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Gianesini S, Rimondi E, Raffetto JD, Melloni E, Pellati A, Menegatti E, Avruscio GP, Bassetto F, Costa AL, Rockson S. Human collecting lymphatic glycocalyx identification by electron microscopy and immunohistochemistry. Sci Rep 2023; 13:3022. [PMID: 36810649 PMCID: PMC9945466 DOI: 10.1038/s41598-023-30043-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023] Open
Abstract
Blood flow is translated into biochemical inflammatory or anti-inflammatory signals based onshear stress type, by means of sensitive endothelial receptors. Recognition of the phenomenon is of paramount importance for enhanced insights into the pathophysiological processes of vascular remodeling. The endothelial glycocalyx is a pericellular matrix, identified in both arteries and veins, acting collectively as a sensor responsive to blood flow changes. Venous and lymphatic physiology is interconnected; however, to our knowledge, a lymphatic glycocalyx structure has never been identified in humans. The objective of this investigation is to identify glycocalyx structures from ex vivo lymphatic human samples. Lower limb vein and lymphatic vessels were harvested. The samples were analyzed by transmission electron microscopy. The specimens were also examined by immunohistochemistry. Transmission electron microscopy identified a glycocalyx structure in human venous and lymphatic samples. Immunohistochemistry for podoplanin, glypican-1, mucin-2, agrin and brevican characterized lymphatic and venous glycocalyx-like structures. To our knowledge, the present work reports the first identification of a glycocalyx-like structure in human lymphatic tissue. The vasculoprotective action of the glycocalyx could become an investigational target in the lymphatic system as well, with clinical implications for the many patients affected by lymphatic disorders.
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Affiliation(s)
- S. Gianesini
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy ,grid.265436.00000 0001 0421 5525Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, USA
| | - E. Rimondi
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - J. D. Raffetto
- grid.265436.00000 0001 0421 5525Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, USA ,grid.38142.3c000000041936754XSurgery Department, VA Boston Healthcare System, Harvard University, Boston, USA
| | - E. Melloni
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - A. Pellati
- grid.8484.00000 0004 1757 2064Department of Translational Medicine, LTTA Centre, University of Ferrara, Ferrara, Italy
| | - E. Menegatti
- grid.8484.00000 0004 1757 2064Environmental Sciences and Prevention Department, University of Ferrara, Ferrara, Italy
| | - G. P. Avruscio
- grid.5608.b0000 0004 1757 3470Department of Cardiac, Thoracic and Vascular Sciences, Hospital-University of Padua, Padua, Italy
| | - F. Bassetto
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - A. L. Costa
- grid.5608.b0000 0004 1757 3470Department of Neuroscience, Clinic of Plastic Surgery, University of Padova, Padua, Italy
| | - S. Rockson
- grid.168010.e0000000419368956Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, USA
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Barinotti A, Radin M, Cecchi I, Foddai SG, Rubini E, Roccatello D, Menegatti E, Sciascia S. AB1433 ASSESSING THE CARDIOVASCULAR RISK IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS: QRISK AND GAPSS SCORES HEAD TO HEAD. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundCardiovascular diseases (CVDs) represent one of the most life-threatening conditions that can affect SLE patients. Assessing the potential CVD risk of these patients is still a challenge and an important aspect in the clinical practice. Recently the QRISK3 score has attempted to encompass for SLE augmented thrombotic risk by adding items (such as corticosteroid use) that are missing in traditional CVD risk scores.ObjectivesTo apply and compare the QRISK3 and the adjusted Global AntiPhospholipid Syndrome Score (aGAPSS), a validated score to assess CVD and overall thrombotic risk in aPL positive patients, in a cohort of SLE patients with and without a concomitant diagnosis of APS.Methods25-85 years old patients attending San Giovanni Bosco Hospital (Turin) during a period of 6 months (Sep 2019 – Feb 2020) with a confirmed diagnosis of SLE (2019 ACR/EULAR classification criteria) and/or a diagnosis of SAPS (Sidney criteria) were included in the study. QRISK3 has been calculated using the official online calculator (https://qrisk.org/). aGAPSS has been calculated using the validated point values based on aPL profile and independent risk factors: aCL=5, aβ2GPI=4, LA=4, aPS/PT=3, hyperlipidemia=3, hypertension=1.ResultsThe analysis included a cohort of 142 SLE patients: 34 SAPS (23.9%) and 108 SLE patients without APS (76.1%), with a mean age of 48±12.9 (SAPS=51.6±12.8/SLE without APS=46.9±12.8). Table 1 summarizes patients characteristics. When focusing on cerebrovascular/coronary events, we found a statistical significance with respect to aGAPSS (pt with event =10.1±6.2 vs pt without event=5.8±6.1; p=0.007), but not QRISK3. Also, a significant association was observed between the occurrence of these events and high risk aGAPSS: p=0.03 for aGAPSS≥8, p=0.01 for aGAPSS ≥9, p=0.008 for aGAPSS ≥10. Moreover, the aGAPSS but not the QRISK3 resulted to strongly correlate with the occurrence of any thrombotic event, both at the uni- and multivariate analysis (univariate: pt with event =8.17±7.1 vs pt without event= 5.41±5.6; p=0.012 / multivariate: p=0.009). The same was observed for gender: male gender resulted to correlate with the occurrence of any thrombotic event at both uni- and multivariate analysis (p=0.017 and p=0.03, respectively). Finally, when focusing on aPL profile, regardless the diagnosis, we found a statistical significance only with respect to aGAPSS (aPL+ =9.6±6.3 vs aPL- = 4.1±5.1; p<0.001).Table 1.Demographic and clinical features of the patients included in the study.ConclusionBy encompassing factors that can contribute to CVD development in complex/autoimmune diseases, QRISK3 has been shown to be more accurate than traditional risk score in predicting SLE patients CVD risk. Nonetheless, the results of this analysis showed how the aGAPSS still seems to be the most valuable tool for this purpose when facing SLE patients. Moreover, the significance observed when focusing on patients’ aPL profile, suggests that adding this item to the QRISK3 could be a useful strategy to improve the management.References[1]Hippisley-Cox J, Coupland C, Brindle P. Development and validation of QRISK3 risk prediction algorithms to estimate future risk of cardiovascular disease: prospective cohort study. BMJ. 2017 May 23;357:j2099. doi: 10.1136/bmj.j2099.[2]Radin M, Sciascia S, Erkan D, et al. The adjusted global antiphospholipid syndrome score (aGAPSS) and the risk of recurrent thrombosis: Results from the APS ACTION cohort. Semin Arthritis Rheum. 2019 Dec;49(3):464-468. doi: 10.1016/j.semarthrit.2019.04.009.Disclosure of InterestsNone declared
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Arbrile M, Radin M, Rossi D, Menegatti E, Roccatello D, Sciascia S. AB1283 HOW TO COUNSEL A WOMAN WITH BEHÇET’S DISEASE: RESULTS FROM A MONOCENTRIC COHORT OF WOMEN DIAGNOSED DURING CHILDBEARING AGE. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.1623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundPatients with autoimmune diseases require appropriate pregnancy counceling, as their disease can negatively impact both maternal and fetal outcomes. In regards to Behçet’s disease (BD), although commonly diagnosed during the childbearing age, only few studies focused on its impact on gestation, with contradictory results.ObjectivesWe aimed to collect new data on BD and its impact on pregnancy by designing a single-center cohort study, reporting the pregnancy and maternal outcomes in BD patients attending the Multidisciplinary Centre for Immunopathology and Rare Diseases at Giovanni Bosco Hospital (Turin, Italy).MethodsWe retrospectively included 26 women diagnosed with BD followed at our center. Out of 26 patients, data from 33 pregnancies in 16 women were collected. Ten patients were never pregnant. Table 1 shows the demographical and clinical characteristics and the pregnancy outcomes of the enrolled patients.Table 1.Clinical characteristics and pregnancy outcome of the Behçet’s disease patients enrolled in the study.Patients(tot=31)Nulliparous; n (%)10/26 (38,46%)Primigravida; n (%)16/26 (61,54%)DemographicsAge at BD diagnosis; mean± S.D.40,56±11,42Age at first pregnancy; mean ± S:D.24,86 ± 6,56Clinical characteristics of BDOral ulcers; n (%)26/26 (100 %)Genital ulcers; n (%)21/26 (80,76%)Folliculitis; n (%)15/26 (57,69%)Erythema