1
|
Villa A, Milito C, Deiana CM, Gambier RF, Punziano A, Buso H, Bez P, Lagnese G, Garzi G, Costanzo G, Giannuzzi G, Pagnozzi C, Dalm VASH, Spadaro G, Rattazzi M, Cinetto F, Firinu D. High Prevalence of Long COVID in Common Variable Immunodeficiency: An Italian Multicentric Study. J Clin Immunol 2024; 44:59. [PMID: 38319477 PMCID: PMC10847195 DOI: 10.1007/s10875-024-01656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/16/2024] [Indexed: 02/07/2024]
Abstract
The long-term effects of SARS-CoV-2 infection represent a relevant global health problem. Long COVID (LC) is defined as a complex of signs and symptoms developed during or after SARS-CoV-2 infection and lasting > 12 weeks. In common variable immunodeficiency (CVID) patients, we previously reported higher risk of hospitalization and death during SARS-CoV-2 infection, as well as prolonged swab positivity and frequent reinfections. The aim of the present study was to assess the risk of LC in an Italian cohort of CVID patients. We used a translated version of the survey proposed by Centers for Disease Control and Prevention (CDC) to collect data on LC. In the enrolled cohort of 175 CVID patients, we found a high prevalence of LC (65.7%). The most frequent LC symptoms were fatigue (75.7%), arthralgia/myalgia (48.7%), and dyspnea (41.7%). The majority of patients (60%) experienced prolonged symptoms, for at least 6 months after infection. In a multivariate analysis, the presence of complicated phenotype (OR 2.44, 95% CI 1.88-5.03; p = 0.015), obesity (OR 11.17, 95% CI 1.37-90.95; p = 0.024), and female sex (OR 2.06, 95% CI 1.09-3.89; p = 0.024) significantly correlated with the development of LC. In conclusion, in this multicenter observational cohort study, we demonstrated that CVID patients present an increased prevalence of LC when compared to the general population. Improved awareness on the risk of LC in CVID patients could optimize management of this new and alarming complication of SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Annalisa Villa
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Carla Maria Deiana
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Renato Finco Gambier
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Helena Buso
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | - Patrick Bez
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Gloria Giannuzzi
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Pagnozzi
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | - Virgil A S H Dalm
- Department of Internal Medicine, Division of Allergy & Clinical Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Immunology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Marcello Rattazzi
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy.
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| |
Collapse
|
2
|
Bettiol A, Urban ML, Padoan R, Groh M, Lopalco G, Egan A, Cottin V, Fraticelli P, Crimi C, Del Giacco S, Losappio L, Moi L, Cinetto F, Caminati M, Novikov P, Berti A, Cameli P, Cathébras P, Coppola A, Durel CA, Folci M, Gullo AL, Lombardi C, Monti S, Parronchi P, Rivera CM, Solans R, Vacca A, Espígol-Frigolé G, Guarnieri G, Bianchi FC, Marchi MR, Tcherakian C, Kahn JE, Iannone F, Venerito V, Desaintjean C, Moroncini G, Nolasco S, Costanzo GAML, Schroeder JW, Ribi C, Tesi M, Gelain E, Mattioli I, Bello F, Jayne D, Prisco D, Vaglio A, Emmi G. Benralizumab for eosinophilic granulomatosis with polyangiitis: a retrospective, multicentre, cohort study. Lancet Rheumatol 2023; 5:e707-e715. [PMID: 38251561 DOI: 10.1016/s2665-9913(23)00243-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/31/2023] [Accepted: 09/07/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Interleukin-5 (IL-5) inhibitors represent novel therapies for eosinophilic granulomatosis with polyangiitis (EGPA). This study assessed the effectiveness and safety of the IL-5 receptor inhibitor benralizumab in a European cohort of patients with EGPA. METHODS This retrospective cohort study included patients with EGPA from 28 European referral centres of the European EGPA Study Group across six countries (Italy, France, UK, Russia, Spain, and Switzerland) who received benralizumab as any line of treatment between Jan 1, 2019, and Sep 30, 2022. We assessed the rates of complete response, defined as no disease activity (Birmingham Vasculitis Activity Score [BVAS] of 0) and a prednisone dose of up to 4 mg/day, in contrast to partial response, defined as a BVAS of 0 and a prednisone dose greater than 4 mg/day. Active disease manifestations, pulmonary function, variation in glucocorticoid dose, and safety outcomes were also assessed over a 12-month follow-up. FINDINGS 121 patients with relapsing-refractory EGPA treated with benralizumab at the dose approved for eosinophilic asthma were included (64 [53%] women and 57 [47%] men; median age at the time of beginning benralizumab treatment 54·1 years [IQR 44·2-62·2]). Complete response was reported in 15 (12·4%, 95% CI 7·1-19·6) of 121 patients at month 3, 25 (28·7%, 19·5-39·4) of 87 patients at month 6, and 32 (46·4%, 34·3-58·8) of 69 patients at month 12; partial response was observed in an additional 43 (35·5%, 27·0-44·8) patients at month 3, 23 (26·4%, 17·6-37·0) at month 6, and 13 (18·8%, 10·4-30·1) at month 12. BVAS dropped from 3·0 (IQR 2·0-8·0) at baseline to 0·0 (0·0-2·0) at months 3 and 6, and to 0·0 (0·0-1·0) at month 12. The proportion of patients with systemic manifestations, active peripheral neurological disease, ear, nose, and throat involvement, and pulmonary involvement decreased, with an improvement in lung function tests. Six patients relapsed after having a complete response. The oral prednisone (or equivalent) dose decreased from 10·0 mg/day (5·0-12·5) at baseline to 5·0 mg/day (3·6-8·5) at month 3 (p<0·01), to 5·0 mg/day (2·5-6·3) at month 6, and to 2·5 mg/day (0·0-5·0) at month 12 (p<0·0001). 19 (16%) of 121 patients had adverse events and 16 (13%) discontinued benralizumab. INTERPRETATION These data suggest that benralizumab could be an effective treatment for EGPA in real-life clinical practice. Further clinical trials are required to confirm the efficacy of benralizumab in patients with a higher baseline disease activity. FUNDING None.
Collapse
Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Roberto Padoan
- Division of Rheumatology, Department of Medicine, University of Padova, Padova, Italy
| | - Matthieu Groh
- National Referral Center for Hypereosinophilic Syndromes, Department of Internal Medicine, Hôpital Foch, Suresnes, France
| | - Giuseppe Lopalco
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Allyson Egan
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | - Vincent Cottin
- Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; UMR754, National Research Institute for Agriculture, Food and the Environment, University of Lyon, Lyon, France
| | | | - Claudia Crimi
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Azienda Ospedaliero Universitaria Policlinico "G Rodolico-San Marco", Catania, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Laura Losappio
- Unit of Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Laura Moi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Francesco Cinetto
- Department of Medicine, University of Padova, Padova, Italy; Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, Treviso, Italy
| | - Marco Caminati
- Asthma Centre and Allergy Unit, Department of Medicine, University of Verona, Verona, Italy
| | - Pavel Novikov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alvise Berti
- Rheumatology Unit, Santa Chiara Hospital, APSS Trento and CISMED, University of Trento, Trento, Italy
| | - Paolo Cameli
- Respiratory Diseases Unit, Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | | | - Angelo Coppola
- Division of Respiratory Medicine, Ospedale San Filippo Neri-ASL Roma 1, Rome, Italy; Saint Camillus International University of Health Sciences, Rome, Italy
| | - Cécile-Audrey Durel
- Department of Internal Medicine, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Marco Folci
- Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology, Clinical Immunology and Pneumology, Fondazione Poliambulanza, Brescia, Italy
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy; Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Carlos Martinez Rivera
- Department of Pneumology, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autònoma de Barcelona, IGTP, Barcelona, Spain
| | - Roser Solans
- Systemic Autoimmune Diseases Unit, Internal Medicine Department, Vall d'Hebron Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angelo Vacca
- Department of Precision and Regenerative Medicine and Ionian Area, UOC Medicina Interna "Guido Baccelli", University of Bari Aldo Moro, Policlinico, Bari, Italy
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain
| | - Gabriella Guarnieri
- Department of Pneumology, Hospital Cittadella ULSS6 Euganea, Cittadella, Italy
| | | | - Maria Rita Marchi
- Department of Pneumology, Hospital Cittadella ULSS6 Euganea, Cittadella, Italy
| | | | - Jean-Emmanuel Kahn
- National Referral Center for Hypereosinophilic Syndromes, Department of Internal Medicine, APHP, CHU Ambroise Paré, Boulogne-Billancourt, France
| | - Florenzo Iannone
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Vincenzo Venerito
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari, Bari, Italy
| | - Charlene Desaintjean
- Reference Center for Rare Pulmonary Diseases (OrphaLung), Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
| | | | - Santi Nolasco
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy; Respiratory Medicine Unit, Azienda Ospedaliero Universitaria Policlinico "G Rodolico-San Marco", Catania, Italy
| | | | - Jan Walter Schroeder
- Unit of Allergy and Clinical Immunology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Camillo Ribi
- Division of Immunology and Allergy, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Vaud, Switzerland
| | - Michelangelo Tesi
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Elena Gelain
- Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Irene Mattioli
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Florence, Italy; Nephrology and Dialysis Unit, Meyer Children's Hospital IRCCS, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Firenze, Florence, Italy; Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Melbourne, VIC, Australia.
| |
Collapse
|
3
|
Scarpa R, Cinetto F, Milito C, Gianese S, Soccodato V, Buso H, Garzi G, Carrabba M, Messina E, Panebianco V, Catalano C, Morana G, Lougaris V, Landini N, Bondioni MP. Common and Uncommon CT Findings in CVID-Related GL-ILD: Correlations with Clinical Parameters, Therapeutic Decisions and Potential Implications in the Differential Diagnosis. J Clin Immunol 2023; 43:1903-1915. [PMID: 37548814 PMCID: PMC10661728 DOI: 10.1007/s10875-023-01552-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 07/11/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE To investigate computed tomography (CT) findings of Granulomatous Lymphocytic Interstitial Lung Disease (GL-ILD) in Common Variable Immunodeficiency (CVID), also in comparison with non-GL-ILD abnormalities, correlating GL-ILD features with functional/immunological parameters and looking for GL-ILD therapy predictive elements. METHODS CT features of 38 GL-ILD and 38 matched non-GL-ILD subjects were retrospectively described. Correlations of GL-ILD features with functional/immunological features were assessed. A logistic regression was performed to find a predictive model of GL-ILD therapeutic decisions. RESULTS Most common GL-ILD CT findings were bronchiectasis, non-perilymphatic nodules, consolidations, Ground Glass Opacities (GGO), bands and enlarged lymphnodes. GL-ILD was usually predominant in lower fields. Multiple small nodules (≤10 mm), consolidations, reticulations and fibrotic ILD are more indicative of GL-ILD. Bronchiectasis, GGO, Reticulations and fibrotic ILD correlated with decreased lung performance. Bronchiectasis, GGO and fibrotic ILD were associated with low IgA levels, whereas high CD4+ T cells percentage was related to GGO. Twenty out of 38 patients underwent GL-ILD therapy. A model combining Marginal Zone (MZ) B cells percentage, IgA levels, lower field consolidations and lymphnodes enlargement showed a good discriminatory capacity with regards to GL-ILD treatment. CONCLUSIONS GL-ILD is a lower field predominant disease, commonly characterized by bronchiectasis, non-perilymphatic small nodules, consolidations, GGO and bands. Multiple small nodules, consolidations, reticulations and fibrotic ILD may suggest the presence of GL-ILD in CVID. MZ B cells percentage, IgA levels at diagnosis, lower field consolidations and mediastinal lymphnodes enlargement may predict the need of a specific GL-ILD therapy.
