamometer. The VAS and UCLA scores were also obtained 2 months postoperatively. Tendon integrity was assessed after 1 year by ultrasound. Patients were homogeneous as per the preoperative assessment. RESULTS After 2 months, results (mean ± standard deviation) for the control, collagen, and polypropylene groups, respectively, were as follows: VAS scores were 6.96 ± 1.11, 6.46 ± 1.02, and 4.92 ± 0.90, while UCLA scores were 11.29 ± 1.46, 11.40 ± 1.51, and 19.15 ± 1.99. After 36 months, the mean scores for the respective groups were 3.66 ± 1.05, 4.06 ± 1.02, and 3.28 ± 1.10 for the VAS and 14.88 ± 1.98, 14.69 ± 1.99, and 24.61 ± 3.22 for the UCLA scale. In addition, after 36 months, elevation on the scapular plane was 140.68° ± 9.84°, 140.61° ± 12.48°, and 174.71° ± 8.18°, and abduction strength was 8.73 ± 0.54 kg, 9.03 ± 0.60 kg, and 13.79 ± 0.64 kg for the control, collagen, and polypropylene groups, respectively. The retear rate after 12 months was 41% (21/51) for the control group, 51% (25/49) for the collagen group, and 17% (9/52) for the polypropylene group. In particular, the reduced 12-month retear rate and the increased UCLA scores, abduction strength, and elevation at 3-year follow-up were statistically significant for patients treated with a polypropylene patch compared with those treated with repair only or with a collagen patch. CONCLUSION Polypropylene patch augmentation of rotator cuff repair was demonstrated to significantly improve the 36-month outcome in terms of function, strength, and retear rate.
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Affiliation(s)
- Pietro Ciampi
- Giuseppe M. Peretti, Department of Biomedical Sciences for Health, University of Milan, Via R. Galeazzi 4, 20161 Milan, Italy. and Gianfranco Fraschini, Department of Orthopaedics and Traumatology, San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milan, Italy (e-mail: )
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Brombin C, Di Serio C, Rancoita PM. Joint modeling of HIV data in multicenter observational studies: A comparison among different approaches. Stat Methods Med Res 2014; 25:2472-2487. [PMID: 24671658 DOI: 10.1177/0962280214526192] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Disease process over time results from the combination of event history information and longitudinal process. Commonly, separate analyses of longitudinal and survival outcomes are performed. However, discharging the dependence between these components may cause misleading results. Separate analyses are difficult to interpret whenever one deals with observational retrospective multicenter cohort studies where the biomarkers are poorly monitored over time, while the survival component may be affected by several sources of bias, such as multiple endpoints, multiple time-scales, and informative censoring. We discuss how joint modeling of longitudinal and survival data represents an effective strategy to incorporate all information simultaneously and to provide valid and efficient inferences, thus allowing to produce a better insight into the biological mechanisms underlying the phenomenon under study. Accounting for the whole dynamics of the disease process is crucial in retrospective longitudinal studies. In this work, we present different approaches for modeling longitudinal and time-to-event data, retrieved from 648 HIV-infected patients enrolled in the Italian cohort of the CASCADE (Concerted Action on SeroConversion to AIDS and Death in Europe) study, one of the largest AIDS collaborative cohort studies. In particular, we evaluate CD4 lymphocyte evolution over time (from the date of seroconversion) and overall survival, CD4 being one of the most important immunologic biomarker for HIV progression. Besides a standard separate modeling approach, we consider two alternative joint models: the traditional joint model and the joint latent class mixed model. Advantages and disadvantages of the different approaches are discussed. To compare the performances of these models, cross-validation procedures are also performed.