nodosum; n (%)6/26 (23,08%)Ocular manifestations; n (%)11/26 (42,31%)HLA B-51+; n (%)13/26 (50%)Pregnancy outcomeRate of live births; n (%)27/33 (81,81%)Any complications; n (%)12/33(36,36%) Early miscarriage before 10 weeks of gestation; n (%)6/33 (18,18%) Gestational diabetes; n (%)3/33 (9,09%) Placental abruption; n (%)2/33 (6,06%) Vaginal bleeding before 20 weeks of gestation; n (%)1/33 (3,03%)Worsening of oral and genital ulcerations; n (%) *2/ 11 (18%)* This information was available only for 11/33 pregnancies.BD – Behçet’s diseaseS.D – Standard deviationResultsAll included patients fulfilled the international criteria for BD (1), with a median age at the time of diagnosis of BD and first pregnancy of 40,56±11,42 and 24,86±6,86 respectively. The frequency of clinical manifestations was oral ulcers (100%), genital ulcers (80,76%), erythema nodosum (23,08%), folliculitis (57,69%), ocular manifestations (42,31%) and HLA B-51+ (50%), respectively.The overall rate of live births was 81,81% (27/33). Twelve women experienced pregnancy complications (36,36%), in particular we report one case of vaginal bleeding before 20 weeks of gestation, six miscarriages before the 10th week of gestation, three cases of gestational diabetes and two placental abruptions. Among the analyzed pregnancies, a worsening of oral and genital ulcerations was observed in the 18% of them, while in the remaining cases a subjective amelioration of aphtosis and other concurrent symptoms was reported by the patients. No systemic flare, worsening of ocular complications and VTE was reported during pregnancy and in the post-partum period.ConclusionThe results of our study highlight an overall favorable rate of life births in BD women and a positive rate of disease remission in pregnancy. Currently, the studies focusing on pregnancy outcomes in BD are scarce, however it might be appropriate to give a specialized counseling to a BD woman planning for a pregnancy and follow these patients with a multidisciplinary approach.References[1]Chan T-M, Meng &, Chiou J, Kuo C-F. Adverse pregnancy outcomes in women with Behçet’s disease: population-based registry linkage study in Taiwan. Available from: https://doi.org/10.1007/s10067-021-05688-6[2]Davatchi F, Assaad-Khalil S, Calamia KT, Crook JE, Sadeghi-Abdollahi B, Schirmer M, et al. The International Criteria for Behçet’s Disease (ICBD): A collaborative study of 27 countries on the sensitivity and specificity of the new criteria. J Eur Acad Dermatology Venereol [Internet]. 2014 Mar [cited 2021 May 1];28(3):338–47. Available from: https://pubmed.ncbi.nlm.nih.gov/23441863Disclosure of InterestsNone declared
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Radin M, Arbrile M, Cecchi I, Barinotti A, Baldovino S, Menegatti E, Rossi D, Sciascia S, Roccatello D. POS0507 TAILORING ORAL THERAPY IN RHEUMATOID ARTHRITIS: THE TuTOR APP. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundMedication non-adherence has a significant impact on the health and well-being of individuals with chronic diseases. Indeed, with respect to important risk factors of Rheumatoid Arthritis (RA), such as cardiovascular risk factors, it is known that up to 50% of patients will stop taking medication for these conditions during the first year of prescription [1].ObjectivesTo support the management of RA patients treated with Tofacitinib, we designed the TuTOR (Tailoring Tofacitinib Oral therapy in Rheumatoid arthritis) Mobile App.MethodsA prospective-controlled study evaluated the impact of TuTOR App on medical adherence in 20 RA patients, that began treatment with Tofacitinib jointly with the App. We used a crossover design alternating Paper-Diary and TuTOR App, with monthly clinical assessments.ResultsSeventeen patients with RA (mean age at inclusion 59±13yrs; 88% females) the study. A statistically significant decrease of DAS28 was observed since the first month of therapy with Tofacitinib (mean DAS28 at baseline 3.9±1 vs. 1° month 3.1±1, p=0.0016). Similarly, Numerical Rating Scale(NRS) of perceived activity of disease (5.8±2.1 vs.3.7±2.5, p=0.02), and subjective fatigue (6.1±2.3 vs 4.3±2.6; p=0.01) progressively decreased. No differences were reported in DAS28 and in all the NRS between the use of the TuTOR App and the Paper-Diary. A significant decrease was observed also in HAQ during the follow-up (baseline 1.38±1.11 vs.six months 0.83±0.9; p=0.01).Most of the patients (82%) when filling out the self-reporting questionnaires preferred the TuTOR App in helping them to remember to take the pills. Further 82% of patients used the TuTOR App regularly (vs.53% Paper-Diary) and 76% of patients would use it in the future (vs.53% Paper-Diary). Three patients suspended the therapy with Tofacitinib due to gastrointestinal intolerance.ConclusionBoth digital- and paper-devices can help maximize the adherence to therapy, leading to an improvement in disease’s activity, highlighting the need of supports for medication adherence.References[1]BJ van den B, HE Z, CH van den E. Medication adherence in patients with rheumatoid arthritis: a critical appraisal of the existing literature. Expert Rev Clin Immunol 2012;8:337–351. Available at: https://pubmed.ncbi.nlm.nih.gov/22607180/. Accessed July 13, 2021.Table 1.Baseline demographic and clinical characteristics of the patients enrolled in the study, who completed follow-up. RA – Rheumatoid ArthritisPatients with RA(N=17)DEMOGRAPHICSAge (mean ± S.D.)59,4 ± 13,5Sex (n; %)M (2; 11,8), F (15; 88,2)Etnicity (caucasian; n; %)16; 94Etnicity (Hispanic; n; %)1; 6CLINICAL CHARACTERISTICSAge at diagnosis (mean ± S.D.)44,7±14,47Follow-up length (years; mean ± S.D.)6,33± 5,17Positive Rheumatoid Factor (n; %)17; 100Positive Anti-Cyclic citrullinated peptides (n;%)15; 88.2Structural articular damage at radiography (n; %)11; 7Figure 1.Decrease of disease activity assessed by DAS28 in the paper-diary and TuTOR App groups.Disclosure of InterestsMassimo Radin Grant/research support from: The study is supported by the Investigator-Initiated Research Studies Grant—CREARE (Pfizer)., Marta Arbrile: None declared, Irene Cecchi Grant/research support from: The study is supported by the Investigator-Initiated Research Studies Grant—CREARE (Pfizer)., Alice Barinotti: None declared, Simone Baldovino: None declared, Elisa Menegatti: None declared, Daniela Rossi Grant/research support from: The study is supported by the Investigator-Initiated Research Studies Grant—CREARE (Pfizer)., Savino Sciascia Grant/research support from: The study is supported by the Investigator-Initiated Research Studies Grant—CREARE (Pfizer)., Dario Roccatello Grant/research support from: The study is supported by the Investigator-Initiated Research Studies Grant—CREARE (Pfizer).
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Pecori Giraldi F, Einaudi S, Sesta A, Verna F, Messina M, Manieri C, Menegatti E, Ghizzoni L. POR polymorphisms are associated with 21 hydroxylase deficiency. J Endocrinol Invest 2021; 44:2219-2226. [PMID: 33666875 PMCID: PMC8421294 DOI: 10.1007/s40618-021-01527-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 12/12/2020] [Indexed: 12/21/2022]
Abstract
PURPOSE Genotype-phenotype correlation in congenital 21 hydroxylase deficiency is strong but by no means absolute. Indeed, clinical and hormonal features may vary among patients carrying similar CYP21A2 mutations, suggesting that modifier genes may contribute to the phenotype. Aim of the present study was to evaluate whether polymorphisms in the p450 oxidoreductase (POR) gene may affect clinical features in patients with 21 hydroxylase deficiency METHODS: Sequencing of the POR gene was performed in 96 patients with 21 hydroxylase deficiency (49 classic, 47 non-classic) and 43 control subjects. RESULTS Prevalence of POR polymorphisms in patients with 21 hydroxylase was comparable to controls and known databases. The rs2228104 polymorphism was more frequently associated with non-classic vs classic 21 hydroxylase deficiency (allelic risk 7.09; 95% C.I. 1.4-29.5, p < 0.05). Classic 21 hydroxylase-deficient carriers of the minor allele in the rs2286822/rs2286823 haplotype presented more frequently the salt-wasting form (allelic risk 1.375; 95% C.I. 1.138-1.137), more severe Prader stage at birth (allelic risk 3.85; 95% C.I. 3.78-3.92), higher ACTH levels, and younger age at diagnosis. CONCLUSIONS Polymorphisms in the POR gene are associated with clinical features of 21 hydroxylase deficiency both as regards predisposition to classic vs non-classic forms and severity of classic adrenal hyperplasia.
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Affiliation(s)
- F Pecori Giraldi
- Department Clinical Sciences and Community Health, University of Milan, Milan, Italy.
- Istituto Auxologico Italiano IRCCS, Neuroendocrinology Research Laboratory, Milan, Italy.