Collapse
Affiliation(s)
- Riccardo Scarpa
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy.
| | - Sabrina Gianese
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Valentina Soccodato
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Helena Buso
- Department of Medicine, DIMED, University of Padova, Padova, Italy
- Internal Medicine 1, Ca' Foncello University Hospital, AULSS2, Treviso, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Maria Carrabba
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Emanuele Messina
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Valeria Panebianco
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Carlo Catalano
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | - Giovanni Morana
- Department of Radiology, Ca' Foncello General Hospital, Treviso, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy
- ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Nicholas Landini
- Department of Radiological Sciences, Oncology and Pathology, Policlinico Umberto I, "Sapienza" University, Rome, Italy
| | | |
Collapse
|
4
|
Milito C, Pulvirenti F, Garzi G, Sculco E, Cinetto F, Firinu D, Lagnese G, Punziano A, Discardi C, Costanzo G, Felice C, Spadaro G, Ferrari S, Quinti I. Decline of gastric cancer mortality in common variable immunodeficiency in the years 2018-2022. Front Immunol 2023; 14:1231242. [PMID: 37868983 PMCID: PMC10587402 DOI: 10.3389/fimmu.2023.1231242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
Introduction In patients with Common Variable Immunodeficiency, malignancy has been reported as the leading cause of death in adults, with a high risk of B-cell lymphomas and gastric cancer. Methods We conducted a five-year prospective study aiming to update the incidence and mortality of gastric cancer and the incidence of gastric precancerous lesions in 512 CVID patients who underwent a total of 400 upper gastrointestinal endoscopies. Results In the pre-pandemic period, 0.58 endoscopies were performed per patient/year and in the COVID-19 period, 0.39 endoscopies were performed per patient/year. Histology revealed areas with precancerous lesions in about a third of patients. Patients who had more than one gastroscopy during the study period were more likely to have precancerous lesions. Two patients received a diagnosis of gastric cancer in the absence of Helicobacter pylori infection. The overall prevalence of Helicobacter pylori infection in biopsy specimens was 19.8% and related only to active gastritis. Among patients who had repeated gastroscopies, about 20% progressed to precancerous lesions, mostly independent of Helicobacter pylori. Discussion While gastric cancer accounted for one in five deaths from CVID in our previous survey, no gastric cancer deaths were recorded in the past five years, likely consistent with the decline in stomach cancer mortality observed in the general population. However, during the COVID-19 pandemic, cancer screening has been delayed. Whether such a delay or true decline could be the reason for the lack of gastric cancer detection seen in CVID may become clear in the coming years. Due to the high incidence of precancerous lesions, we cannot rely on observed and predicted trends in gastric cancer mortality and strongly recommend tailored surveillance programs.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Pulvirenti
- Reference Center for Primary Immune Deficiencies, AOU Policlinico Umberto I, Rome, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Eleonora Sculco
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Claudia Discardi
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carla Felice
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Simona Ferrari
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
5
|
Bressan A, Faggin E, Donato M, Tonon L, Buso R, Nardin C, Tiepolo M, Cinetto F, Scarpa R, Agostini C, Pauletto P, Ventura L, Fusaro M, Felice C, Rattazzi M. NETosis in Acute Thrombotic Disorders. Semin Thromb Hemost 2023; 49:709-715. [PMID: 37308098 DOI: 10.1055/s-0043-1769510] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The release of extracellular traps by neutrophils (NETs) represents a novel active mechanism of cell death that has been recently implicated in the pathogenesis of thrombotic disorders. The aim of this study was to investigate the generation of NETs in different groups of patients with acute thrombotic events (ATEs) and to establish whether NETs markers can predict the risk of new cardiovascular events. We performed a case-control study of patients with ATE, including acute coronary syndrome (n = 60), cerebrovascular accident (n = 50), and venous thromboembolism (n = 55). Control subjects (n = 70) were identified among patients admitted for acute chest pain and in which a diagnosis of ATE was excluded. Serum levels of NET markers and neutrophil activation, such as myeloperoxidase (MPO)-DNA complexes, neutrophil gelatinase-associated lipocalin, polymorphonuclear neutrophil elastase, lactoferrin, and MPO, were measured in each patient. We found that circulating levels of MPO-DNA complexes were significantly increased in patients with ATE (p < 0.001) compared with controls and that this association remained significant even after fully adjustment for traditional risk factors (p = 0.001). A receiver operating characteristics analysis of circulating MPO-DNA complexes in discriminating between controls and patients with ATE showed a significant area under the curve of 0.76 (95% confidence interval: 0.69-0.82). After a median follow-up of 40.7 (± 13.8) months, 24 out of the 165 patients with ATE presented a new cardiovascular event and 18 patients died. None of the markers under investigation influenced survival or the incidence of new cardiovascular events. In conclusion, we found that increase of markers of NETosis can be observed in acute thrombotic conditions, occurring both on the arterial and venous site. Nevertheless, the level of neutrophil markers measured during the ATE is not predictive of future risk of mortality and cardiovascular events.
Collapse
Affiliation(s)
| | | | - Maristella Donato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Padova, Italy
| | - Luca Tonon
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Roberta Buso
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Chiara Nardin
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Marta Tiepolo
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Carlo Agostini
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Paolo Pauletto
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Laura Ventura
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | | | - Carla Felice
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| | - Marcello Rattazzi
- Department of Medicine, University of Padova, Padova, Italy
- Medicine 1^, Ca' Foncello University Hospital, Treviso, Italy
| |
Collapse
|
6
|
Bez P, D’ippolito G, Deiana CM, Finco Gambier R, Pica A, Costanzo G, Garzi G, Scarpa R, Landini N, Cinetto F, Firinu D, Milito C. Struggling with COVID-19 in Adult Inborn Errors of Immunity Patients: A Case Series of Combination Therapy and Multiple Lines of Therapy for Selected Patients. Life (Basel) 2023; 13:1530. [PMID: 37511905 PMCID: PMC10381188 DOI: 10.3390/life13071530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND The SARS-CoV-2 infection is now a part of the everyday lives of immunocompromised patients, but the choice of treatment and the time of viral clearance can often be complex, exposing patients to possible complications. The role of the available antiviral and monoclonal therapies is a matter of debate, as are their effectiveness and potential related adverse effects. To date, in the literature, the amount of data on the use of combination therapies and on the multiple lines of anti-SARS-CoV-2 therapy available to the general population and especially to inborn error of immunity (IEI) patients is small. METHODS Here, we report a case series of five adult IEI patients managed as inpatients at three Italian IEI referral centers (Rome, Treviso, and Cagliari) treated with combination therapy or multiple therapeutic lines for SARS-CoV-2 infection, such as monoclonal antibodies (mAbs), antivirals, convalescent plasma (CP), mAbs plus antiviral, and CP combined with antiviral. RESULTS This study may support the use of combination therapy against SARS-CoV-2 in complicated IEI patients with predominant antibody deficiency and impaired vaccine response.
Collapse
Affiliation(s)
- Patrick Bez
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital-AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (P.B.); (R.F.G.); (R.S.); (F.C.)
- Department of Medicine-DIMED, University of Padova, 35122 Padua, Italy
| | - Giancarlo D’ippolito
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.D.); (A.P.); (G.G.); (C.M.)
| | - Carla Maria Deiana
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (G.C.); (D.F.)
| | - Renato Finco Gambier
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital-AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (P.B.); (R.F.G.); (R.S.); (F.C.)
- Department of Medicine-DIMED, University of Padova, 35122 Padua, Italy
| | - Andrea Pica
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.D.); (A.P.); (G.G.); (C.M.)
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (G.C.); (D.F.)
| | - Giulia Garzi
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.D.); (A.P.); (G.G.); (C.M.)
| | - Riccardo Scarpa
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital-AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (P.B.); (R.F.G.); (R.S.); (F.C.)
- Department of Medicine-DIMED, University of Padova, 35122 Padua, Italy
| | - Nicholas Landini
- Department of Radiological, Oncological and Anatomopathological Sciences, Sapienza University of Rome, Policlinico Umberto I Hospital, 00161 Rome, Italy;
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital-AULSS2 Marca Trevigiana, 31100 Treviso, Italy; (P.B.); (R.F.G.); (R.S.); (F.C.)
- Department of Medicine-DIMED, University of Padova, 35122 Padua, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, 09100 Cagliari, Italy; (G.C.); (D.F.)
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (G.D.); (A.P.); (G.G.); (C.M.)
| |
Collapse
|
7
|
Tana C, Azorin DG, Cinetto F, Mantini C, Tana M, Caulo M, Ricci F, Martelletti P, Cipollone F, Giamberardino MA. Common Clinical and Molecular Pathways between Migraine and Sarcoidosis. Int J Mol Sci 2023; 24:ijms24098304. [PMID: 37176011 PMCID: PMC10179000 DOI: 10.3390/ijms24098304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 04/07/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Migraine and sarcoidosis are two distinct medical conditions that may have some common biological and clinical pathways. Sarcoidosis is a chronic granulomatous disease characterized by the formation of granulomas in various organs, including the lungs, skin, cardiovascular system, lymph nodes, and brain. Migraine is a common comorbidity in sarcoidosis patients and a common neurological disorder characterized by recurrent headaches that can be accompanied by other symptoms, such as nausea, vomiting, and sensitivity to light and sound. There have been several reports of individuals with neurosarcoidosis experiencing migraines, though the exact relationship between the two disorders is not well understood. Both conditions have been associated with inflammation and the activation of the immune system. In sarcoidosis, the formation of granulomas is thought to be an immune response to the presence of an unknown antigen. Similarly, the pain and other symptoms associated with migraines are thought to be caused by inflammation in the brain and the surrounding blood vessels. There is also evidence to suggest an interplay of environmental and genetic factors playing a role in both conditions, but evidence is inconsistent with the hypothesis of shared genetic susceptibility. This review aims to illustrate common clinical and biological pathways between migraine and sarcoidosis, including inflammation and dysregulation of the immune system, with a focus on the cumulative burden of concurrent disorders and therapeutic implications.