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Affiliation(s)
- Chiara Brombin
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy
| | - Clelia Di Serio
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy
| | - Paola Mv Rancoita
- University Centre of Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milano, Italy
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Baldan R, Cigana C, Testa F, Bianconi I, De Simone M, Pellin D, Di Serio C, Bragonzi A, Cirillo DM. Adaptation of Pseudomonas aeruginosa in Cystic Fibrosis airways influences virulence of Staphylococcus aureus in vitro and murine models of co-infection. PLoS One 2014; 9:e89614. [PMID: 24603807 PMCID: PMC3945726 DOI: 10.1371/journal.pone.0089614] [Citation(s) in RCA: 108] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/23/2014] [Indexed: 12/18/2022] Open
Abstract
Cystic fibrosis (CF) airways disease represents an example of polymicrobial infection whereby different bacterial species can interact and influence each other. In CF patients Staphylococcus aureus is often the initial pathogen colonizing the lungs during childhood, while Pseudomonas aeruginosa is the predominant pathogen isolated in adolescents and adults. During chronic infection, P. aeruginosa undergoes adaptation to cope with antimicrobial therapy, host response and co-infecting pathogens. However, S. aureus and P. aeruginosa often co-exist in the same niche influencing the CF pathogenesis. The goal of this study was to investigate the reciprocal interaction of P. aeruginosa and S. aureus and understand the influence of P. aeruginosa adaptation to the CF lung in order to gain important insight on the interplay occurring between the two main pathogens of CF airways, which is still largely unknown. P. aeruginosa reference strains and eight lineages of clinical strains, including early and late clonal isolates from different patients with CF, were tested for growth inhibition of S. aureus. Next, P. aeruginosa/S. aureus competition was investigated in planktonic co-culture, biofilm, and mouse pneumonia model. P. aeruginosa reference and early strains, isolated at the onset of chronic infection, outcompeted S. aureus in vitro and in vivo models of co-infection. On the contrary, our results indicated a reduced capacity to outcompete S. aureus of P. aeruginosa patho-adaptive strains, isolated after several years of chronic infection and carrying several phenotypic changes temporally associated with CF lung adaptation. Our findings provide relevant information with respect to interspecies interaction and disease progression in CF.
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Affiliation(s)
- Rossella Baldan
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Cristina Cigana
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Testa
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Irene Bianconi
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Maura De Simone
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Danilo Pellin
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Alessandra Bragonzi
- Infection and Cystic Fibrosis Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Daniela M. Cirillo
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
- * E-mail:
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Aiuti A, Biasco L, Scaramuzza S, Ferrua F, Cicalese MP, Baricordi C, Dionisio F, Calabria A, Giannelli S, Castiello MC, Bosticardo M, Evangelio C, Assanelli A, Casiraghi M, Di Nunzio S, Callegaro L, Benati C, Rizzardi P, Pellin D, Di Serio C, Schmidt M, Von Kalle C, Gardner J, Mehta N, Neduva V, Dow DJ, Galy A, Miniero R, Finocchi A, Metin A, Banerjee PP, Orange JS, Galimberti S, Valsecchi MG, Biffi A, Montini E, Villa A, Ciceri F, Roncarolo MG, Naldini L. Lentiviral hematopoietic stem cell gene therapy in patients with Wiskott-Aldrich syndrome. Science 2013; 341:1233151. [PMID: 23845947 PMCID: PMC4375961 DOI: 10.1126/science.1233151] [Citation(s) in RCA: 777] [Impact Index Per Article: 70.6] [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: 01/08/2023]
Abstract
Wiskott-Aldrich syndrome (WAS) is an inherited immunodeficiency caused by mutations in the gene encoding WASP, a protein regulating the cytoskeleton. Hematopoietic stem/progenitor cell (HSPC) transplants can be curative, but, when matched donors are unavailable, infusion of autologous HSPCs modified ex vivo by gene therapy is an alternative approach. We used a lentiviral vector encoding functional WASP to genetically correct HSPCs from three WAS patients and reinfused the cells after a reduced-intensity conditioning regimen. All three patients showed stable engraftment of WASP-expressing cells and improvements in platelet counts, immune functions, and clinical scores. Vector integration analyses revealed highly polyclonal and multilineage haematopoiesis resulting from the gene-corrected HSPCs. Lentiviral gene therapy did not induce selection of integrations near oncogenes, and no aberrant clonal expansion was observed after 20 to 32 months. Although extended clinical observation is required to establish long-term safety, lentiviral gene therapy represents a promising treatment for WAS.