| | - S Einaudi
- Department Pediatric Endocrinology, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - A Sesta
- Istituto Auxologico Italiano IRCCS, Neuroendocrinology Research Laboratory, Milan, Italy
| | - F Verna
- Department Pediatric Endocrinology, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - M Messina
- Clinical Pathology and Experimental Medicine Unit, Department Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - C Manieri
- Division of Endocrinology, Diabetes and Metabolism, Department Medical Sciences, University of Turin, Turin, Italy
| | - E Menegatti
- Department Medical Genetics, Azienda Ospedaliera Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - L Ghizzoni
- Division of Endocrinology, Diabetes and Metabolism, Department Medical Sciences, University of Turin, Turin, Italy
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Radin M, Barinotti A, Cecchi I, Foddai SG, Rubini E, Roccatello D, Menegatti E, Sciascia S. POS0172 THROMBIN GENERATION ASSAY AND LUPUS ANTICOAGULANT IDENTIFY DIFFERENT POPULATIONS OF PATIENTS WITH ANTIPHOSPHOLIPID ANTIBODIES. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Risk stratification in patients with antiphospholipid antibodies (aPL) remains a clinical challenge [1].Objectives:We aimed to evaluate the role of Thrombin Generation Assay (TGA) in distinguishing various populations of aPL positive patients (with and without lupus anticoagulant - LA) and its association with β2GPI-dependent and anti-phosphatidyl-serine/prothrombin(aPS/PT) antibodies.Methods:One-hundred-and-eight patients were tested with TGA and divided as follows: 21 patients with aPS/PT IgG/IgM (Group 1), 29 with aβ2GPI IgG/IgM (Group 2), 31 with aPS/PT and aβ2GPI IgG/IgM (Group 3), 27 with aPS/PT and/or aβ2GPI IgM low-titers (Group 4). Table 1 resumes the clinical characteristics of the APS patients (excluding aPL asymptomatic). Thirty-one healthy donors (HDs) and 24 controls treated with VKA were also included.Results:The most deranged TGA and LA profile was observed in patients with both aPS/PT and aβ2GPI when compared to those with an isolated positivity for aPS/PT or aβ2GPI and patients with aPS/PT and/or aβ2GPI IgM at low titres (Figure 1). Similarly, patients with aPS/PT and/or aβ2GPI at medium/high titres presented with the higher rate of clinical manifestations.When comparing the TGA curves of APS patients, asymptomatic aPL positive (aPL+) subjects, HDs and controls treated with VKA, we observed that aPL+ patients (particularly those with a confirmed diagnosis of APS) showed a characteristic profile.Differences among groups were confirmed also when comparing APS clinical manifestations. When comparing Group 1 and Group 4 we found significant differences with respect to the number of thrombotic events (21vs.15,p<0.05), the number of venous events (9vs.3,p<0.05), the recurrence of thrombosis (19%vs.0%,p<0.05). Group 2 and Group 4 showed differences in the occurrence of venous thromboses (50vs.20,p<0.05), and in the occurrence of DVT (8vs.2,p<0.05). Group 3 and Group 4, had higher number of thrombotic events (36vs15, p<0.05), the occurrence and the number of venous events (46%-15vs20%-3,p<0.05), the occurrence of TIA and DVT (4-11vs0-2,p<0.05).When analysing the cumulative frequency of extra-criteria APS manifestations, Group 1,2 and 3 were comparable, while comparing Group 3 and those positive for aβ2GPI and/or aPS/PT IgM at low titres (Group 4) we found a statistically significant difference (71%vs13%,p<0.05).Conclusion:TGA seems a valuable approach to stratify aPL+ patients according to their risk profile. The differences among groups and different populations of autoantibodies specificities obtained from this test can be considered a translational validation of the increased thrombotic risk of patients with triple or tetra aPL positivity.References:[1]Miyakis S et al. International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS). J. Thromb. Haemost. 2006;4(2):295–306.Table 1.“Classical” and “Extra-criteria” APS clinical manifestations of each group (considering solely patients with a confirmed diagnosis of APS).Group 1: isolated aPS/PT+ IgG/IgM (16)Group 2: isolated aβ2GPI+ IgG/IgM(20)Group 3: aPS/PT+ and aβ2GPI+ IgG/IgM (24)Group 4: aPS/PT+ and/or aβ2GPI+ IgM low titres (15)APS clinical manifestationsThrombosis (Y/N), n (%)14 (87,5%)16 (80%)21 (87,5%)13 (86,6%)N of thrombotic events21233615Arterial thrombosis (Y/N), n (%)10 (62,5%)9 (45%)14 (58,3%)11 (73,3%)Arterial events, n13102112Venous thrombosis (Y/N), n (%)6 (37,5%)10 (50%)11 (45,8%)3 (20%)Venous events, n913153Pregnancy morbidity, n (%)3 (18,8%)4 (20%)3 (12,5%)2 (13,3%)Recurrent thrombosis (Y/N), n (%)3 (18,8%)3 (15%)7 (29,1%)0Livedo reticularis, n (%)1 (6,2%)1 (5%)4 (16,6%)0Thrombocytopenia, n (%)4 (25%)4 (20%)6 (25%)2 (13,3%)Valvular, n (%)1 (6,2%)02 (8,3%)0Peripheral artery disease, n (%)03 (15%)4 (16,6%)0Diffuse alveolar hemorrhage, n (%)001 (4,1%)0Figure 1.Graphical representation of the differences between TGA and LA profiles between groups.Disclosure of Interests:None declared
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Barinotti A, Radin M, Cecchi I, Foddai SG, Rubini E, Roccatello D, Sciascia S, Menegatti E. AB0008 APPLYING WHOLE EXOME SEQUENCING TO FAMILIAL ANTIPHOSPHOLIPID SYNDROME: NEW PLAYERS IN A RARE DISEASE? Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Antiphospholipid Syndrome (APS) is an autoimmune disease whose precise aetiology is still unknown, but the high heterogeneity of its manifestations and clinical course is presumably due to the occurrence of different mechanisms and alterations at different levels and pathways [1]. The first genetic studies in APS focused primarily on the human leukocytes antigen system region, but more recent data highlighted a role of other genes in APS susceptibility, primarily those involved in the immune response and in the haemostatic process.Objectives:We aimed to deepen the investigation of APS genetic background starting from a case of familial APS, analysing two siblings with thrombotic APS (Table 1), both triple positive for antiphospholipid antibodies (aPL).Table 1.Main clinical and laboratory characteristics of the patients included in the study.PatientAgeaPL ProfileRelevant Clinical History1 (F)51Triple positive (LA, aCL IgG, aβ2GPI IgG)Two episodes of ischemic stroke, one episode of CAPS (renal thrombotic microangiopathy, visual impairment, ischemic stroke)2 (M)47Triple positive (LA, aCL IgG, aβ2GPI IgG)Three episodes of deep vein thrombosis, regardless ongoing well conducted therapy vitamin k antagonist and additional retinal vein thrombosisLA: lupus anticoagulant; aCL: anti-cardiolipin antibodies; aβ2GPI: anti- β2 glycoprotein I antibodies; CAPS: catastrophic APS.Methods:Genomic DNA was extracted from peripheral blood and the samples underwent Whole Exome Sequencing (WES). Sequencing was done on a 100X coverage, and reads have been aligned to the human reference genome (GRCh37/hg19 assembly) using the Burrows–Wheeler Alignment tool (BWA). The mean sequencing depth on target regions was 170X for patient 1, 205X for patient 2, moreover, 99.50% of the targeted bases had at least 10X coverage for all the three donors. The resulting single nucleotide polymorphisms (SNPs) have been analysed through a step-by-step process based on their frequency population (using Genome Aggregation Database), their predicted effects on the protein (using VarSome) and a literature research about the genes carrying them. Moreover, genes previously associated with a pro-thrombotic tendency and with APS have been analysed in the two patients.Results:Starting from more than 120000 SNPs for each patients, the analysis led to reduce the list of SNPs of interest to 27 missense mutations. The complete literature research regarding the genes carrying these mutations allowed to further reduce the number of selected genes, focusing on those that exert a role potentially involved in APS pathogenesis and development. In particular, these genes (PLA2G6, HSPG2, BCL3, ZFAT, ATP2B2, CRTC3 and ADCY3) take part in the immune response and the vascular homeostasis. The list of the DNA missense variants of interest found in our cases of familial APS is resumed in Figure 2.Figure 2.List of DNA missense variants of interest found in patient 1 and 2. Genes potentially involved in APS pathogenesis and development are highlighted in bold.No mutations on genes known to be associated with a pro-thrombotic state (F5, F2, MTHFR, F13A1, PROC, PROS1, FGB and SERPINE1), or on genes previously associated with APS (B2GPI, PF4V1, SELP, TLR2, TLR4, GP Ia, GP1BA, F2R, F2RL1, TFPI, F3, VEGFA, FLT1, and TNF) have been found in the WES analysis.Conclusion:To some extent, this can be seen as a proof of concept of the complexity of APS. Efforts to interpret the genetic risk factors involved in the heterogeneous clinical features of the syndrome, for instance, the integration of WES and network-based approaches might help to identify and stratify patients at risk of developing APS.References:[1]Iuliano A, Galeazzi M, Sebastiani GD. Antiphospholipid syndrome’s genetic and epigenetic aspects. Autoimmun Rev. 2019;18(9).Disclosure of Interests:None declared
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Roccatello D, Sciascia S, Rossi D, Naretto C, Bazzan M, Solfietti L, Sandrone M, Radin M, Baldovino S, Menegatti E. Safety of outpatient percutaneous native renal biopsy in systemic autoimmune diseases: results from a monocentric cohort. Lupus 2018; 27:1393-1394. [PMID: 29325491 DOI: 10.1177/0961203317751645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- D Roccatello
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,2 Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - S Sciascia
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy.,2 Nephrology and Dialysis Unit, S. Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - D Rossi
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - C Naretto
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - M Bazzan
- 3 UOSD Hematology and Thrombosis Unit, S. Giovanni Bosco Hospital, Turin, Italy
| | - L Solfietti
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - M Sandrone
- 4 Radiology Department, S. Giovanni Bosco Hospital, Turin, Italy
| | - M Radin
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - S Baldovino
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - E Menegatti
- 1 Center of Research of Immunopathology and Rare Diseases-Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
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9
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Abstract
OBJECTIVE The gravitational gradient is the major component to face when considering the physiology of venous return, and there is a growing interest in understanding the mechanisms ensuring the heart filling, in the absence of gravity, for astronauts who perform long-term space missions. APPROACH The purpose of the Drain Brain project was to monitor the cerebral venous outflow of a crew member during an experiment on the International Space Station (ISS), so as to study the compensatory mechanisms that facilitate this essential physiological action in subjects living in a microgravity environment. Such venous function has been characterized by means of a novel application of strain-gauge plethysmography which uses a capacitive sensor. MAIN RESULTS In this contribution, preliminary results of our investigation have been presented. In particular, comparison of plethysmography data confirmed that long duration spaceflights lead to a redistribution of venous blood volume, and showed interesting differences in the amplitude of cardiac oscillations measured at the level of the neck veins. SIGNIFICANCE The success of the experiment has also demonstrated that thanks to its easy portability, non-invasiveness, and non-operator dependence, the proposed device can be considered as a novel tool for use aboard the ISS. Further trials are now under way to complete the investigation on the drainage function of the neck veins in microgravity.
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Affiliation(s)
- A Taibi
- Dipartimento di Fisica e Scienze della Terra, Università degli Studi di Ferrara and INFN, Sezione di Ferrara, via Saragat 1, 44122 Ferrara, Italy
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10
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Sciascia S, Baldovino S, Menegatti E, Solfietti L, Di Simone D, Rossi D, Roccatello D. FRI0347 Phenotypic Changes of Lymphocytes in Patients with Severe Systemic Lupus Erythematosus Treated with An Intensified B-Cell Depletion Therapy with Rituximab. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.4609] [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: 11/03/2022]
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11
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Mohammed N, Vannini M, Menegatti E, Tessari M, Zomboni P, Di Domenico G, Sisini F, Gambaccini M. Opening fraction time of internal jugular valves using ultrasound traces. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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12
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Abstract
OBJECTIVES To study the ultrastructure of intraluminal defects found in the internal jugular vein by using a scanning electron microscopy. METHODS Using a scanning electron microscopy, intraluminal septa and/or defective valves blocking the flow in the distal internal jugular vein of seven patients were studied together with the adjacent wall and compared with control specimen. RESULTS The internal jugular veins' wall showed a significant derangement of the endothelial layer as compared to controls. Surprisingly, no endothelial cells were found in the defective cusps, and the surface of the structure is covered by a fibro-reticular lamina. CONCLUSIONS Although the lack of endothelial cells in the internal jugular vein intraluminal obstacles is a further abnormality found in course of chronic cerebrospinal venous insufficiency, our investigation cannot clarify whether this finding is primary or caused by progressive loss of endothelium in relation to altered haemodynamic forces and/or to a past post-thrombotic/inflammatory remodelling.