Collapse
Affiliation(s)
- Claudio Tana
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy
| | - David Garcia Azorin
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, 47003 Valladolid, Spain
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital-AULSS2 Marca Trevigiana and Department of Medicine-DIMED, University of Padova, 35122 Padova, Italy
| | - Cesare Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Marco Tana
- 2nd Internal Medicine Unit, SS. Medical Department, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy
| | - Massimo Caulo
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
- University Cardiology Division, Heart Department, SS. Annunziata Hospital of Chieti, 66100 Chieti, Italy
| | - Paolo Martelletti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Francesco Cipollone
- Medical Clinic, Department of Medicine and Science of Aging, SS. Annunziata Hospital of Chieti, "G. D'Annunzio" University of Chieti-Pescara, 66100 Chieti, Italy
| | - Maria Adele Giamberardino
- Center of Excellence on Headache, Geriatrics and COVID-19 Clinic, SS Annunziata Hospital of Chieti, 66100 Chieti, Italy
| |
Collapse
|
8
|
Cinetto F, Francisco IE, Fenchel K, Scarpa R, Montefusco V, Pluta A, Wolf HM. Use of immunoglobulin replacement therapy in patients with secondary antibody deficiency in daily practice: a European expert Q&A-based review. Expert Rev Hematol 2023; 16:237-243. [PMID: 37009667 DOI: 10.1080/17474086.2023.2176843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
INTRODUCTION Secondary antibody deficiencies (SAD) are often a side effect of specific therapies that target B cells directly or affect the antibody response indirectly. Treatment of immunodeficiency by immunoglobulin replacement therapy (IgRT) is well established in primary antibody deficiencies, although the evidence for its use in SAD is less well established. To fill the gap and provide opinion and advice for daily practice, a group of experts met to discuss current issues and share best practical experience. AREAS COVERED A total of 16 questions were considered that covered use of a tailored approach, definition of severe infections, measurement of IgG levels and specific antibodies, indications for IgRT, dosage, monitoring, discontinuation of IgRT, and Covid-19. EXPERT OPINION Key points for better management SID should include characterization of the immunological deficiency, determination of the severity and degree of impairment of antibody production, distinguish between primary and secondary deficiency, and design a tailored treatment protocol that should include dose, route, and frequency of Ig replacement. There remains the need to carry out well-designed clinical studies to develop clear guidelines for the use of IgRT in patients with SAD.
Collapse
Affiliation(s)
- Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | | | | | - Riccardo Scarpa
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine - DIMED, University of Padova, Treviso, Italy
| | | | | | - Hermann M Wolf
- Immunology Outpatient Clinic, Vienna, Austria
- Sigmund Freud Private University- Medical School, Vienna, Austria
| |
Collapse
|
9
|
Buso G, Faggin E, Bressan A, Galliazzo S, Cinetto F, Felice C, Fusaro M, Erdmann A, Pauletto P, Rattazzi M, Mazzolai L. Biomarkers of Neutrophil Activation in Patients with Symptomatic Chronic Peripheral Artery Disease Predict Worse Cardiovascular Outcome. Biomedicines 2023; 11:biomedicines11030866. [PMID: 36979845 PMCID: PMC10045814 DOI: 10.3390/biomedicines11030866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/14/2023] Open
Abstract
Neutrophils play a role in cardiovascular (CV) disease. However, relatively scant evidence exists in the setting of peripheral artery disease (PAD). The aims of this study were to measure biomarkers of neutrophil activation in patients with symptomatic chronic PAD compared with healthy controls, to assess their association with PAD severity, and to evaluate their prognostic value in patients with PAD. The following circulating markers of neutrophil degranulation were tested: polymorphonuclear neutrophil (PMN) elastase, neutrophil gelatinase-associated lipocalin (NGAL), and myeloperoxidase (MPO). Neutrophil extracellular traps (NETs) were quantified by measuring circulating MPO–DNA complexes. Patients with PAD underwent a comprehensive series of vascular tests. The occurrence of 6-month major adverse CV (MACE) and limb events (MALE) was assessed. Overall, 110 participants were included, 66 of which had PAD. After adjustment for conventional CV risk factors, PMN-elastase (adjusted odds ratio [OR]: 1.008; 95% confidence interval [CI]: 1.002–1.015; p = 0.006), NGAL (adjusted OR: 1.045; 95%CI: 1.024–1.066; p < 0.001), and MPO (adjusted OR: 1.013; 95%CI: 1.001–1.024; p = 0.028) were significantly associated with PAD presence. PMN-elastase (adjusted hazard ratio [HR]: 1.010; 95%CI: 1.000–1.020; p = 0.040) and MPO (adjusted HR: 1.027; 95%CI: 1.004–1.051; p = 0.019) were predictive of 6-month MACE and/or MALE. MPO displayed fair prognostic performance on receiver operating characteristic (ROC) curve analyses, with an area under the curve (AUC) of 0.74 (95%CI: 0.56–0.91) and a sensitivity and specificity of 0.80 and 0.65, respectively, for a cut-off of 108.37 ng/mL. MPO–DNA showed a weak inverse correlation with transcutaneous oximetry (TcPO2) on proximal foot (adjusted ρ −0.287; p = 0.032). In conclusion, in patients with symptomatic chronic PAD, enhanced neutrophil activity may be associated with an increased risk of acute CV events, rather than correlate with disease severity. Further research is needed to clarify the role of neutrophils in PAD natural history.
Collapse
Affiliation(s)
- Giacomo Buso
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
- Department of Clinical and Experimental Sciences, 2a Medicina—Azienda Socio Sanitaria Territoriale Spedali Civili di Brescia, University of Brescia, 25100 Brescia, Italy
- Correspondence:
| | - Elisabetta Faggin
- Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy
| | | | - Silvia Galliazzo
- Department of Internal Medicine Unit, Ospedale S. Valentino, 31044 Montebelluna, Italy
| | - Francesco Cinetto
- Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy
- Medicina Interna I, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Carla Felice
- Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy
- Medicina Interna I, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Michele Fusaro
- Department of Radiology, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Andreas Erdmann
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Paolo Pauletto
- Ospedale Riabilitativo di Alta Specializzazione (ORAS)-ULSS 2 TV, Motta di Livenza, 31045 Treviso, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padua, 35122 Padua, Italy
- Medicina Interna I, Ca’ Foncello University Hospital, 31100 Treviso, Italy
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| |
Collapse
|
10
|
Vianello F, Romano Gargarella L, Cinetto F, Scarpa R, Ceccato J, Marcolongo R. Usefulness of methotrexate in relapsing idiopathic retroperitoneal fibrosis. Clin Exp Rheumatol 2023:19439. [PMID: 36912332 DOI: 10.55563/clinexprheumatol/atxzl5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 01/11/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES Glucocorticoids are the mainstay for treatment of retroperitoneal fibrosis (RPF), a disease characterised by a periaortic proliferation of fibroinflammatory tissue frequently causing urinary obstruction. The therapeutic approach to patients unsuitable for steroid therapy and to relapsing cases is still undefined. METHODS In this retrospective single-centre study we evaluated 15 patients with RPF who received second-line therapy with methotrexate (MTX) between January 2011 to December 2019. RESULTS Fourteen out of 15 patients (93%) showed response to MTX. Two patients experienced relapse: one patient when on MTX therapy (28 months), the other, 58 months after MTX was interrupted. Liver toxicity grade 2 was documented in 2 patients and resolved with temporary dosage reduction. One patient stopped MTX autonomously because of nausea. No severe infections were recorded. CONCLUSIONS In selected patients with RPF who are intolerant or refractory to steroid single therapy, MTX may be considered as useful and safe second-line treatment.
Collapse
Affiliation(s)
- Fabrizio Vianello
- Haematology and Clinical Immunology Unit, Department of Medicine (DIMED), University of Padova, Italy.