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Affiliation(s)
- Alessandro Aiuti
- San Raffaele Telethon Institute for Gene Therapy, Division of Regenerative Medicine, Stem Cells, and Gene Therapy, San Raffaele Scientific Institute, 20132 Milan, Italy.
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Biffi A, Montini E, Lorioli L, Cesani M, Fumagalli F, Plati T, Baldoli C, Martino S, Calabria A, Canale S, Benedicenti F, Vallanti G, Biasco L, Leo S, Kabbara N, Zanetti G, Rizzo WB, Mehta NAL, Cicalese MP, Casiraghi M, Boelens JJ, Del Carro U, Dow DJ, Schmidt M, Assanelli A, Neduva V, Di Serio C, Stupka E, Gardner J, von Kalle C, Bordignon C, Ciceri F, Rovelli A, Roncarolo MG, Aiuti A, Sessa M, Naldini L. Lentiviral hematopoietic stem cell gene therapy benefits metachromatic leukodystrophy. Science 2013; 341:1233158. [PMID: 23845948 DOI: 10.1126/science.1233158] [Citation(s) in RCA: 857] [Impact Index Per Article: 77.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Metachromatic leukodystrophy (MLD) is an inherited lysosomal storage disease caused by arylsulfatase A (ARSA) deficiency. Patients with MLD exhibit progressive motor and cognitive impairment and die within a few years of symptom onset. We used a lentiviral vector to transfer a functional ARSA gene into hematopoietic stem cells (HSCs) from three presymptomatic patients who showed genetic, biochemical, and neurophysiological evidence of late infantile MLD. After reinfusion of the gene-corrected HSCs, the patients showed extensive and stable ARSA gene replacement, which led to high enzyme expression throughout hematopoietic lineages and in cerebrospinal fluid. Analyses of vector integrations revealed no evidence of aberrant clonal behavior. The disease did not manifest or progress in the three patients 7 to 21 months beyond the predicted age of symptom onset. These findings indicate that extensive genetic engineering of human hematopoiesis can be achieved with lentiviral vectors and that this approach may offer therapeutic benefit for MLD patients.
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Affiliation(s)
- Alessandra Biffi
- San Raffaele Telethon Institute for Gene Therapy, San Raffaele Scientific Institute, 20132 Milan, Italy.
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Gagliani N, Magnani CF, Huber S, Gianolini ME, Pala M, Licona-Limon P, Guo B, Herbert DR, Bulfone A, Trentini F, Di Serio C, Bacchetta R, Andreani M, Brockmann L, Gregori S, Flavell RA, Roncarolo MG. Coexpression of CD49b and LAG-3 identifies human and mouse T regulatory type 1 cells. Nat Med 2013; 19:739-46. [PMID: 23624599 DOI: 10.1038/nm.3179] [Citation(s) in RCA: 590] [Impact Index Per Article: 53.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Accepted: 03/27/2013] [Indexed: 12/12/2022]
Abstract
CD4(+) type 1 T regulatory (Tr1) cells are induced in the periphery and have a pivotal role in promoting and maintaining tolerance. The absence of surface markers that uniquely identify Tr1 cells has limited their study and clinical applications. By gene expression profiling of human Tr1 cell clones, we identified the surface markers CD49b and lymphocyte activation gene 3 (LAG-3) as being stably and selectively coexpressed on mouse and human Tr1 cells. We showed the specificity of these markers in mouse models of intestinal inflammation and helminth infection and in the peripheral blood of healthy volunteers. The coexpression of CD49b and LAG-3 enables the isolation of highly suppressive human Tr1 cells from in vitro anergized cultures and allows the tracking of Tr1 cells in the peripheral blood of subjects who developed tolerance after allogeneic hematopoietic stem cell transplantation. The use of these markers makes it feasible to track Tr1 cells in vivo and purify Tr1 cells for cell therapy to induce or restore tolerance in subjects with immune-mediated diseases.