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Affiliation(s)
- P Zamboni
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - V Tisato
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - E Menegatti
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - F Mascoli
- Vascular Disease Center, University of Ferrara, Italy Vascular and Endovascular Unit, S. Anna University Hospital, Ferrara, Italy
| | - S Gianesini
- Vascular Disease Center, University of Ferrara, Italy Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
| | - F Salvi
- IRCCS Neurosciences, Bologna, Italy
| | - P Secchiero
- Department of Morphology, Surgery, and Experimental Medicine, University of Ferrara, Italy
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13
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Rollino C, Roccatello D, Cavalli G, Amprimo MC, Quattrocchio G, Menegatti E, Mediate I, Ferrero A, Basolo B, Ferro M. Effects of ANCA-positive sera on the generation of oxygen free radicals by neutrophils. Contrib Nephrol 2015; 99:108-13. [PMID: 1458914 DOI: 10.1159/000421698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- C Rollino
- Divisone di Nefrologia e Dialisi, Ospedale Giovanni Bosco di Torino, Italia
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14
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Rollino C, Roccatello D, Coppo R, Menegatti E, Basolo B, Giraudo G, Martina G, Piccoli G. Experience on antineutrophil cytoplasm antibodies and antimyeloperoxidase antibodies in rapidly progressive glomerulonephritis. Contrib Nephrol 2015; 94:101-6. [PMID: 1687269 DOI: 10.1159/000420617] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- C Rollino
- Institute of Nephrourology, University of Turin, Italy
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15
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Crespini C, Bersani G, Menegatti E. PP-005 Complete formulae for parenteral nutrition in neonatal intensive care: a stability trial. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2015-000639.285] [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: 11/03/2022] Open
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16
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Gianesini S, Sisini F, di Domenico G, Menegatti E, Vannini M, Spath P, Caneva PD, Occhionorelli S, Tessari M, Gambaccini M, Zamboni P. Lower Limbs Venous Kinetics and Consequent Impact on Drainage Direction. J Vasc Surg Venous Lymphat Disord 2015; 3:120. [DOI: 10.1016/j.jvsv.2014.10.014] [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: 10/24/2022]
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17
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Gianesini S, Occhionorelli S, Menegatti E, Zuolo M, Tessari M, Spath P, Ascanelli S, Zamboni P. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology 2014; 30:157-71. [PMID: 24755924 DOI: 10.1177/0268355514531953] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [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
Along the years, scientific clinical data have been collected concerning the possible saphenous flow restoration without any ablation and according with the CHIVA strategy. Moreover, in 2013 a Cochrane review highlighted the smaller recurrence risk following a CHIVA strategy rather than a saphenous stripping. Nevertheless, the saphenous sparing strategy surely remains a not-so-worldwide-spread and accepted therapeutic option, also because considered not so immediate and easy to perform. Aim of this paper is to provide an easily accessible guide to an everyday use of a saphenous sparing strategy for chronic venous disease, highlighting how even apparently too complicated reflux patterns classifications can be fastly and successfully managed and exploited for a hemodynamic correction.
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Affiliation(s)
- S Gianesini
- Vascular Disease Center, University of Ferrara, Italy
| | | | - E Menegatti
- Vascular Disease Center, University of Ferrara, Italy
| | - M Zuolo
- Vascular Disease Center, University of Ferrara, Italy
| | - M Tessari
- Vascular Disease Center, University of Ferrara, Italy
| | - P Spath
- Vascular Disease Center, University of Ferrara, Italy
| | - S Ascanelli
- Vascular Disease Center, University of Ferrara, Italy
| | - P Zamboni
- Vascular Disease Center, University of Ferrara, Italy
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18
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Sisini F, Taibi A, Gambaccini M, Menegatti E, Zamboni P. Comment on "Reproducibility of cerebrospinal venous blood flow and vessel anatomy with the use of phase contrast-vastly undersampled isotropic projection reconstruction and contrast-enhanced MRA". AJNR Am J Neuroradiol 2014; 35:E3. [PMID: 24436344 DOI: 10.3174/ajnr.a3868] [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: 11/07/2022]
Affiliation(s)
- F Sisini
- Department of Physics and Earth Sciences
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19
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Baldovino S, Naretto C, Mereuta M, Sciascia S, Manna E, Salussolia I, Strani G, Giancaspero K, Menegatti E, Roccatello D. C1 esterase inhibitor deficiency and SLE: A case report and review of the literature. Mol Immunol 2013. [DOI: 10.1016/j.molimm.2013.05.122] [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: 10/26/2022]
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20
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Abstract
Objectives Fusion imaging technology (FIT) combines different imaging techniques by means of properly designed software. The aim of this study was to validate the ultrasonographic representation of intracranial vein anatomy by combining transcranial echo-colour Doppler (TECD) with conventional magnetic resonance imaging (MRI). In addition, we investigated the possibility of insonating the veins of the base of the skull through the novel condylar window. Methods We examined venous brain circulation in five healthy subjects by means of FIT, using a 1.5 T MR scanner and an ultrasound TECD equipped with Virtual Navigator technology. Results and conclusions Insonation of the Rosenthal and other intracranial veins through the classical transtemporal window, based on anatomical assumption, but never before validated by means of FIT study, was confirmed. Moreover, in all five subjects, FIT demonstrated the possibility of insonating the petrosal sinuses and the cavernous sinus area through the novel transcondylar approach. In conclusion, the feasibility of FIT of the intracranial veins potentially permits to study subjects in different postures and/or at the bed of non-transportable patients, after the initial MRI acquisition. Finally, the novel transcondylar approach allows obtaining haemodynamic information from the cavernous and the petrosal sinuses usually not investigated by TECD alone.
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Affiliation(s)
- P Zamboni
- Vascular Disease Center, University of Ferrara, Ferrara
| | - E Menegatti
- Vascular Disease Center, University of Ferrara, Ferrara
| | - G Viselner
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
| | - S Morovic
- Vascular Disease Center, University of Ferrara, Ferrara
| | - S Bastianello
- Neuroradiological Department, Fondazione Istituto Neurologico Nazionale Casimiro Mondino, University of Pavia, Pavia, Italy
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21
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Roccatello D, Sciascia S, Rossi D, Alpa M, Naretto C, Baldovino S, Menegatti E, La Grotta R, Modena V. Intensive short-term treatment with rituximab, cyclophosphamide and methylprednisolone pulses induces remission in severe cases of SLE with nephritis and avoids further immunosuppressive maintenance therapy. Nephrol Dial Transplant 2011; 26:3987-3992. [DOI: 10.1093/ndt/gfr109] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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22
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Zamboni P, Morovic S, Menegatti E, Viselner G, Nicolaides AN. Screening for chronic cerebrospinal venous insufficiency (CCSVI) using ultrasound--recommendations for a protocol. INT ANGIOL 2011; 30:571-597. [PMID: 22233619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses or obstructions of the internal jugular and/or azygos veins with disturbed flow and formation of collateral venous channels. Studies using ultrasound in patients with multiple sclerosis (MS) have demonstrated a high prevalence of CCSVI (mean 70%; range 0-100%; N.=1496), whereas, in normal controls and patients without MS the prevalence was much lower (mean 10%; range 0-36%; N.=635). Ultrasound uses a combination of physiological measurements as well as anatomical imaging and has been used for the detection of CCSVI by different centers with variable results. A high prevalence ranging from 62% to 100% of obstructive lesions has been found by some teams in patients with MS compared with a lower prevalence of 0-25% in controls. However, absence of such lesions or a lower prevalence (16-52%) has been reported by others. This variability could be the result of differences in technique, training, experience or criteria used. The current lack of a methodology shared among experts is a confounding element in epidemiologic studies, and does not permit further Bayesan or other kind of analysis. In order to ensure a high reproducibility of Duplex scanning with comparable accuracy between centers, a detailed protocol with standard methodology and criteria is proposed. This is also necessary for training. It has been shown that inter-rater variability increases post-training (from k=0.47 to k=0.80), while within-rater reproducibility in trained operators was k=0.75. Finally, the consensus document proposes a reporting standard of Duplex measurements, and future research to answer areas of uncertainty.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
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23
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Gentili V, Gianesini S, Balboni PG, Menegatti E, Rotola A, Zuolo M, Caselli E, Zamboni P, Di Luca D. Panbacterial real-time PCR to evaluate bacterial burden in chronic wounds treated with Cutimed™ Sorbact™. Eur J Clin Microbiol Infect Dis 2011; 31:1523-9. [PMID: 22113306 PMCID: PMC3364422 DOI: 10.1007/s10096-011-1473-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [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: 06/24/2011] [Accepted: 10/19/2011] [Indexed: 01/11/2023]
Abstract
The impact of polymicrobial bacterial infection on chronic wounds has been studied extensively, but standard bacteriological analysis is not always sensitive enough. Molecular approaches represent a promising alternative to the standard bacteriological analysis. This work aimed to assess the usefulness of a panbacterial quantitative real-time PCR reaction to quantitate the total bacterial load in chronic wounds treated with Cutimed™ Sorbact™, a novel therapeutic approach based on hydrophobic binding of bacteria to a membrane. The results obtained by panbacterial real-time PCR on conserved sequences of the bacterial 16S gene show that the bacterial burden significantly decreased in 10 out of 15 healing chronic wounds, and did not change in 5 out of 5 non-healing chronic wounds. On the contrary, classical culture for S. aureus and P. aeruginosa, and real-time PCR for Bacteroides and Fusobacterium did not show any correlation with the clinical outcome. Our study also shows that quantification of chronic wounds by panbacterial real-time PCR is to be performed on biopsies and not on swabs. These results show that panbacterial real-time PCR is a promising and quick method of determining the total bacterial load in chronic wounds, and suggest that it might be an important biomarker for the prognosis of chronic wounds under treatment.