| | | | - Francesco Cinetto
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Jessica Ceccato
- Haematology and Clinical Immunology Unit, Department of Medicine (DIMED), University of Padova, Italy
| | - Renzo Marcolongo
- Cardiology Unit, Cardioimmunology Branch, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Italy
| |
Collapse
|
11
|
Marzollo A, Riggioni C, Cinetto F. Editorial comment on "Expected impact of immunomodulatory agents during pregnancy: A newborn's perspective". Pediatr Allergy Immunol 2023; 34:e13933. [PMID: 36974651 DOI: 10.1111/pai.13933] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 02/23/2023] [Accepted: 02/24/2023] [Indexed: 03/29/2023]
Affiliation(s)
- Antonio Marzollo
- Pediatric Hematology, Oncology and Stem Cell Transplant Division, Padua University Hospital, Padua, Italy
| | - Carmen Riggioni
- Allergy, Immunology and Rheumatology Division, Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| |
Collapse
|
12
|
Milito C, Firinu D, Bez P, Villa A, Punziano A, Lagnese G, Costanzo G, van Leeuwen LPM, Piazza B, Deiana CM, d’Ippolito G, Del Giacco SR, Rattazzi M, Spadaro G, Quinti I, Scarpa R, Dalm VASH, Cinetto F. A beacon in the dark: COVID-19 course in CVID patients from two European countries: Different approaches, similar outcomes. Front Immunol 2023; 14:1093385. [PMID: 36845159 PMCID: PMC9944020 DOI: 10.3389/fimmu.2023.1093385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 02/10/2023] Open
Abstract
Background CVID patients present an increased risk of prolonged SARS-CoV-2 infection and re-infection and a higher COVID-19-related morbidity and mortality compared to the general population. Since 2021, different therapeutic and prophylactic strategies have been employed in vulnerable groups (vaccination, SARS-CoV-2 monoclonal antibodies and antivirals). The impact of treatments over the last 2 years has not been explored in international studies considering the emergence of viral variants and different management between countries. Methods A multicenter retrospective/prospective real-life study comparing the prevalence and outcomes of SARS-CoV-2 infection between a CVID cohort from four Italian Centers (IT-C) and one cohort from the Netherlands (NL-C), recruiting 773 patients. Results 329 of 773 CVID patients were found positive for SARS-CoV-2 infection between March 1st, 2020 and September 1st 2022. The proportion of CVID patients infected was comparable in both national sub-cohorts. During all waves, chronic lung disease, "complicated" phenotype, chronic immunosuppressive treatment and cardiovascular comorbidities impacted on hospitalization, whereas risk factors for mortality were older age, chronic lung disease, and bacterial superinfections. IT-C patients were significantly more often treated, both with antivirals and mAbs, than NL-C patients. Outpatient treatment, available only in Italy, started from the Delta wave. Despite this, no significant difference was found for COVID-19 severity between the two cohorts. However, pooling together specific SARS-CoV-2 outpatient treatments (mAbs and antivirals), we found a significant effect on the risk of hospitalization starting from Delta wave. Vaccination with ≥ 3 doses shortened RT-PCR positivity, with an additional effect only in patients receiving antivirals. Conclusions The two sub-cohorts had similar COVID-19 outcomes despite different treatment approaches. This points out that specific treatment should now be reserved for selected subgroups of CVID patients, based on pre-existing conditions.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Patrick Bez
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Annalisa Villa
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Leanne P. M. van Leeuwen
- Department of Viroscience, Travel Clinic, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Beatrice Piazza
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Carla Maria Deiana
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | | | - Marcello Rattazzi
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Scarpa
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy,*Correspondence: Riccardo Scarpa,
| | - Virgil A. S. H. Dalm
- Department of Internal Medicine, Division of Allergy and Clinical Immunology, Department of Immunology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Department of Medicine (DIMED), University of Padova, Padova, Italy
| |
Collapse
|
13
|
Milito C, Cinetto F, Garzi G, Palladino A, Puca M, Brambilla E, De Vitis C, Costanzo G, Scarpa R, Punziano A, Lagnese G, Del Giacco S, Spadaro G, Quinti I, Firinu D. Safety of mRNA COVID-19 Vaccines in Patients with Inborn Errors of Immunity: an Italian Multicentric Study. J Clin Immunol 2023; 43:299-307. [PMID: 36374363 PMCID: PMC9662105 DOI: 10.1007/s10875-022-01402-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/31/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Little is known about vaccine safety in inborn errors of immunity (IEI) patients during the current vaccination campaign for COVID-19. To better investigate the reactogenicity and adverse event profile after two, three, and four doses of mRNA vaccines, we conducted an observational, multicentric study on 342 PID patients from four Italian Referral Centres. METHODS We conducted a survey on self-reported adverse reactions in IEI patients who received mRNA vaccine by administering a questionnaire after each dose. RESULTS Over the whole study period, none of the patients needed hospitalization or had hypersensitivity reactions, including anaphylaxis and delayed injection site reaction. After two vaccination doses, 35.4% of patients showed only local reactogenicity-related symptoms (RrS), 44.4% reported both systemic and local RrS, and 5% reported only systemic RrS. In more than 60% of cases, local or systemic RrS were mild. After the first and second booster doses, patients showed fewer adverse events (AEs) than after the first vaccination course. Patients aged 50 years and older reported adverse events and RrS less frequently. Among AEs requiring treatment, one common variable immune deficiency patient affected by T cell large granular lymphocytic leukemia developed neutropenia and one patient had Bell's paralysis perhaps during herpes zoster reactivation. CONCLUSION Although our follow-up period is relatively short, the safety data we reported are reassuring. This data would help to contrast the vaccine hesitancy often manifested by patients with IEI and to better inform their healthcare providers.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giulia Garzi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea Palladino
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Marco Puca
- Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero Universitaria, SS 554-Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Elena Brambilla
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Camilla De Vitis
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero Universitaria, SS 554-Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero Universitaria, SS 554-Bivio Sestu, 09042, Monserrato, CA, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Azienda Ospedaliero Universitaria, SS 554-Bivio Sestu, 09042, Monserrato, CA, Italy.
| |
Collapse
|
14
|
Abstract
Sarcoidosis is a heterogeneous disease, which can affect virtually every body organ, even though lungs and intra thoracic lymph nodes are almost universally affected. The presence of noncaseating granulomas is the histopathological hallmark of the disease, and clinical picture depends on the organs affected. Data about interaction between sarcoidosis and comorbidities, such as cardiovascular and pulmonary diseases, autoimmune disorders, malignancy and drug-related adverse events are limited. Several lung conditions can be associated with sarcoidosis, such as pulmonary hypertension and fibrosis, making it difficult sometimes the differentiation between complications and distinctive pathologies. Their coexistence may complicate the diagnosis of sarcoidosis and contribute to the highly variable and unpredictable natural history, particularly if several diseases are recognised. A thorough assessment of specific disorders that can be associated with sarcoidosis should always be carried out, and future studies will need to evaluate sarcoidosis not only as a single disorder, but also in the light of possible concomitant conditions.Key messagesComorbidities in sarcoidosis are common, especially cardiovascular and pulmonary diseases.In the diagnostic workup, a distinction must be made between sarcoidosis-related complaints and complaints caused by other separate disorders. It can be very difficult to distinguish between complications of sarcoidosis and other concomitant conditions.The coexistence of multiple conditions may complicate the diagnosis of sarcoidosis, affect its natural course and response to treatment.
Collapse
Affiliation(s)
- Claudio Tana
- Geriatrics Clinic, Medicine Department, SS Annunziata Hospital of Chieti, Chieti, Italy
| | - Marjolein Drent
- Department of Pharmacology and Toxicology, Faculty of Health, Medicine and Life Science, Maastricht University, Maastricht, The Netherlands.,ILD Center of Excellence, Department of Respiratory Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands.,ILD Care Foundation Research Team, Ede, The Netherlands
| | - Hilario Nunes
- AP-HP, Hôpital Avicenne, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares de l'adulte, Université Sorbonne Paris Nord, Bobigny, France
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College London, London, UK
| | - Francesco Cinetto
- Rare Diseases Referral Center, Internal Medicine 1, Ca' Foncello Hospital - AULSS2 Marca Trevigiana and Department of Medicine - DIMED, University of Padova, Italy
| | - Naomi T Jessurun
- ILD Care Foundation Research Team, Ede, The Netherlands.,Netherlands Pharmacovigilance Centre Lareb, 's-Hertogenbosch, The Netherlands
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, Padova, Italy
| |
Collapse
|
15
|
Ceccato J, Piazza M, Pizzi M, Manni S, Piazza F, Caputo I, Cinetto F, Pisoni L, Trojan D, Scarpa R, Zambello R, Tos APD, Trentin L, Semenzato G, Vianello F. A bone-based 3D scaffold as an in-vitro model of microenvironment–DLBCL lymphoma cell interaction. Front Oncol 2022; 12:947823. [PMID: 36330473 PMCID: PMC9623125 DOI: 10.3389/fonc.2022.947823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/22/2022] [Indexed: 12/02/2022] Open
Abstract
About 30% of patients with diffuse large B-cell lymphoma (DLBCL) relapse or exhibit refractory disease (r/r DLBCL) after first-line immunochemotherapy. Bone marrow (BM) involvement confers a dismal prognosis at diagnosis, likely due to the interaction between neoplastic cells and a complex tumor microenvironment (TME). Therefore, we developed a 3D in-vitro model from human decellularized femoral bone fragments aiming to study the role of mesenchymal stromal cells (MSC) and the extracellular matrix (ECM) in the adaptation, growth, and drug resistance of DLBCL lymphoma cells. The 3D spatial configuration of the model was studied by histological analysis and confocal and multiphoton microscopy which allowed the 3D digital reproduction of the structure. We proved that MSC adapt and expand in the 3D scaffold generating niches in which also other cell types may grow. DLBCL cell lines adhered and grew in the 3D scaffold, both in the presence and absence of MSC, suggesting an active ECM–lymphocyte interaction. We found that the germinal center B-cell (GCB)-derived OCI-LY18 cells were more resistant to doxorubicin-induced apoptosis when growing in the decellularized 3D bone scaffold compared to 2D cultures (49.9% +/- 7.7% Annexin V+ cells in 2D condition compared to 30.7% + 9.2% Annexin V+ 3D adherent cells in the ECM model), thus suggesting a protective role of ECM. The coexistence of MSC in the 3D scaffold did not significantly affect doxorubicin-induced apoptosis of adherent OCI-LY18 cells (27.6% +/- 7.3% Annexin V+ 3D adherent cells in the ECM/MSC model after doxorubicin treatment). On the contrary, ECM did not protect the activated B-cell (ABC)-derived NU-DUL-1 lymphoma cell line from doxorubicin-induced apoptosis but protection was observed when MSC were growing in the bone scaffold (40.6% +/- 5.7% vs. 62.1% +/- 5.3% Annexin V+ 3D adherent cells vs. 2D condition). These data suggest that the interaction of lymphoma cells with the microenvironment may differ according to the DLBCL subtype and that 2D systems may fail to uncover this behavior. The 3D model we proposed may be improved with other cell types or translated to the study of other pathologies with the final goal to provide a tool for patient-specific treatment development.
Collapse
Affiliation(s)
- Jessica Ceccato
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
| | - Maria Piazza
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Marco Pizzi
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Sabrina Manni
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
| | - Francesco Piazza
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
| | - Ilaria Caputo
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Francesco Cinetto
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca’ Foncello Hospital, Treviso, Italy
| | - Lorena Pisoni
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
| | | | - Riccardo Scarpa
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca’ Foncello Hospital, Treviso, Italy
| | - Renato Zambello
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
| | - Angelo Paolo Dei Tos
- Surgical Pathology and Cytopathology Unit, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Livio Trentin
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
| | - Gianpietro Semenzato
- Laboratory of Myeloma and Lymphoma Pathobiology, Veneto Institute of Molecular Medicine (VIMM) and Foundation for Advanced Biomedical Research (FABR), Padua, Italy
| | - Fabrizio Vianello
- Hematology Unit, Department of Medicine, University of Padua, Padua, Italy
- *Correspondence: Fabrizio Vianello,
| |
Collapse
|
16
|
Buso G, Faggin E, Bressan A, Galliazzo S, Cinetto F, Felice C, Fusaro M, Erdmann A, Pauletto P, Rattazzi M, Mazzolai L. Enhanced neutrophil activity, but not neutrophil extracellular trap markers, is found in patients with symptomatic chronic peripheral arterial disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background/Introduction
Neutrophil degranulation and neutrophil extracellular traps (NETs) are suggested to play a role in cardiovascular (CV) disease development [1]. Human studies showed that markers of NETs, are increased in patients with severe coronary atherosclerosis and predict risk of cardiac events [2]. The role of NETs in peripheral artery disease (PAD) has not been investigated.
Purpose
To measure circulating markers of neutrophil activity in patients with symptomatic PAD compared with matched healthy controls, evaluate their association with disease severity, and assess their prognostic value.