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Affiliation(s)
- Nicola Gagliani
- San Raffaele Telethon Institute for Gene Therapy (HSR-TIGET), Division of Regenerative Medicine, Stem Cells and Gene Therapy, San Raffaele Scientific Institute, Milan, Italy
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Briganti A, Nonis A, Brombin C, Capitanio U, Gallina A, Nini A, Bianchi M, Freschi M, Doglioni C, Rigatti P, Kluth L, Chun F, Shariat S, Montorsi F, Di Serio C. 373 PATHOLOGICAL NODAL STAGING SCORE FOR PROSTATE CANCER: A TOOL TO ADDRESS ADEQUATE NODAL DISSECTION IN MEN TREATED WITH RADICAL PROSTATECTOMY. J Urol 2013. [DOI: 10.1016/j.juro.2013.02.1761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Xynos A, Neguembor MV, Caccia R, Licastro D, Nonis A, Di Serio C, Stupka E, Gabellini D. Facioscapulohumeral muscular dystrophy region gene 1 over-expression causes primary defects of myogenic stem cells. J Cell Sci 2013; 126:2236-45. [DOI: 10.1242/jcs.121533] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Over-expression of FSHD Region Gene 1 (FRG1) in mice, frogs and worms leads to muscular and vascular abnormalities. Nevertheless, the mechanism that follows FRG1 over-expression and finally leads to muscular defects is currently unknown. Here, we show that the earliest phenotype displayed by FRG1 mice is a postnatal muscle-growth defect. Long before the development of muscular dystrophy, FRG1 mice exhibit also a muscle regeneration impairment. Ex-vivo and in-vivo experiments revealed that FRG1 over-expression causes myogenic stem-cell activation, proliferative, clonogenic and differentiation defects. A comparative gene expression profiling of WT and FRG1 muscles from young pre-dystrophic mice identified differentially expressed genes in several gene categories and networks that could explain the emerging tissue and myogenic stem-cell defects. Overall, our study provides new insights in the pathways regulated by FRG1 and suggests that muscle-stem cells defects could contribute to the pathology of FRG1 mice.
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Miotto P, Forti F, Ambrosi A, Pellin D, Veiga DF, Balazsi G, Gennaro ML, Di Serio C, Ghisotti D, Cirillo DM. Genome-wide discovery of small RNAs in Mycobacterium tuberculosis. PLoS One 2012; 7:e51950. [PMID: 23284830 PMCID: PMC3526491 DOI: 10.1371/journal.pone.0051950] [Citation(s) in RCA: 58] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 11/06/2012] [Indexed: 01/29/2023] Open
Abstract
Only few small RNAs (sRNAs) have been characterized in Mycobacterium tuberculosis and their role in regulatory networks is still poorly understood. Here we report a genome-wide characterization of sRNAs in M. tuberculosis integrating experimental and computational analyses. Global RNA-seq analysis of exponentially growing cultures of M. tuberculosis H37Rv had previously identified 1373 sRNA species. In the present report we show that 258 (19%) of these were also identified by microarray expression. This set included 22 intergenic sRNAs, 84 sRNAs mapping within 5′/3′ UTRs, and 152 antisense sRNAs. Analysis of promoter and terminator consensus sequences identified sigma A promoter consensus sequences for 121 sRNAs (47%), terminator consensus motifs for 22 sRNAs (8.5%), and both motifs for 35 sRNAs (14%). Additionally, 20/23 candidates were visualized by Northern blot analysis and 5′ end mapping by primer extension confirmed the RNA-seq data. We also used a computational approach utilizing functional enrichment to identify the pathways targeted by sRNA regulation. We found that antisense sRNAs preferentially regulated transcription of membrane-bound proteins. Genes putatively regulated by novel cis-encoded sRNAs were enriched for two-component systems and for functional pathways involved in hydrogen transport on the membrane.