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Affiliation(s)
- V Gentili
- Department of Experimental and Diagnostic Medicine, University of Ferrara, Via Borsari 46, 44121, Ferrara, Italy
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24
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Einaudi S, Napolitano E, Restivo F, Motta G, Baldi M, Tuli G, Grosso E, Migone N, Menegatti E, Manieri C. Genotype, phenotype and hormonal levels correlation in non-classical congenital adrenal hyperplasia. J Endocrinol Invest 2011; 34:660-4. [PMID: 21169730 DOI: 10.3275/7410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Non-classical congenital adrenal hyperplasia (NCAH) is a morbid condition sustained by the reduced function of one of the enzymes involved in the adrenal steroid biosynthesis pathway, mainly the 21-hydroxylase. Different degrees of enzyme activity impairment determine different clinical pictures, with childhood or post-pubertal onset. The aim of this study was to evaluate the relationship between genotype, phenotype, and adrenal hormonal levels in a group of 66 patients affected by NCAH attending outpatient pediatric or endocrinological Clinics. Our findings show that age at pubarche/menarche was significantly younger, height SD score) and Δ bone age-chronological age were significantly higher in patients with a more severe enzyme activity impairment, while cutaneous androgenization and menstrual irregularities in post-pubertal girls were not related to the grading of genotype.
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Affiliation(s)
- S Einaudi
- Division of Pediatric Endocrinology and Diabetology, University of Turin, Turin, Italy
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25
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Napolitano E, Manieri C, Restivo F, Composto E, Lanfranco F, Repici M, Pasini B, Einaudi S, Menegatti E. Correlation between genotype and hormonal levels in heterozygous mutation carriers and non-carriers of 21-hydroxylase deficiency. J Endocrinol Invest 2011; 34:498-501. [PMID: 20671415 DOI: 10.3275/7225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital adrenal hyperplasia, both in its classic (CCAH) and non-classic form (NCAH), is a morbid condition sustained by the absent or reduced function of one of the enzymes involved in cortisol biosynthesis - mainly 21 hydroxylase - associated with different levels of clinical androgenization. In a wide group of relatives of patients affected by CCAH and NCAH (no.=222) and healthy volunteers (no.=30), a clinical, hormonal and genetic evaluation was performed in order to differentiate between the condition of heterozygous mutation carrier and non-carrier of any among 21-hydroxylase gene (CYP21) mutations. This study shows that clinical presentation and basal 17α-hydroxyprogesterone (17α-OHP) are not able to differentiate between heterozygous carriers and non-carriers, whereas 17α-OHP value after ACTH bolus is significantly different between heterozygous carriers and non-carriers: p<0.001 with a cut-off value of 3 ng/ml (90% sensitivity and 74,3% specificity). Moreover, our data indicate that 17α-OHP response to ACTH may be a useful tool to select subjects for genetic analysis.
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Affiliation(s)
- E Napolitano
- Division of Endocrinology, Diabetology and Metabolism, Department of Internal Medicine, University of Turin, Turin, Italy
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26
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Abstract
The objective of this study is to report an overlooked cause of cervical swelling linked to a thoracic duct (TD) intraluminal obstruction. Four consecutive patients underwent supraclavicular fossa echo-colour-Doppler assessment (ECD) because of recurrent spontaneous cervical swelling. In all patients, during the swelling period we documented a TD dilation with hyperechogenic content, resulting undetectable during asymptomatic periods; ECD also allowed an effective differential diagnosis with TD cysts, obstructive malignancy or other causes of cervical swelling. In conclusion, ECD is to be considered an effective tool in cervical swelling and TD anomalies investigation.
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Affiliation(s)
- C Franceschi
- Vascular Surgery Department, Hopital Saint-Joseph, Paris, France
| | - S Gianesini
- Vascular Disease Centre, University of Ferrara, Ferrara, Italy
| | - A Bahnini
- Vascular Surgery Department, American Hospital of Paris and Pitié-Salpétrière University Hospital, Paris, France
| | - C Laurian
- Vascular Surgery Department, Hopital Saint-Joseph, Paris, France
| | - E Menegatti
- Vascular Disease Centre, University of Ferrara, Ferrara, Italy
| | - P Zamboni
- Vascular Disease Centre, University of Ferrara, Ferrara, Italy
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27
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Zivadinov R, Galeotti R, Hojnacki D, Menegatti E, Dwyer MG, Schirda C, Malagoni AM, Marr K, Kennedy C, Bartolomei I, Magnano C, Salvi F, Weinstock-Guttman B, Zamboni P. Value of MR venography for detection of internal jugular vein anomalies in multiple sclerosis: a pilot longitudinal study. AJNR Am J Neuroradiol 2011; 32:938-46. [PMID: 21474626 DOI: 10.3174/ajnr.a2386] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE CCSVI was recently described in patients with MS. CCSVI is diagnosed noninvasively by Doppler sonography and invasively by catheter venography. We assessed the role of conventional MRV for the detection of IJV anomalies in patients with MS diagnosed with CCSVI and in healthy controls who underwent MRV and Doppler sonography examinations during 6 months. MATERIALS AND METHODS Ten patients with MS underwent TOF, TRICKS, Doppler sonography, and catheter venography at baseline. They were treated at baseline with percutaneous angioplasty and re-evaluated 6 months' posttreatment with MRV and Doppler sonography. In addition, 6 healthy controls underwent a baseline and a 6-month follow-up evaluation by Doppler sonography and MRV. RESULTS At baseline, the sensitivity, specificity, PPV, and NPV of Doppler sonography for detecting IJV abnormalities relative to catheter venography in patients with MS were calculated, respectively, at 82%, 100%, 99%, and 95%. The figures were 99%, 33%, 33%, 99% for TOF and 99%, 39%, 35%, and 99% for TRICKS. Venous anomalies included the annulus, septum, membrane, and malformed valve. No agreement was found between TOF and catheter venography in 70% of patients with MS and between TRICKS and catheter venography in 60% of patients with MS. At follow-up, 50% of the patients with MS presented with abnormalities on Doppler sonography but only 30% were diagnosed with restenosis. CONCLUSIONS Conventional MRV has limited value for assessing IJV anomalies for both diagnostic and posttreatment purposes.
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Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, State University of New York, Buffalo, USA.
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28
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Arduino PG, Menegatti E, Scoletta M, Battaglio C, Mozzati M, Chiecchio A, Berardi D, Vandone AM, Donadio M, Gandolfo S, Scully C, Broccoletti R. Vascular endothelial growth factor genetic polymorphisms and haplotypes in female patients with bisphosphonate-related osteonecrosis of the jaws. J Oral Pathol Med 2011; 40:510-5. [PMID: 21251073 DOI: 10.1111/j.1600-0714.2010.01004.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the polymorphisms of the vascular endothelial growth factor (VEGF) gene in relation to female patients who developed bisphosphonate-related osteonecrosis of the jaws (BRONJ). METHODS Test subjects were 30 Italian female patients with BRONJ (Group A). Control subjects were 30 female patients with a history of intravenous bisphosphonate use without any evidence of osteonecrosis (Group B) and 125 unrelated healthy volunteers (Group C). Three single-nucleotide polymorphisms were investigated: -634 G>C, occurring in 5' untranslated region (UTR); +936 C>T, occurring in 3' UTR; and -2578 C>A of the promoter region. RESULTS The frequency of the VEGF CAC (+936/-2578/-634) haplotype was increased in patients with BRONJ, compared with female disease-negative controls [odds ratio (OR) = 2.76, 95% CI = 1.09-4.94, P = 0.039; corrected P value: P(c) = 0.117], and was also increased compared with female healthy controls (OR = 2.11, 95% CI = 1.14-3.89, P = 0.024; corrected P value: P(c) = 0.072). The CC homozygotes of -634G>C of VEGF gene and AA homozygotes of -2578C>A have also been significantly correlated in female patients who developed BRONJ compared with healthy controls (OR = 2.04, 95% CI = 1.12-3.70, P = 0.008; corrected P value: P(c) = 0.024). CONCLUSIONS These results suggest a possible haplotype effect of VEGF polymorphisms expression in BRONJ Italian female patients. Studies with different and larger populations possibly using TagSNP to represent all haplotypes within the VEGF gene are needed to further delineate the genetic contribution of this gene to BRONJ.
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Affiliation(s)
- P G Arduino
- Department of Biomedical Sciences and Human Oncology, Oral Medicine Section, University of Turin, Turin, Italy.
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29
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Cortesi R, Ravani L, Zaid AN, Menegatti E, Romagnoli R, Drechsler M, Esposito E. Ethosomes for the delivery of anti-HSV-1 molecules: preparation, characterization and in vitro activity. Pharmazie 2010; 65:743-749. [PMID: 21105576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
This paper describes the production, characterization and in vitro activity of ethosomes containing two molecules with antiviral activity, such as acyclovir (ACY) and N1-beta-D-ribofuranosyl-pyrazole [3,4d]pyridazin-7(6p-chlorine-phenyl)-one nucleoside (N1CP). Ethosomes were prepared and morphologically characterized by Cryo-TEM. The encapsulation efficiency was 92.3 +/- 2.5% for ACY and 94.2 +/- 2.8% for N1CP. The release of the drug from vesicles, determined by a Franz cell method, indicated that both drugs were released in a controlled manner. In order to possibly guarantee the stability during long-term storage ethosome suspensions was freeze-dried. It was found that the freeze-dried ethosomes' cakes were compact, glassy characterized by low density and quick re-hydration. However, the storage time slightly influences the percentage of drug encapsulation within ethosomes showing a drug leakage after re-hydration around 10%. The antiviral activity against HSV-1 of both drugs was tested by plaque reduction assay in monolayer cultures of Vero cells. Data showed that ethosomes allowed a reduction of the ED50 of N1CP evidencing an increase of its antiviral activity. However, ACY remains more active than N1CP. No differences are appreciable between drug-containing ethosomes before and after freeze-drying. Taken together these results, ethosomal formulation could be possibly proposed as mean for topical administration of anti-herpetic molecules.
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Affiliation(s)
- R Cortesi
- Department of Pharmaceutical Sciences, University of Ferrara BioPharmaNet, Technologic Pole of Ferrara University, Ferrara, Italy.