Methods
Multicenter, prospective case-control study. Circulating levels of polymorphonuclear neutrophil (PMN)-elastase, neutrophil gelatinase-associated lipocalin (NGAL), myeloperoxidase (MPO), and NETs-associated MPO-DNA complexes were measured in patients with symptomatic PAD and heathy controls. The former underwent comprehensive vascular evaluation including ankle-brachial index (ABI) calculation, transcutaneous oximetry measurement, constant-load treadmill test, 6-minute walking test, pulse wave velocity, and flow-mediated dilatation of the brachial artery. Six-month outcomes were: occurrence of major adverse CV (MACE) and limb events (MALE), ABI reduction ≥0.15, and 6-minute walking distance reduction ≥20 m.
Results
Overall, 110 participants were included, 66 had symptomatic PAD. Levels of all but one biomarker (MPO-DNA) were significantly higher in patients with PAD compared with healthy controls (Fig. 1). No significant correlation was found between biomarkers and vascular tests in patients with PAD. Baseline PMN-elastase (adjusted hazard ratio [HR]: 1.010; 95% CI: 1.000–1.020; p=0.040) and MPO (adjusted HR: 1.027; 95% CI: 1.004–1.051; p=0.019) were predictive of MACE and/or MALE at 6-month follow-up in patients with symptomatic PAD (Table 1).
Conclusions
Present data show enhanced neutrophil activity, but not NETs levels, in patients with symptomatic PAD compared to controls. Baseline PMN-elastase and MPO levels were associated with worst CV outcome in patients with chronic PAD. These data suggest a role of neutrophils in PAD development and severity that needs to be further elucidated.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- G Buso
- University Hospital of Lausanne , Lausanne , Switzerland
| | - E Faggin
- University of Padova , Padua , Italy
| | - A Bressan
- University of Padova , Padua , Italy
| | - S Galliazzo
- Hospital Center of Montebelluna , Montebelluna , Italy
| | - F Cinetto
- University of Padova , Padua , Italy
| | - C Felice
- University of Padova , Padua , Italy
| | - M Fusaro
- Treviso Hospital , Treviso , Italy
| | | | - P Pauletto
- Motta di Livenza High Specialization Rehabilitation Hospital , Motta di Livenza , Italy
| | | | - L Mazzolai
- University Hospital of Lausanne , Lausanne , Switzerland
| |
Collapse
|
17
|
Garzi G, Cinetto F, Firinu D, Di Napoli G, Lagnese G, Punziano A, Bez P, Cinicola BL, Costanzo G, Scarpa R, Pulvirenti F, Rattazzi M, Spadaro G, Quinti I, Milito C. Real-life data on monoclonal antibodies and antiviral drugs in Italian inborn errors of immunity patients during COVID-19 pandemic. Front Immunol 2022; 13:947174. [PMID: 35967382 PMCID: PMC9367468 DOI: 10.3389/fimmu.2022.947174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/29/2022] [Indexed: 12/16/2022] Open
Abstract
BackgroundSince the beginning of the COVID-19 pandemic, patients with Inborn Errors of Immunity have been infected by SARS-CoV-2 virus showing a spectrum of disease ranging from asymptomatic to severe COVID-19. A fair number of patients did not respond adequately to SARS-CoV-2 vaccinations, thus early therapeutic or prophylactic measures were needed to prevent severe or fatal course or COVID-19 and to reduce the burden of hospitalizations.MethodsLongitudinal, multicentric study on patients with Inborn Errors of Immunity immunized with mRNA vaccines treated with monoclonal antibodies and/or antiviral agents at the first infection and at reinfection by SARS-CoV-2. Analyses of efficacy were performed according to the different circulating SARS-CoV-2 strains.ResultsThe analysis of the cohort of 192 SARS-CoV-2 infected patients, across 26 months, showed the efficacy of antivirals on the risk of hospitalization, while mabs offered a positive effect on hospitalization, and COVID-19 severity. This protection was consistent across the alpha, delta and early omicron waves, although the emergence of BA.2 reduced the effect of available mabs. Hospitalized patients treated with mabs and antivirals had a lower risk of ICU admission. We reported 16 re-infections with a length of SARS-CoV-2 positivity at second infection shorter among patients treated with mabs. Treatment with antivirals and mabs was safe.ConclusionsThe widespread use of specific therapy, vaccination and better access to care might have contributed to mitigate risk of mortality, hospital admission, and severe disease. However, the rapid spread of new viral strains underlines that mabs and antiviral beneficial effects should be re- evaluated over time.
Collapse
Affiliation(s)
- Giulia Garzi
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Giulia Di Napoli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Patrick Bez
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Bianca Laura Cinicola
- Department of Maternal Infantile and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Riccardo Scarpa
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Federica Pulvirenti
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, Padua, Italy
- Rare Diseases Referral Center, Internal Medicine I, Ca’ Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
- *Correspondence: Isabella Quinti,
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
18
|
Scarpa R, Dell'Edera A, Felice C, Buso R, Muscianisi F, Finco Gambier R, Toffolo S, Grossi U, Giobbia M, Barberio G, Landini N, Facchini C, Agostini C, Rattazzi M, Cinetto F. Impact of Hypogammaglobulinemia on the Course of COVID-19 in a Non-Intensive Care Setting: A Single-Center Retrospective Cohort Study. Front Immunol 2022; 13:842643. [PMID: 35359947 PMCID: PMC8960988 DOI: 10.3389/fimmu.2022.842643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/01/2022] [Indexed: 12/11/2022] Open
Abstract
Background Severity and mortality of COVID-19 largely depends on the ability of the immune system to clear the virus. Among various comorbidities potentially impacting on this process, the weight and the consequences of an antibody deficiency have not yet been clarified. Methods We used serum protein electrophoresis to screen for hypogammaglobulinemia in a cohort of consecutive adult patients with COVID-19 pneumonia, hospitalized in non-intensive care setting between December 2020 and January 2021. The disease severity, measured by a validated score and by the need for semi intensive (sICU) or intensive care unit (ICU) admission, and the 30-day mortality was compared between patients presenting hypogammaglobulinemia (HYPO) and without hypogammaglobulinemia (no-HYPO). Demographics, comorbidities, COVID-19 specific treatment during the hospital stay, disease duration, complications and laboratory parameters were also evaluated in both groups. Results We enrolled 374 patients, of which 39 represented the HYPO cohort (10.4%). In 10/39 the condition was previously neglected, while in the other 29/39 hematologic malignancies were common (61.5%); 2/39 were on regular immunoglobulin replacement therapy (IgRT). Patients belonging to the HYPO group more frequently developed a severe COVID-19 and more often required sICU/ICU admission than no-HYPO patients. IgRT were administered in 8/39 during hospitalization; none of them died or needed sICU/ICU. Among HYPO cohort, we observed a significantly higher prevalence of neoplastic affections, of active oncologic treatment and bronchiectasis, together with higher prevalence of viral and bacterial superinfections, mechanical ventilation, convalescent plasma and SARS-CoV-2 monoclonal antibodies administration during hospital stay, and longer disease duration. Multivariate logistic regression analysis and Cox proportional hazard regression confirmed the impact of hypogammaglobulinemia on the COVID-19 severity and the probability of sICU/ICU admission. The analysis of the mortality rate in the whole cohort showed no significant difference between HYPO and no-HYPO. Conclusions Hypogammaglobulinemia, regardless of its cause, in COVID-19 patients hospitalized in a non-intensive care setting was associated to a more severe disease course and more frequent admission to s-ICU/ICU, particularly in absence of IgRT. Our findings emphasize the add-value of routine serum protein electrophoresis evaluation in patients admitted with COVID-19 to support clinicians in patient care and to consider IgRT initiation during hospitalization.
Collapse
Affiliation(s)
- Riccardo Scarpa
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Alessandro Dell'Edera
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Carla Felice
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Roberta Buso
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Francesco Muscianisi
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Renato Finco Gambier
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Sara Toffolo
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Ugo Grossi
- Department of Surgery, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Mario Giobbia
- Infectious Diseases Unit, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Giuseppina Barberio
- Laboratory Medicine, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Nicholas Landini
- Radiology Unit, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Cesarina Facchini
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy
| | - Carlo Agostini
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Marcello Rattazzi
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| | - Francesco Cinetto
- Internal Medicine I, Ca' Foncello Hospital, Azienda Unità Locale Socio Sanitaria n. 2 (AULSS2) Marca Trevigiana, Treviso, Italy.,Department of Medicine, University of Padova, Padua, Italy
| |
Collapse
|
19
|
Grossi U, Gallo G, Di Tanna GL, Bracale U, Ballo M, Galasso E, Kazemi Nava A, Zucchella M, Cinetto F, Rattazzi M, Felice C, Zanus G. Surgical Management of Hemorrhoidal Disease in Inflammatory Bowel Disease: A Systematic Review with Proportional Meta-Analysis. J Clin Med 2022; 11:709. [PMID: 35160159 PMCID: PMC8837177 DOI: 10.3390/jcm11030709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 02/06/2023] Open
Abstract
Surgical treatment of hemorrhoidal disease (HD) in inflammatory bowel disease (IBD) has been considered to be potentially harmful, but the evidence for this is poor. Therefore, a systematic review of the literature was undertaken to reappraise the safety and effectiveness of surgical treatments in this special circumstance. A MEDLINE, Web of Science, Scopus, and Cochrane Library search was performed to retrieve studies reporting the outcomes of surgical treatment of HD in patients with Crohn's disease (CD) and ulcerative colitis (UC). From a total of 2072 citations, 10 retrospective studies including 222 (range, 2-70) patients were identified. Of these, 119 (54%) had CD and 103 (46%) UC. Mean age was between 41 and 49 years (range 14-77). Most studies lacked information on the interval between surgery and the onset of complications. Operative treatments included open or closed hemorrhoidectomy (n = 156 patients (70%)), rubber band ligation (n = 39 (18%)), excision or incision of thrombosed hemorrhoid (n = 14 (6%)), and doppler-guided hemorrhoidal artery ligation (DG-HAL, n = 13 (6%)). In total, 23 patients developed a complication (pooled prevalence, 9%; (95%CI, 3-16%)), with a more than two-fold higher rate in patients with CD compared to UC (11% (5-16%) vs. 5% (0-13%), respectively). Despite the low quality evidence, surgical management of HD in IBD and particularly in CD patients who have failed nonoperative therapy should still be performed with caution and limited to inactive disease. Further studies should determine whether advantages in terms of safety and effectiveness with the use of non-excisional techniques (e.g., DG-HAL) can be obtained in this patient population.