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Affiliation(s)
- Paolo Miotto
- Emerging Bacterial Pathogens Unit, S. Raffaele Scientific Institute, Milan, Italy
| | - Francesca Forti
- Dipartimento di BioScienze, University of Milan, Milan, Italy
| | - Alessandro Ambrosi
- University Statistical Center for Biomedical Sciences – Università Vita-Salute S. Raffaele, Milan, Italy
| | - Danilo Pellin
- University Statistical Center for Biomedical Sciences – Università Vita-Salute S. Raffaele, Milan, Italy
| | - Diogo F. Veiga
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Gabor Balazsi
- Department of Systems Biology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Maria L. Gennaro
- Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, United States of America
| | - Clelia Di Serio
- University Statistical Center for Biomedical Sciences – Università Vita-Salute S. Raffaele, Milan, Italy
| | | | - Daniela M. Cirillo
- Emerging Bacterial Pathogens Unit, S. Raffaele Scientific Institute, Milan, Italy
- * E-mail:
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Brombin C, Di Serio C. Evaluating treatment effect within a multivariate stochastic ordering framework: Nonparametric combination methodology applied to a study on multiple sclerosis. Stat Methods Med Res 2012; 25:366-84. [PMID: 22843205 DOI: 10.1177/0962280212454203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Multiple sclerosis is an autoimmune complex disease that affects the central nervous system. It has a multitude of symptoms that are observed in different people in many different ways. At this time, there is no definite cure for multiple sclerosis. However, therapies that slow the progression of disability, controlling symptoms and helping patients to maintain a normal quality of life, are available. We will focus on relapsing-remitting multiple sclerosis patients treated with interferons or glatiramer acetate. These treatments have been shown to be effective, but their relative effectiveness has not been well established yet. To assess the superiority of a treatment, instead of classical parametric methods, we propose a statistical approach within the permutation setting and the nonparametric combination of dependent permutation tests. In this framework, we may easily handle with hypothesis testing problems for multivariate monotonic stochastic ordering. This approach has been motivated by the analysis of a large observational Italian multicentre study on multiple sclerosis, with several continuous and categorical outcomes measured at multiple time points.
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Affiliation(s)
- Chiara Brombin
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Italy
| | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Vita-Salute San Raffaele University, Italy
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Pellin D, Miotto P, Ambrosi A, Cirillo DM, Di Serio C. A genome-wide identification analysis of small regulatory RNAs in Mycobacterium tuberculosis by RNA-Seq and conservation analysis. PLoS One 2012; 7:e32723. [PMID: 22470422 PMCID: PMC3314655 DOI: 10.1371/journal.pone.0032723] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/03/2012] [Indexed: 12/29/2022] Open
Abstract
We propose a new method for smallRNAs (sRNAs) identification. First we build an effective target genome (ETG) by means of a strand-specific procedure. Then we propose a new bioinformatic pipeline based mainly on the combination of two types of information: the first provides an expression map based on RNA-seq data (Reads Map) and the second applies principles of comparative genomics leading to a Conservation Map. By superimposing these two maps, a robust method for the search of sRNAs is obtained. We apply this methodology to investigate sRNAs in Mycobacterium tuberculosis H37Rv. This bioinformatic procedure leads to a total list of 1948 candidate sRNAs. The size of the candidate list is strictly related to the aim of the study and to the technology used during the verification process. We provide performance measures of the algorithm in identifying annotated sRNAs reported in three recent published studies.
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Affiliation(s)
- Danilo Pellin
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Miotto
- Emerging Bacterial Pathogens Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ambrosi
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Clelia Di Serio
- University Centre for Statistics in the Biomedical Sciences, Università Vita-Salute San Raffaele, Milan, Italy
- * E-mail:
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