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Esposito E, Drechsler M, Mariani P, Sivieri E, Bozzini R, Montesi L, Menegatti E, Cortesi R. Nanosystems for skin hydration: a comparative study. Int J Cosmet Sci 2010; 29:39-47. [PMID: 18489310 DOI: 10.1111/j.1467-2494.2007.00362.x] [Citation(s) in RCA: 21] [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: 11/28/2022]
Abstract
The present investigation describes a comparative study for the design of innovative topical formulation for skin hydration. In particular, different colloidal forms based on lipidic components have been produced and characterized. Morphology and dimensional distribution have been investigated by means of electron microscopy and photon correlation spectroscopy. Nanoparticulate systems characterized by different morphology and dimensions depending on production procedures have been obtained, namely cubosomes, nanovesicles, solid lipid nanoparticles and liposomes. Hydration power has been studied by means of a corneometer, measuring the skin electrical capacitance before and after the application of opportunely viscosized nanoparticulate systems. It has been demonstrated that nanovesicle gel displayed a pronounced hydration power with respect to the other nanostructured forms, its hydration effect on skin was 3.5-fold higher, with respect to the untreated area, after 5 min from the application and 1.5-fold higher after 2 h.
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Affiliation(s)
- E Esposito
- Department of Pharmaceutical Sciences, University of Ferrara, I-44100 Ferrara, Italy.
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Zamboni P, Gianesini S, Menegatti E, Tacconi G, Palazzo A, Liboni A. Great saphenous varicose vein surgery without saphenofemoral junction disconnection. Br J Surg 2010; 97:820-5. [DOI: 10.1002/bjs.7022] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
The aim of this case–control study was to determine whether preoperative duplex imaging could predict the outcome of varicose vein surgery without saphenofemoral junction (SFJ) disconnection. The duplex protocol included a reflux elimination test (RET) and assessment of the competence of the terminal valve of the femoral vein.
Methods
One hundred patients with chronic venous disease who had a positive RET result and an incompetent terminal valve were compared with 100 patients matched for age, sex, clinical class (Clinical Etiologic Anatomic Pathophysiologic (CEAP) class C2–C6) and disease duration, but who had a positive RET result and a competent terminal valve. All patients underwent ligation and proximal avulsion of the incompetent tributaries from the great saphenous vein trunk without SFJ disconnection. Clinical and duplex follow-up lasted for 3 years, and included Hobbs' clinical score.
Results
Of legs with a competent terminal valve, 100 per cent were rated as cured (Hobbs' class A or B) and 14·0 per cent developed recurrent varices. Patients with an incompetent terminal valve had significantly worse results: 29·0 per cent had Hobbs' class A or B and 82·0 per cent developed recurrence (P < 0·001).
Conclusion
Preoperative duplex assessment of the terminal valve could be used to identify patients suitable for varicose vein surgery without the need for SFJ disconnection.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - S Gianesini
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - E Menegatti
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - G Tacconi
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - A Palazzo
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
| | - A Liboni
- Vascular Diseases Centre, Department of Surgery, University of Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy
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Menegatti E, Genova V, Tessari M, Malagoni AM, Bartolomei I, Zuolo M, Galeotti R, Salvi F, Zamboni P. The reproducibility of colour Doppler in chronic cerebrospinal venous insufficiency associated with multiple sclerosis. INT ANGIOL 2010; 29:121-126. [PMID: 20351668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome described in multiple sclerosis (MS) patients, characterized by stenosis of the main extracranial veins with hampered cerebral venous outflow. In the original description echo-colour Doppler demonstrated to be an ideal non invasive tool for screening CCSVI patients, but the reproducibility was not assessed. Aim of this study is to assess the variability coefficient between trained and in not trained echo-colour Doppler operators. METHODS Thirty-six (36) subjects, matched for age and gender, were subset in 3 groups (group A, 12 healthy controls, HC; group B, 12 multiple sclerosis patients, MS; group C, 12 patients with other neurological disease, OND) underwent echo-colour Doppler screening for CCSVI according to an original protocol previously described. The inter observer variability rate was assessed by comparing respectively trained vs not trained operators, and trained vs trained operators, by using the same echo-colour Doppler equipment. In addition, by scanning 15 subjects after one month from the first session, intra observer coefficient was also assessed in trained operator. RESULTS The inter observer variability rate between trained and not trained echo-colour Doppler operators, were not completely satisfactory (K coefficient 0.47 95% CI 0.27-0.68). To the contrary the inter observer agreement between trained operators was much more reliable (K coefficient 0.80 95% CI 0.59-1.01). Finally, the intra observer variability rate in trained operators was 0.93, (95% CI 0.80-1.06) confirming a highly satisfactory agreement. CONCLUSION Echo-colour Doppler is a powerful, non-invasive and reproducible tool for screening CCSVI-MS but it needs special training.
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Affiliation(s)
- E Menegatti
- Vascular Diseases Centre, University of Ferrara, Italy.
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Zivadinov R, Schirda C, Dwyer MG, Haacke ME, Weinstock-Guttman B, Menegatti E, Heininen-Brown M, Magnano C, Malagoni AM, Wack DS, Hojnacki D, Kennedy C, Carl E, Bergsland N, Hussein S, Poloni G, Bartolomei I, Salvi F, Zamboni P. Chronic cerebrospinal venous insufficiency and iron deposition on susceptibility-weighted imaging in patients with multiple sclerosis: a pilot case-control study. INT ANGIOL 2010; 29:158-175. [PMID: 20351672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular phenomenon recently described in multiple sclerosis (MS) that is characterized by stenoses affecting the main extracranial venous outflow pathways and by a high rate of cerebral venous reflux that may lead to increased iron deposition in the brain. Aim of this study was to investigate the relationship between CCSVI and iron deposition in the brain of MS patients by correlating venous hemodynamic (VH) parameters and iron concentration in deep-gray matter structures and lesions, as measured by susceptibility-weighted imaging (SWI), and to preliminarily define the relationship between iron measures and clinical and other magnetic resonance imaging (MRI) outcomes. METHODS Sixteen (16) consecutive relapsing-remitting MS patients and 8 age- and sex-matched healthy controls (HC) were scanned on a GE 3T scanner, using SWI. RESULTS All 16 MS patients fulfilled the diagnosis of CCSVI (median VH=4), compared to none of the HC. In MS patients, the higher iron concentration in the pulvinar nucleus of the thalamus, thalamus, globus pallidus, and hippocampus was related to a higher number of VH criteria (P<0.05). There was also a significant association between a higher number of VH criteria and higher iron concentration of overlapping T2 (r=-0.64, P=0.007) and T1 (r=-0.56, P=0.023) phase lesions. Iron concentration measures were related to longer disease duration and increased disability as measured by EDSS and MSFC, and to increased MRI lesion burden and decreased brain volume. CONCLUSION The findings from this pilot study suggest that CCSVI may be an important mechanism related to iron deposition in the brain parenchyma of MS patients. In turn, iron deposition, as measured by SWI, is a modest-to-strong predictor of disability progression, lesion volume accumulation and atrophy development in patients with MS.
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Affiliation(s)
- R Zivadinov
- Buffalo Neuroimaging Analysis Center, University at Buffalo, Buffalo, NY, USA.
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Malagoni AM, Galeotti R, Menegatti E, Manfredini F, Basaglia N, Salvi F, Zamboni P. Is chronic fatigue the symptom of venous insufficiency associated with multiple sclerosis? A longitudinal pilot study. INT ANGIOL 2010; 29:176-182. [PMID: 20351673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic fatigue (CF) severely affects patients with multiple sclerosis (MS), but its pathogenesis remains elusive and the effectiveness of available treatments is modest. We aimed to evaluate the effect on CF of the balloon dilatation of stenosing lesions affecting the main extracranial veins configuring the chronic cerebrospinal venous insufficiency (CCSVI), a condition strongly associated with MS. METHODS Thirty-one MS consecutive patients (16 males, age 46.2+/-9.4 years) with associated CCSVI and CF underwent the endovascular procedure. Fatigue was assessed using the Fatigue Severity Scale (FSS) and Modified Fatigue Impact Scale (MFIS) at baseline (T0) and one (T1), six (T6) and twelve (T12) months after the procedure. In ambulatory patients (N.=28), mobility was evaluated using the 6-min walking test at T0 and T1. RESULTS and MFIS scores significantly improved from preoperative values, and the positive trend was maintained at one year (FSS: T0=5.1+/-1.0 to T12=3.5+/-1.8, P<0.001; MFIS-total score: T0=34.9+/-14.8 to T12=22.5+/-13.7, P<0.001; MFIS-Physical subscale: T0=21.2+/-8.0 to T12=13.5+/-9.7 P<0.001; MFIS-Cognitive subscale: T0=9.2+/-9.5 to T12=6.0+/-6.3, P=0.03; MFIS-Psychosocial subscale: T0=4.5+/-2.1 to T12=2.5+/-2.1, P<0.001). Six-min walking distance (6MWD) at T1 improved significantly (332+/-190m to 378+/-200m, P=0.0002). In addition, an inverted correlation between 6MWD and MFIS-physical subscale variations was found in the subgroup of patients (N.=8) with no lower limb motor impairment (r=-0.74, P=0.035). CONCLUSION The reestablishment of cerebral venous return dramatically reduced CF perception in a group of MS patients with associated CCSVI, suggesting that CF is likely the symptom of CCSVI.