Collapse
Affiliation(s)
- Ugo Grossi
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, 35128 Padua, Italy
| | - Gaetano Gallo
- Department of Medicine, Surgery and Neurosciences, Unit of General Surgery and Surgical Oncology, University of Siena, 53100 Siena, Italy;
| | - Gian Luca Di Tanna
- Statistics Division, The George Institute for Global Health, University of New South Wales, Sydney 2042, Australia;
| | - Umberto Bracale
- Department of Advanced Biomedical Sciences, ‘Federico II’ University of Naples, 80131 Naples, Italy;
| | - Mattia Ballo
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, 35128 Padua, Italy
| | - Elisa Galasso
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, 35128 Padua, Italy
| | - Andrea Kazemi Nava
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
| | - Martino Zucchella
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy; (F.C.); (M.R.); (C.F.)
| | - Marcello Rattazzi
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy; (F.C.); (M.R.); (C.F.)
| | - Carla Felice
- Department of Medicine-DIMED, University of Padua, 35128 Padua, Italy; (F.C.); (M.R.); (C.F.)
| | - Giacomo Zanus
- II Surgery Unit, Regional Hospital Treviso, AULSS2, 31100 Treviso, Italy; (M.B.); (E.G.); (A.K.N.); (M.Z.); (G.Z.)
- Department of Surgery, Oncology and Gastroenterology-DISCOG, University of Padua, 35128 Padua, Italy
| |
Collapse
|
20
|
Spinato G, Fabbris C, Costantini G, Conte F, Scotton PG, Cinetto F, De Siati R, Matarazzo A, Citterio M, Contro G, De Filippis C, Agostini C, Emanuelli E, Boscolo-Rizzo P, Frezza D. The Effect of Isotonic Saline Nasal Lavages in Improving Symptoms in SARS-CoV-2 Infection: A Case-Control Study. Front Neurol 2021; 12:794471. [PMID: 34938268 PMCID: PMC8687114 DOI: 10.3389/fneur.2021.794471] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mainly colonizes nasopharynx. In upper airways acute infections, e.g., the common cold, saline nasal irrigations have a significant efficacy in reducing symptoms. The present study aimed to test the efficacy of nasal lavages in upper airways symptoms of Coronavirus Disease 2019 (COVID-19). Methods: A series of consecutive adult subjects who tested positive for SARS-CoV-2 from December 2020 to February 2021 performed daily nasal lavages with saline solution (Lavonase®—Purling, Lugo di Romagna, Italy) for 12 days, starting on the day after the SARS-CoV-2 positive swab. A control group included a historical series of patients who were infected in February-March 2020 and who did not perform lavages. An ad hoc questionnaire regarding symptoms was administered to each subjects at base-line and 10 days after diagnosis (i.e., on the same day of the control swab) in both cases and controls. Results: A total of 140 subjects were enrolled. 68 participants in the treatment group and 72 in the control group were included. 90% of respondents declared the lavages were simple to use and 70% declared they were satisfied. Symptoms of blocked nose, runny nose, or sneezing decreased by an average of 24.7% after the treatment. Blocked nose and sneezing increased in the same period of time in the control group. Ears and eyes symptoms, anosmia/ageusia symptoms, and infection duration (10.53 days in the treatment group and 10.48 days in the control group) didn't vary significantly among the two groups. Conclusion: Nasal lavages resulted to significantly decrease nasal symptoms in newly diagnosed SARS-CoV-2 patients. These devices proved to be well-tolerated and easy to be used. Further studies on a larger number of subjects are needed in order to possibly confirm these preliminary results.
Collapse
Affiliation(s)
- Giacomo Spinato
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Giulio Costantini
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Federica Conte
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | | | | | | | | | - Marco Citterio
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Giacomo Contro
- Department of Neurosciences, University of Padua, Padua, Italy
| | | | - Carlo Agostini
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Enzo Emanuelli
- Department of Otolaryngology, Ospedale di Treviso, Treviso, Italy
| | | | - Daniele Frezza
- Department of Otolaryngology, Ospedale di Treviso, Treviso, Italy
| |
Collapse
|
21
|
Buso R, Cinetto F, Dell’Edera A, Veneran N, Facchini C, Biscaro V, Schiavon S, Vian E, Grossi U, Zanus G, Giobbia M, Scarpa R, Agostini C, Rattazzi M, Felice C. Comparison between Dexamethasone and Methylprednisolone Therapy in Patients with COVID-19 Pneumonia Admitted to Non-Intensive Medical Units. J Clin Med 2021; 10:jcm10245812. [PMID: 34945108 PMCID: PMC8703463 DOI: 10.3390/jcm10245812] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/08/2021] [Accepted: 12/09/2021] [Indexed: 02/07/2023] Open
Abstract
(1) Background: Data on different steroid compounds for the treatment of hospitalized COVID-19 (coronavirus disease 2019) patients are still limited. The aim of this study was to compare COVID-19 patients admitted to non-intensive units and treated with methylprednisolone or dexamethasone. (2) Methods: This was a single-center retrospective study that included consecutive patients with COVID-19 hospitalized in medical wards during the second wave of the pandemic. Thirty-day mortality and the need for intensive or semi-intensive care were the main clinical outcomes analyzed in patients receiving methylprednisolone (60 mg/day) compared with dexamethasone (6 mg/day). Secondary outcomes included complication rates, length of hospital stay, and time to viral clearance. (3) Results: Two-hundred-forty-six patients were included in the analysis, 110 treated with dexamethasone and 136 with methylprednisolone. No statistically significant differences were found between the two groups of patients regarding 30-day mortality (OR 1.35, CI95% 0.71-2.56, p = 0.351) and the need for intensive or semi-intensive care (OR 1.94, CI95% 0.81-4.66, p = 0.136). The complication rates, length of hospital stay, and time to viral clearance did not significantly differ between the two groups. (4) Conclusions: In patients hospitalized for COVID-19 in non-intensive units, the choice of different steroid compounds, such as dexamethasone or methylprednisolone, did not affect the main clinical outcomes.
Collapse
Affiliation(s)
- Roberta Buso
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Francesco Cinetto
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
| | - Alessandro Dell’Edera
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Nicola Veneran
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Cesarina Facchini
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Valeria Biscaro
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Stefania Schiavon
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Elisa Vian
- Microbiology Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (V.B.); (S.S.); (E.V.)
| | - Ugo Grossi
- Surgery 2 Unit, DISCOG, Ca’ Foncello University Hospital, University of Padua, 31100 Treviso, Italy; (U.G.); (G.Z.)
| | - Giacomo Zanus
- Surgery 2 Unit, DISCOG, Ca’ Foncello University Hospital, University of Padua, 31100 Treviso, Italy; (U.G.); (G.Z.)
| | - Mario Giobbia
- Infective Disease Unit, Department of Specialist and Laboratory Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy;
| | - Riccardo Scarpa
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| | - Carlo Agostini
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
| | - Marcello Rattazzi
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
- Department of Medicine, DIMED, University of Padova, 35122 Padova, Italy
- Correspondence: or ; Tel.: +39-0498211867 or +39-0422322207; Fax: +39-0498754179
| | - Carla Felice
- Medicine 1 Unit, Department of Medicine, Ca’ Foncello University Hospital, 31100 Treviso, Italy; (R.B.); (F.C.); (A.D.); (N.V.); (C.F.); (R.S.); (C.A.); (C.F.)
| |
Collapse
|
22
|
Spinato G, Fabbris C, Conte F, Menegaldo A, Franz L, Gaudioso P, Cinetto F, Agostini C, Costantini G, Boscolo‐Rizzo P. COVID-Q: Validation of the first COVID-19 questionnaire based on patient-rated symptom gravity. Int J Clin Pract 2021; 75:e14829. [PMID: 34510668 PMCID: PMC8646717 DOI: 10.1111/ijcp.14829] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 08/11/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES The aim of the present study was to develop and validate the CoronaVirus-Disease-2019 (COVID-19) Questionnaire (COVID-Q), a novel symptom questionnaire specific for COVID-19 patients, to provide a comprehensive evaluation that may be helpful for physicians, and evaluate the questionnaire's performance in identifying subjects at higher risk of testing positive. MATERIALS AND METHODS Consecutive non-hospitalised adults who underwent nasopharyngeal-throat swab for severe-acute-respiratory-syndrome-coronavirus-2 (SARS-CoV-2) detection at Treviso Hospital in March 2020, were enrolled. Subjects were divided into positive (cases) and negative (controls). All subjects answered the COVID-Q. Patients not able to answer COVID-Q because of clinical conditions were excluded. Parallel Analysis and Principal Component Analysis identified items measuring the same dimension. The Item Response Theory (IRT)-based analyses evaluated the functioning of item categories, the presence of clusters of local dependence among items, item fit within the model and model fit to the data. RESULTS Answers obtained from 230 cases (113 males; mean age 55 years, range 20-99) and 230 controls (61 males; mean age 46 years, range 21-89) were analysed. Six components were extracted with parallel analysis: asthenia, influenza-like symptoms, ear and nose symptoms, breathing issues, throat symptoms, and anosmia/ageusia. The final IRT models retained 27 items as significant for symptom assessment. The total questionnaire's score was significantly associated with positivity to the molecular test: subjects with multiple symptoms were more likely to be affected (P < .001). Older age, male gender presence of breathing issues and anosmia/ageusia were significantly related to positivity (P < .001). Comorbidities had not a significant association with the COVID-19 diagnosis. CONCLUSION COVID-Q could be validated since the evaluated aspects were overall significantly related to infection. The application of the questionnaire to clinical practice may help to identify subjects who are likely to be affected by COVID-19 and address them to a nasopharyngeal swab in order to achieve an early diagnosis.