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Affiliation(s)
- A M Malagoni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
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Hojnacki D, Zamboni P, Lopez-Soriano A, Galleotti R, Menegatti E, Weinstock-Guttman B, Schirda C, Magnano C, Malagoni AM, Kennedy C, Bartolomei I, Salvi F, Zivadinov R. Use of neck magnetic resonance venography, Doppler sonography and selective venography for diagnosis of chronic cerebrospinal venous insufficiency: a pilot study in multiple sclerosis patients and healthy controls. INT ANGIOL 2010; 29:127-139. [PMID: 20351669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular condition characterized by anomalies of primary veins outside the skull that restrict normal outflow of blood from the brain. CCSVI was recently described as highly prevalent in patients with multiple sclerosis (MS), and can be non-invasively diagnosed by Doppler sonography (DS) and invasively by selective venography (SV). The aim of this paper was to investigate the value of neck magnetic resonance venography (MRV) for the diagnosis of CCSVI compared to DS and SV in patients with MS and in healthy controls (HC). METHODS Ten MS patients and 7 HC underwent DS, 2D-Time-Of-Flight venography (TOF) and 3D-Time Resolved Imaging of Contrast Kinetics angiography (TRICKS). MS patients also underwent SV. The internal jugular veins (IJVs) and the vertebral veins (VVs) were assessed by both MRV sequences, and the findings were validated against SV and DS. SV has been considered the diagnostic gold standard for MS patients. RESULTS All MS patients and none of the HC presented CCSVI, according to the DS criteria. This was confirmed by SV. For CCSVI diagnosis, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, whereas the figures were 40%, 85%, 58%, 80% and 50% for 3D-TRICKS, and 30%, 85%, 52%, 75% and 46% for 2D-TOF in the IJVs. In MS patients, compared to SV, DS showed sensitivity, specificity, accuracy, PPV and NPV of 100%, 75%, 95%, 94% and 100%, whereas the figures were 31%, 100%, 45%, 100% and 26% for 3D-TRICKS and 25%, 100%, 40%, 100% and 25% for 2D-TOF in the IJVs. CONCLUSION The use of MRV for diagnosis of CCSVI in MS patients has limited value, and the findings should be interpreted with caution and confirmed by other imaging techniques such as DS and SV.
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Affiliation(s)
- D Hojnacki
- The Jacobs Neurological Institute, State University of New York, Buffalo, NY, USA.
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Bartolomei I, Salvi F, Galeotti R, Salviato E, Alcanterini M, Menegatti E, Mascalchi M, Zamboni P. Hemodynamic patterns of chronic cerebrospinal venous insufficiency in multiple sclerosis. Correlation with symptoms at onset and clinical course. INT ANGIOL 2010; 29:183-188. [PMID: 20351674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM Chronic cerebrospinal venous insufficiency (CCSVI) is associated with multiple sclerosis (MS). CCSVI is detected by transcranial and extracranial color-Doppler high-resolution examination (TCCS-ECD) and venography that permit to identify five types of venous malformations and four major (A-D) hemodynamic patterns of anomalous extracranial-extravertebral venous outflow. We investigated possible correlation between such hemodynamic patterns and both the symptoms at onset and clinical course in patients with MS and CCSVI. METHODS TCCS-ECD, selective venography and clinical records of 65 patients affected by definite MS and CCSVI were reviewed. RESULTS The four hemodynamic patterns of CCSVI were unevenly (P<0.0001) distributed with respect to the types of clinical presentation and course. In particular the Type A or B patterns were common in patients with onset of optic neuritis, but rare in patients presenting with spinal cord symptoms who typically showed a type D pattern. As well, the type A or type B hemodynamic were more common in patients with relapsing remitting course than in patients with secondary progressive course and rare in patients with primary progressive course. The C hemodynamic pattern was not observed in patients with primary progressive course who showed a remarkable prevalence of the type D pattern. CONCLUSION The distribution of venous malformations and the resulting hemodynamic pattern show correlation with symptoms at onset and clinical course in patients with MS and CCSVI.
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Affiliation(s)
- I Bartolomei
- Center for Rare and Neuroimmunitary Diseases, Department of Neurological Science, Bellaria Hospital, Bologna, Italy
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Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojnacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Ramanathan M, Zivadinov R. CSF dynamics and brain volume in multiple sclerosis are associated with extracranial venous flow anomalies: a pilot study. INT ANGIOL 2010; 29:140-148. [PMID: 20351670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIM We previously reported unexpectedly robust associations between vascular haemodynamic (VH) anomalies in the principal extracranial cerebral veins, causing chronic cerebrospinal venous insufficiency (CCSVI), and multiple sclerosis (MS). Aim of this study was to investigate the relationship between the VH changes and MRI measures of MS disease severity in a cross sectional survey. METHODS The number of anomalous VH criteria were measured using an echo-color Doppler, whereas CSF flow, atrophy and lesion measures were obtained from quantitative magnetic resonance imaging (MRI) analysis in sixteen consecutive relapsing-remitting MS patients, (mean age: 36.1+/-SD 7.3 years, disease duration: 7.5+/-1.9 years and median EDSS: 2.5) and in 8 healthy controls (HC) with similar age and sex distributions. RESULTS All 16 MS patients investigated and none of the HCs met the VH criteria for CCSVI (P<0.0001). MS patients showed significantly lower net CSF flow compared to the HC (P=0.038) that was associated with number of anomalous VH criteria present (r=0.79, P<0.001). Moreover, increases in the number of anomalous VH criteria present were negatively associated with lower whole brain volume (Spearman R=-0.5, P=0.05). CONCLUSION VH changes occur more frequently in MS patients than controls. Altered VH is associated with abnormal CSF flow dynamics and decreased brain volume.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrara-Bellaria Neurosciences, Ferrara and Bologna, Italy.
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Zamboni P, Galeotti R, Weinstock-Guttman B, Cutter G, Menegatti E, Malagoni A, Bartolomei I, Cox J, Salvi F, Zivadinov R. Endovascular Treatment for Chronic Cerebrospinal Venous Insufficiency in Multiple Sclerosis: A Longitudinal, Magnetic Resonance Imaging, Blinded Pilot Study. J Vasc Surg 2010. [DOI: 10.1016/j.jvs.2009.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Zamboni P, Menegatti E, Weinstock-Guttman B, Schirda C, Cox JL, Malagoni AM, Hojanacki D, Kennedy C, Carl E, Dwyer MG, Bergsland N, Galeotti R, Hussein S, Bartolomei I, Salvi F, Zivadinov R. The severity of chronic cerebrospinal venous insufficiency in patients with multiple sclerosis is related to altered cerebrospinal fluid dynamics. Funct Neurol 2009; 24:133-138. [PMID: 20018140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Chronic cerebrospinal venous insufficiency (CCSVI) is a vascular picture that shows a strong association with multiple sclerosis (MS). The aim of this study was to investigate the relationship between a Doppler cerebral venous hemodynamic insufficiency severity score (VHISS) and cerebrospinal fluid (CSF) flow dynamics in 16 patients presenting with CCSVI and relapsing-remitting MS (CCSVI-MS) and in eight healthy controls (HCs). The two groups (patients and controls) were evaluated using validated echo-Doppler and advanced 3T-MRI CSF flow measures. Compared with the HCs, the CCSVI-MS patients showed a significantly lower net CSF flow (p=0.027) which was highly associated with the VHISS (r=0.8280, r2=0.6855; p=0.0001). This study demonstrates that venous outflow disturbances in the form of CCSVI significantly impact on CSF pathophysiology in patients with MS.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrera, and Bellaria Neurosciences, Ferrara and Bologna, Italy.
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Zamboni P, Galeotti R, Menegatti E, Malagoni AM, Tacconi G, Dall'Ara S, Bartolomei I, Salvi F. Chronic cerebrospinal venous insufficiency in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry 2009; 80:392-9. [PMID: 19060024 PMCID: PMC2647682 DOI: 10.1136/jnnp.2008.157164] [Citation(s) in RCA: 454] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The extracranial venous outflow routes in clinically defined multiple sclerosis (CDMS) have not previously been investigated. METHODS Sixty-five patients affected by CDMS, and 235 controls composed, respectively, of healthy subjects, healthy subjects older than CDMS patients, patients affected by other neurological diseases and older controls not affected by neurological diseases but scheduled for venography (HAV-C) blindly underwent a combined transcranial and extracranial colour-Doppler high-resolution examination (TCCS-ECD) aimed at detecting at least two of five parameters of anomalous venous outflow. According to the TCCS-ECD screening, patients and HAV-C further underwent selective venography of the azygous and jugular venous system with venous pressure measurement. RESULTS CDMS and TCCS-ECD venous outflow anomalies were dramatically associated (OR 43, 95% CI 29 to 65, p<0.0001). Subsequently, venography demonstrated in CDMS, and not in controls, the presence of multiple severe extracranial stenosis, affecting the principal cerebrospinal venous segments; this provides a picture of chronic cerebrospinal venous insufficiency (CCSVI) with four different patterns of distribution of stenosis and substitute circle. Moreover, relapsing-remitting and secondary progressive courses were associated with CCSVI patterns significantly different from those of primary progressive (p<0.0001). Finally, the pressure gradient measured across the venous stenosies was slightly but significantly higher. CONCLUSION CDMS is strongly associated with CCSVI, a scenario that has not previously been described, characterised by abnormal venous haemodynamics determined by extracranial multiple venous strictures of unknown origin. The location of venous obstructions plays a key role in determining the clinical course of the disease.
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Affiliation(s)
- P Zamboni
- Vascular Diseases Center, University of Ferrara, Ferrara, Italy.
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Gianesini S, Menegatti E, Tacconi G, Scognamillo F, Liboni A, Zamboni P. Echo-guided foam sclerotherapy treatment of venous malformation involving the sciatic nerve. Phlebology 2009; 24:46-7. [DOI: 10.1258/phleb.2008.008058] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Primary sciatic nerve varices (SNV) lie within the sciatic nerve possibly causing chronic venous disease and sciatic pain as well. We report a series of 12 consecutive patients affected by symptomatic SNV. All of them were treated by echo-guided Tessari foam sclerotherapy (EGFSCL). Mean follow up lasted two years. Reflux through the sciatic veins, as the connected superficial varicose veins, disappeared in the entire cohort and only minor complications have emerged. EGFSCL seems to be both safe and effective, so representing a reliable and minimally invasive treatment.
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Affiliation(s)
- S Gianesini
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - E Menegatti
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - G Tacconi
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - F Scognamillo
- Institute of Surgical Pathology, University of Sassari, Italy
| | - A Liboni
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
| | - P Zamboni
- Department of Surgery, Vascular Diseases Centre, University of Ferrara
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Menegatti E, Ferroni R, Benassi CA, Rocchi R. Arginine modification in Kunitz bovine trypsin inhibitor through 1, 2-cyclohexanedione. Int J Pept Protein Res 2009; 10:146-52. [PMID: 302243 DOI: 10.1111/j.1399-3011.1977.tb02788.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Arginine residues (5.5 out of 6) of the trypsin-kallikrein inhibitor from bovine organs (Kunitz inhibitor) were selectively modified by reaction with 1, 2-cyclohexanedione in sodium borate buffer, pH 9.0. The modified inhibitor is still highly active in inhibiting trypsin and chymotrypsin at 1:1 inhibitor: enzyme molar ratio and full inhibition was achieved at slightly higher molar ratio. The extent of correct refolding, upon reoxidation, of the reduced, arginine-modified inhibitor is diminished and regeneration of two arginines occurred under the reduction conditions. The stability constants and the standard-free energies of binding of the complexes between trypsin, or chymotrypsin, and the native, the arginine-modified and the reduced and reoxidized arginine-modified inhibitor have been determined from inhibitory assays.
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Rocchi R, Benassi CA, Tomatis R, Ferroni R, Menegatti E. On the reaction of acetamidomethanol with native and reduced bovine pancreatic trypsin inhibtor (Kunitz inhibitor). Int J Pept Protein Res 2009; 8:167-75. [PMID: 1270188 DOI: 10.1111/j.1399-3011.1976.tb02492.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The stability of native and reduced bovine pancreatic trypsin inhibitor (Kunitz inhibitor) in anhydrous hydrogen fluoride and their reaction with acetamidomethanol, in the same solvent, have been investigated. The bovine Kunitz inhibitor appears to be stable in liquid hydrogen fluoride but the reduced molecule loses about 50% of its ability to regain inhibitory power, upon air oxidation, by exposure to this solvent. Tyrosine residues appear to be affected by acetamidomethylation of the native protein to give a modified inhibitor which is still highly active in inhibiting trypsin. The extent of correct refolding, upon reoxidation, of the reduced tyrosine modified-inhibitor is greatly diminished. Tyrosine modification can be prevented by carrying out the acetamidomethylation reaction in the presence of excess anisole. The stability constants and the standard free energies of binding of the complexes between trypsin and the native and the tyrosine modified-inhibitor have been determined.
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Alpa M, Ferrero B, Cavallo R, Naretto C, Menegatti E, Di Simone D, Napoli F, La Grotta R, Rossi D, Baldovino S, Sena L, Roccatello D. Anti-neuronal antibodies in patients with HCV-related mixed cryoglobulinemia. Autoimmun Rev 2008; 8:56-8. [DOI: 10.1016/j.autrev.2008.07.027] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Cortesi R, Marastoni M, Tomatis R, Menegatti E, Esposito E, Nastruzzi C. Peptide-based cationic molecules for the production of positive charged liposomes and micelles. J Microencapsul 2008; 25:71-81. [PMID: 18246485 DOI: 10.1080/02652040701711403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper describes the synthesis and the physico-chemical characterization of cationic peptides (CPs) for possible application as non-viral gene delivery systems. Particularly, the production of cationic liposomes and micelle solutions was considered. Liposomes were prepared by REV-phase and extrusion presenting an average diameter reflecting the pore size of the membrane used for the extrusion. After DNA complexation the mean diameter of complexes decreased by increasing the number of positive charges. The non-complexed liposome preparations showed a net positive zeta potential comprised between 17.8-30 mV. After adding Defibrotide (DFT) to liposomes (at a 1:4 +/- molar ratio) the zeta potential fell down to a net negative value indicating the formation of the ionic complex. Concerning micelles, before complexation it was not possible to measure their size by PCS. However, after DFT complexation the size of complexes highly increased. In addition, as previously seen for liposomes, before complexation, the five CPs solutions showed a positive zeta potential ranging from 10-17.8 mV, while after addition of DFT the zeta potential fell to negative values. Concerning toxicity studies, in general CP-liposomes displayed a lower toxicity towards K562 cells as compared to the corresponding CP-solution. Taking into account these results, the studied CPs could be efficiently used to obtain both cationic liposomes and micelles. Moreover they are able to complex DNA with different interaction strength, depending on the type of peptide-based cationic molecule used.
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Affiliation(s)
- R Cortesi
- Dipartimento di Scienze Farmaceutiche, Università di Ferrara, via Fossato di Mortara 19, Ferrara, Italy.
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Antonelli A, Ferri C, Galeazzi M, Giannitti C, Manno D, Mieli-Vergani G, Menegatti E, Olivieri I, Puoti M, Palazzi C, Roccatello D, Vergani D, Sarzi-Puttini P, Atzeni F. HCV infection: pathogenesis, clinical manifestations and therapy. Clin Exp Rheumatol 2008; 26:S39-S47. [PMID: 18570753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Chronic hepatitis C virus (HCV) infection is a worldwide public health problem with a global prevalence of 2-3%. It is believed that about 170 million people are currently infected (about 3% of the world's population), and a further 3-4 million are infected each year. HCV is the main reason for liver transplantation in the developed world, and the main cause of liver-related morbidity and mortality in a number of countries, including Italy. It is not only a frequent cause of chronic liver diseases such as hepatitis, cirrhosis and hepatocellular carcinoma, but is also involved in the pathogenesis of various autoimmune and rheumatic disorders (arthritis, vasculitis, sicca syndrome, porphyria cutanea tarda, lichen planus, nephropathies, thyroid diseases, and lung fibrosis), as well as in the development of B-cell lymphoproliferative diseases. Furthermore, patients suffering from C hepatitis tend to produce rheumatoid factor, cryoglobulins and a large series of autoantibodies (ANA, anti-SSA/SSB, SAM, ATG, aCL). The use of glucocorticoids or immuno-suppressant agents in HCV infected individuals, which are needed to treat autoimmune and rheumatic disorders, leads to a risk of worsening the clinical outcome of HCV. Under these conditions, the viral infection often needs to be treated with antiviral agents, mainly pegylated interferon combined with ribavirin. However, cyclosporine A seems to be safe and effective in patients with autoimmune disease (AD) and concomitant chronic HCV infection as is documented by the reduction in viremia and transaminases, particularly in patients with high baseline levels. Finally, HCV is the main trigger of mixed cryoglobulinemia. An attempt at viral eradication is therefore indicated in most patients, and is particularly effective in the case of mild or moderate manifestations. In severe cases, rituximab is an apparently safe and effective alternative to conventional immunosuppression and, specifically, it controls B-cell proliferation.
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Affiliation(s)
- A Antonelli
- University of Pisa School of Medicine, Pisa, Italy
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Fundueanu G, Constantin M, Bortolotti F, Cortesi R, Ascenzi P, Menegatti E. Poly[(N-isopropylacrylamide-co-acrylamide-co-(hydroxyethylmethacrylate))] thermoresponsive microspheres: An accurate method based on solute exclusion technique to determine the volume phase transition temperature. Eur Polym J 2007. [DOI: 10.1016/j.eurpolymj.2007.05.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cortesi R, Esposito E, Cuccu I, Romagnoli R, Menegatti E, Zaid AN, Nastruzzi C. Liposomes and micellar dispersions for delivery of benzoheterocyclic derivatives of distamycin A. Drug Deliv 2007; 14:1-8. [PMID: 17107925 DOI: 10.1080/10717540600640211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
In this article we describe the production and characterization of specialized delivery systems for some distamycin derivatives (DD), namely liposomes and micellar dispersions. All the formulations were designed to increase the solubility of DD in an aqueous environment and to reduce the possible toxicity problems related to the administration of these drugs. For instance, liposomes were prepared by reverse phase evaporation technique followed by extrusion through polycarbonate filters, then characterized in terms of dimensions, morphology, and encapsulation efficacy. The analysis of their in vitro antiproliferative activity on cultured human and mouse leukemic cells demonstrated that liposomes and micellar dispersions containing DD exert quite different effects. These effects were compared with those shown by the free drug depending on type of drug and also cell line used.
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Affiliation(s)
- R Cortesi
- Department of Pharmaceutical Sciences, University of Ferrara, Ferrara, Italy.
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Constantin M, Fundueanu G, Bortolotti F, Cortesi R, Ascenzi P, Menegatti E. A novel multicompartimental system based on aminated poly(vinyl alcohol) microspheres/succinoylated pullulan microspheres for oral delivery of anionic drugs. Int J Pharm 2007; 330:129-37. [PMID: 17027206 DOI: 10.1016/j.ijpharm.2006.09.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2005] [Revised: 09/07/2006] [Accepted: 09/09/2006] [Indexed: 11/23/2022]
Abstract
Poly(vinyl alcohol) (PVA) microspheres were prepared by dispersion reticulation with glutaraldehyde and further aminated. These microspheres were firstly loaded with diclofenac (DF) and then entrapped in cellulose acetate butyrate (CAB) microcapsules by an o/w solvent evaporation technique for intestinal delivery of drug. The encapsulated PVA microspheres due to their low swelling degree in intestinal fluids, do not have enough force to produce the disruption of CAB shell, therefore different amounts of succinoylated pullulan microspheres (SP-Ms) (exchange capacity up to 5.2 meq/g) were co-encapsulated. The SP-Ms do not swell in acidic pH, but swell up to 20-times in intestinal fluids causing the rupture of CAB shell and facilitating the escape of loaded PVA microspheres.
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Affiliation(s)
- M Constantin
- Department of Bioactive and Biocompatible Polymers, Petru Poni Institute of Macromolecular Chemistry, 700487 Iassy, Romania
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Nastruzzi C, Pastesini C, Menegatti E, Scalia S. High-Performance Liquid Chromatographic Determination of Aromatic Poly-Amidines: Formulatory and Preclinical Applications. ACTA ACUST UNITED AC 2006. [DOI: 10.1080/10826079408013479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Nastruzzi
- a Department of Pharmaceutical Sciences , University of Ferrara , I-44100, Ferrara , Italy
| | - C. Pastesini
- a Department of Pharmaceutical Sciences , University of Ferrara , I-44100, Ferrara , Italy
| | - E. Menegatti
- a Department of Pharmaceutical Sciences , University of Ferrara , I-44100, Ferrara , Italy
| | - S. Scalia
- b Institute of Pharmaceutical Chemistry, University of Catania , I-95100, Catania , Italy
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