Collapse
Affiliation(s)
- Giacomo Spinato
- Department of NeurosciencesSection of Otolaryngology and Regional Centre for Head and Neck CancerUniversity of PadovaTrevisoItaly
- Department of Surgery, Oncology and GastroenterologySection of Oncology and ImmunologyUniversity of PadovaPadovaItaly
| | - Cristoforo Fabbris
- Department of NeurosciencesSection of Otolaryngology and Regional Centre for Head and Neck CancerUniversity of PadovaTrevisoItaly
| | - Federica Conte
- Department of PsychologyUniversity of Milano BicoccaMilanItaly
| | - Anna Menegaldo
- Department of NeurosciencesSection of Otolaryngology and Regional Centre for Head and Neck CancerUniversity of PadovaTrevisoItaly
| | - Leonardo Franz
- Department of NeurosciencesSection of Otolaryngology and Regional Centre for Head and Neck CancerUniversity of PadovaTrevisoItaly
| | - Piergiorgio Gaudioso
- Department of NeurosciencesSection of Otolaryngology and Regional Centre for Head and Neck CancerUniversity of PadovaTrevisoItaly
| | - Francesco Cinetto
- Department of MedicineClinical Immunology and HematologyUniversity of PadovaTrevisoItaly
| | - Carlo Agostini
- Department of MedicineClinical Immunology and HematologyUniversity of PadovaTrevisoItaly
| | | | - Paolo Boscolo‐Rizzo
- Section of OtorhinolaryngologyAzienda Sanitaria Universitaria Integrata di TriesteTriesteItaly
| |
Collapse
|
23
|
Pulvirenti F, Milito C, Cinetto F, Salinas AF, Terreri S, Mortari EP, Auria S, Soccodato V, Miriam L, Nicastri E, Vincenzi L, Carsetti R, D'Offizi G, Quinti I. SARS-CoV-2 monoclonal antibody combination therapy in patients with COVID-19 and primary antibody deficiency. J Infect Dis 2021; 225:820-824. [PMID: 34746954 PMCID: PMC8689914 DOI: 10.1093/infdis/jiab554] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Previous reports highlighted the efficacy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific monoclonal antibodies (mAbs) against coronavirus disease 2019. Methods We conducted a prospective study on the clinical outcome and antiviral effects of mAbs added to standard of care therapy in SARS-CoV-2-infected patients with primary antibody defects. Results Median time of SARS-CoV-2 quantitative polymerase chain reaction (qPCR) positivity was shorter in 8 patients treated with mAbs (22 days) than in 10 patients treated with standard of care therapy only (37 days, P=.026). Median time of SARS-CoV-2 qPCR positivity from mAb administration was 10 days. Conclusions The SARS-CoV-2 mAbs treatment was effective and well tolerated in patients with primary antibody defects.
Collapse
Affiliation(s)
- Federica Pulvirenti
- Primary Immune Deficiencies Unit, Azienda Ospedaliera Universitaria Policlinico Umberto I, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome; Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, and Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Ane Fernandez Salinas
- Department of Molecular Medicine, Sapienza University of Rome and Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Sara Terreri
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Eva Piano Mortari
- Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Stefania Auria
- Department of Molecular Medicine, Sapienza University of Rome; Rome, Italy
| | | | - Lichtner Miriam
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Italy.,Infectious Diseases Unit, SM Goretti Hospital, Sapienza University of Rome, Latina, Italy
| | - Emanuele Nicastri
- National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy
| | - Laura Vincenzi
- POIT- INMI Spallanzani Infectious Diseases/Hepatology Unit, Rome, Italy
| | - Rita Carsetti
- Department of Molecular Medicine, Sapienza University of Rome and Diagnostic Immunology Research Unit, Multimodal Medicine Research Area, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome; Rome, Italy
| |
Collapse
|
24
|
Bettiol A, Urban ML, Dagna L, Cottin V, Franceschini F, Del Giacco S, Schiavon F, Neumann T, Lopalco G, Novikov P, Baldini C, Lombardi C, Berti A, Alberici F, Folci M, Negrini S, Sinico RA, Quartuccio L, Lunardi C, Parronchi P, Moosig F, Espígol-Frigolé G, Schroeder J, Kernder AL, Monti S, Silvagni E, Crimi C, Cinetto F, Fraticelli P, Roccatello D, Vacca A, Mohammad AJ, Hellmich B, Samson M, Bargagli E, Cohen Tervaert JW, Ribi C, Fiori D, Bello F, Fagni F, Moroni L, Ramirez GA, Nasser M, Marvisi C, Toniati P, Firinu D, Padoan R, Egan A, Seeliger B, Iannone F, Salvarani C, Jayne D, Prisco D, Vaglio A, Emmi G. Mepolizumab for Eosinophilic Granulomatosis with Polyangiitis (EGPA): a European multicenter observational study. Arthritis Rheumatol 2021; 74:295-306. [PMID: 34347947 PMCID: PMC9305132 DOI: 10.1002/art.41943] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/18/2021] [Accepted: 07/29/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Mepolizumab proved efficacious for eosinophilic granulomatosis with polyangiitis (EGPA, former Churg-Strauss) at the dosage of 300mg/4 weeks in the randomized controlled MIRRA trial. Few successful real-life experiences with the dosage approved for severe eosinophilic asthma (100mg/4 weeks) were recently reported. We retrospectively assessed the effectiveness and safety of mepolizumab 100 and 300mg/4 weeks in a large European EGPA cohort. METHODS We included all EGPA patients treated with mepolizumab at the recruiting centres in 2015-2020. Treatment response was evaluated from month 3 through 24 (T3-T24) after mepolizumab starting. Complete response (CR) was defined as no disease activity (Birmingham Vasculitis Activity Score, BVAS=0) and a prednisone dose ≤4mg/day. Respiratory outcomes included asthma and ear-nose-throat (ENT) exacerbations. RESULTS We included 203 patients, of whom 191 at stable dosage (158 mepolizumab 100mg/4 weeks, 33 300mg/4 weeks). At T3, 25 patients (12.3%) had a CR. CR rates increased to 30.4% and 35.7% at T12 and T24 and were comparable between mepolizumab 100 and 300mg/4 weeks. Mepolizumab led to a significant reduction in BVAS, prednisone dose, eosinophil counts from T3 through T24, with no significant differences between 100 and 300 mg/4weeks. Eighty-two patients (40.4%) experienced asthma exacerbations [57/158 (36%) on 100mg/4 weeks; 17/33 (52%) on 300mg/4 weeks]. Thirty-one (15.3%) experienced ENT exacerbations. Forty-four patients (21.7%) experienced adverse events, most being non-serious (38/44). CONCLUSION Mepolizumab both at 100 and 300mg/4 weeks is effective for EGPA. The two dosages should be compared in the setting of a controlled trial.
Collapse
Affiliation(s)
- Alessandra Bettiol
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria Letizia Urban
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Vincent Cottin
- Department of Respiratory Medicine, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Franco Franceschini
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy.,Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franco Schiavon
- Unit of Rheumatology, Department of Systems Medicine, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Thomas Neumann
- Department of Rheumatology and Immunology, Cantonal Hospital St, Gallen St, Gallen Switzerland.,Department of Internal Medicine III, Jena University Hospital, Jena, Germany
| | - Giuseppe Lopalco
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Pavel Novikov
- Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Carlo Lombardi
- Departmental Unit of Allergology-Clinical Immunology & Pneumology, Fondazione Poliambulanza Istituto Ospedaliero, Brescia
| | - Alvise Berti
- Santa Chiara Hospital, Department of Cellular, Computational and Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Nephrology Unit, Spedali Civili Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Marco Folci
- Humanitas Clinical and Research Center-IRCCS, Milan, Italy.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Simone Negrini
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research and Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Luca Quartuccio
- Department of Medicine, Rheumatology Clinic, University of Udine, ASUFC Udine, Udine, Italy
| | | | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Frank Moosig
- Rheumazentrum Schleswig-Holstein Mitte, Neumünster, Germany
| | - Georgina Espígol-Frigolé
- Department of Autoimmune Diseases, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Institut d'investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Spain
| | - Jan Schroeder
- Unit of Allergy and Immunology, ASST GOM Niguarda, Milan, Italy
| | | | - Sara Monti
- Department of Rheumatology, IRCCS Policlinico S. Matteo Fondazione, University of Pavia, Pavia, Italy
| | - Ettore Silvagni
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Claudia Crimi
- Respiratory Medicine Unit, Policlinico-Vittorio Emanuele San Marco" University Hospital, Catania, Italy
| | | | - Paolo Fraticelli
- Department of Internal Medicine, University Hospital "Ospedali Riuniti", Ancona, Italy
| | - Dario Roccatello
- Nephrology and Dialysis Unit (ERKnet Member)-CMID, Center of Research of Immunopathology and Rare Diseases, San Giovanni Bosco Hospital and University of Turin, Turin, Italy
| | - Angelo Vacca
- Guido Baccelli Unit of Internal Medicine, Department of Biomedical Sciences and Human Oncology, School of Medicine, Aldo Moro University of Bari, Bari, Italy
| | - Aladdin J Mohammad
- Lund University, Department of Clinical Sciences Lund, Rheumatology, Skåne University Hospital, Lund, Sweden.,Department of Medicine, University of Cambridge, Cambridge, UK
| | - Bernhard Hellmich
- Klinik für Innere Medizin, Rheumatologie und Immunologie, Vaskulitiszentrum Süd, Medius Kliniken, University of Tübingen, Kirchheim unter Teck, Germany
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | | | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.,Maastricht University, Maastricht, Netherlands
| | - Camillo Ribi
- Division of Immunology and Allergy, University Hospital Center of Lausanne, Lausanne, Switzerland
| | - Davide Fiori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Federica Bello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Filippo Fagni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Moroni
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Mouhamad Nasser
- Department of Respiratory Medicine, Hospices Civils de Lyon, University of Lyon, Lyon, France
| | - Chiara Marvisi
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia.,Università di Modena e Reggio Emilia, Reggio Emilia and Modena, Italy
| | - Paola Toniati
- Rheumatology and Clinical Immunology Unit, ASST Spedali Civili of Brescia, Brescia, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Roberto Padoan
- Unit of Rheumatology, Department of Systems Medicine, Azienda Ospedaliera-Universitaria di Padova, Padova, Italy
| | - Allyson Egan
- Department of Medicine, University of Cambridge, Cambridge, UK
| | | | - Florenzo Iannone
- Rheumatology Unit, Department of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Carlo Salvarani
- Rheumatology Unit, Azienda USL-IRCCS di Reggio Emilia.,Università di Modena e Reggio Emilia, Reggio Emilia and Modena, Italy
| | - David Jayne
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Augusto Vaglio
- Department of Biomedical, Experimental and Clinical Sciences "Mario Serio", University of Firenze, Florence, Italy.,Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy
| | - Giacomo Emmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | |
Collapse
|
25
|
Donato M, Faggin E, Cinetto F, Felice C, Lupo MG, Ferri N, Rattazzi M. The Emerging Role of Nutraceuticals in Cardiovascular Calcification: Evidence from Preclinical and Clinical Studies. Nutrients 2021; 13:nu13082603. [PMID: 34444763 PMCID: PMC8401694 DOI: 10.3390/nu13082603] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/22/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023] Open
Abstract
Cardiovascular calcification is the ectopic deposition of calcium-phosphate crystals within the arterial wall and the aortic valve leaflets. This pathological process leads to increased vascular stiffness, reduced arterial elasticity, and aortic valve stenosis, increasing the risk of cardiovascular diseases. Although cardiovascular calcification is an increasing health care burden, to date no medical therapies have been approved for treating or preventing it. Considering the current lack of therapeutic strategies and the increasing prevalence of cardiovascular calcification, the investigation of some nutraceuticals to prevent this pathological condition has become prevalent in recent years. Recent preclinical and clinical studies evaluated the potential anti-calcific role of nutraceuticals (including magnesium, zinc, iron, vitamin K, and phytate) in the progression of vascular calcification, providing evidence for their dietary supplementation, especially in high-risk populations. The present review summarizes the current knowledge and latest advances for nutraceuticals with the most relevant preclinical and clinical data, including magnesium, zinc, iron, vitamin K, and phytate. Their supplementation might be recommended as a cost-effective strategy to avoid nutritional deficiency and to prevent or treat cardiovascular calcification. However, the optimal dose of nutraceuticals has not been identified and large interventional trials are warranted to support their protective effects on cardiovascular disease.
Collapse
Affiliation(s)
- Maristella Donato
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Elisabetta Faggin
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
| | - Francesco Cinetto
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Carla Felice
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Maria Giovanna Lupo
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, 35122 Padua, Italy; (M.D.); (M.G.L.); (N.F.)
| | - Marcello Rattazzi
- Department of Medicine—DIMED, University of Padova, 35122 Padua, Italy; (E.F.); (F.C.); (C.F.)
- Medicina Generale I^, Ca’ Foncello Hospital, 31100 Treviso, Italy
- Correspondence: ; Tel.: +39-04-9821-1867 or +39-04-2232-2207
| |
Collapse
|
26
|
Cinetto F, Ceccato J, Caputo I, Cangiano D, Montini B, Lunardi F, Piazza M, Agostini C, Calabrese F, Semenzato G, Rattazzi M, Gurrieri C, Scarpa R, Felice C, Vianello F. GSK-3 Inhibition Modulates Metalloproteases in a Model of Lung Inflammation and Fibrosis. Front Mol Biosci 2021; 8:633054. [PMID: 34235177 PMCID: PMC8255387 DOI: 10.3389/fmolb.2021.633054] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 05/20/2021] [Indexed: 12/15/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is mainly characterized by aberrant extracellular matrix deposition, consequent to epithelial lung injury and myofibroblast activation, and inflammatory response. Glycogen synthase kinase 3 (GSK-3) is a serine-threonine kinase involved in several pathways, and its inhibition has been already suggested as a therapeutic strategy for IPF patients. There is evidence that GSK-3 is able to induce matrix metalloproteinase (MMP) expression and that its inhibition modulates MMP expression in the tissues. The aim of our study was to investigate the role of GSK-3 and its inhibition in the modulation of MMP-9 and -2 in an in vivo mouse model of lung fibrosis and in vitro using different cell lines exposed to pro-inflammatory or pro-fibrotic stimuli. We found that GSK-3 inhibition down-modulates gene expression and protein levels of MMP-9, MMP-2, and their inhibitors TIMP-1 and TIMP-2 in inflammatory cells harvested from bronchoalveolar lavage fluid (BALF) of mice treated with bleomycin as well as in interstitial alveolar macrophages and cuboidalized epithelial alveolar cells. To the same extent, GSK-3 inhibition blunted the increased MMP-9 and MMP-2 activity induced by pro-fibrotic stimuli in a human lung fibroblast cell line. Moreover, the αSMA protein level, a marker of fibroblast-to-myofibroblast transition involved in fibrosis, was decreased in primary fibroblasts treated with TGFβ following GSK-3 inhibition. Our results confirm the implication of GSK-3 in lung inflammation and fibrosis, suggesting that it might play its role by modulating MMP expression and activity but also pushing fibroblasts toward a myofibroblast phenotype and therefore enhancing extracellular matrix deposition. Thus, its inhibition could represent a possible therapeutic strategy.
Collapse
Affiliation(s)
- Francesco Cinetto
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Jessica Ceccato
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Ilaria Caputo
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Daniela Cangiano
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Barbara Montini
- Institute of Pediatric Research (IRP) Città Della Speranza, Padua, Italy
| | - Francesca Lunardi
- Department of Cardiothoracic and Vascular Sciences, Pathology Section, University of Padova, Padua, Italy
| | - Maria Piazza
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Carlo Agostini
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Fiorella Calabrese
- Department of Cardiothoracic and Vascular Sciences, Pathology Section, University of Padova, Padua, Italy
| | | | - Marcello Rattazzi
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Carmela Gurrieri
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Riccardo Scarpa
- Internal Medicine and Allergology and Clinical Immunology Units, Treviso Ca' Foncello Hospital, Treviso, Italy
| | - Carla Felice
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| | - Fabrizio Vianello
- Hematology Unit, Department of Medicine, University of Padova, Padova, Italy
| |
Collapse
|
27
|
Milito C, Soccodato V, Collalti G, Lanciarotta A, Bertozzi I, Rattazzi M, Scarpa R, Cinetto F. Vaccination in PADs. Vaccines (Basel) 2021; 9:vaccines9060626. [PMID: 34207916 PMCID: PMC8230118 DOI: 10.3390/vaccines9060626] [Citation(s) in RCA: 6] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/27/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022] Open
Abstract
Primary antibody deficiencies (PADs) are the most common primary immunodeficiencies (PIDs). They can be divided into the following groups, depending on their immunological features: agammaglobulinemia; common variable immunodeficiency (CVID) isotype; hyper IgM isotype; light chain or functional deficiencies with normal B cell count; specific antibody deficiency with normal Ig concentrations and normal numbers of B cells and transient hypogammaglobulinemia of infancy. The role of vaccination in PADs is recognized as therapeutic, diagnostic and prognostic and may be used in patients with residual B-cell function to provide humoral immunity to specific infective agents. According to their content and mechanisms, vaccines are grouped as live attenuated, inactivated (conjugated, polysaccharide), mRNA or replication-deficient vector vaccines. Vaccination may be unsafe or less effective when using certain vaccines and in specific types of immunodeficiency. Inactivated vaccines can be administered in PAD patients even if they could not generate a protective response; live attenuated vaccines are not recommended in major antibody deficiencies. From December 2020, European Medicines Agency (EMA) approved vaccines against COVID-19 infection: according to ESID advises, those vaccinations are recommended in patients with PADs. No specific data are available on safety and efficacy in PAD patients.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.S.); (G.C.)
- Correspondence:
| | - Valentina Soccodato
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.S.); (G.C.)
| | - Giulia Collalti
- Department of Molecular Medicine, Sapienza University of Rome, 00161 Rome, Italy; (V.S.); (G.C.)
| | - Alison Lanciarotta
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.L.); (I.B.); (M.R.); (R.S.); (F.C.)
- Internal Medicine I, Ca’ Foncello Hospital, 10103 Treviso, Italy
| | - Ilaria Bertozzi
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.L.); (I.B.); (M.R.); (R.S.); (F.C.)
- Internal Medicine I, Ca’ Foncello Hospital, 10103 Treviso, Italy
| | - Marcello Rattazzi
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.L.); (I.B.); (M.R.); (R.S.); (F.C.)
- Internal Medicine I, Ca’ Foncello Hospital, 10103 Treviso, Italy
| | - Riccardo Scarpa
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.L.); (I.B.); (M.R.); (R.S.); (F.C.)
- Internal Medicine I, Ca’ Foncello Hospital, 10103 Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine, University of Padua, 35122 Padua, Italy; (A.L.); (I.B.); (M.R.); (R.S.); (F.C.)
- Internal Medicine I, Ca’ Foncello Hospital, 10103 Treviso, Italy
| |
Collapse
|
28
|
Cinetto F, Scarpa R, Carrabba M, Firinu D, Lougaris V, Buso H, Garzi G, Gianese S, Soccodato V, Punziano A, Lagnese G, Tessarin G, Costanzo G, Landini N, Vio S, Bondioni MP, Consonni D, Marasco C, Del Giacco S, Rattazzi M, Vacca A, Plebani A, Fabio G, Spadaro G, Agostini C, Quinti I, Milito C. Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID): A Multicenter Retrospective Study of Patients From Italian PID Referral Centers. Front Immunol 2021. [PMID: 33777011 DOI: 10.3389/fimmu.2021.627423.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Granulomatous and Lymphocytic Interstitial Lung Diseases (GLILD) is a severe non-infectious complication of Common Variable Immunodeficiency (CVID), often associated with extrapulmonary involvement. Due to a poorly understood pathogenesis, GLILD diagnosis and management criteria still lack consensus. Accordingly, it is a relevant cause of long-term loss of respiratory function and is closely associated with a markedly reduced survival. The aim of this study was to describe clinical, immunological, laboratory and functional features of GLILD, whose combination in a predictive model might allow a timely diagnosis. Methods: In a multicenter retrospective cross-sectional study we enrolled 73 CVID patients with radiologic features of interstitial lung disease (ILD) associated to CVID (CVID-ILD) and 125 CVID patients without ILD (controls). Of the 73 CVID-ILD patients, 47 received a definite GLILD diagnosis while 26 received a clinical-radiologic diagnosis of CVID related ILD defined as uILD. Results: In GLILD group we found a higher prevalence of splenomegaly (84.8 vs. 39.2%), autoimmune cytopenia (59.6 vs. 6.4%) and bronchiectasis (72.3 vs. 28%), and lower IgA and IgG serum levels at CVID diagnosis. GLILD patients presented lower percentage of switched-memory B cells and marginal zone B cells, and a marked increase in the percentage of circulating CD21lo B cells (14.2 vs. 2.9%). GLILD patients also showed lower total lung capacity (TLC 87.5 vs. 5.0%) and gas transfer (DLCO 61.5 vs. 5.0%) percent of predicted. By univariate logistic regression analysis, we found IgG and IgA levels at CVID diagnosis, presence of splenomegaly and autoimmune cytopenia, CD21lo B cells percentage, TLC and DCLO percent of predicted to be associated to GLILD. The joint analysis of four variables (CD21lo B cells percentage, autoimmune cytopenia, splenomegaly and DLCO percent of predicted), together in a multiple logistic regression model, yielded an area under the ROC curve (AUC) of 0.98 (95% CI: 0.95-1.0). The AUC was only slightly modified when pooling together GLILD and uILD patients (0.92, 95% CI: 0.87-0.97). Conclusions: we propose the combination of two clinical parameters (splenomegaly and autoimmune cytopenia), one lung function index (DLCO%) and one immunologic variable (CD21lo%) as a promising tool for early identification of CVID patients with interstitial lung disease, limiting the use of aggressive diagnostic procedures.
Collapse
Affiliation(s)
- Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Maria Carrabba
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Helena Buso
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giulia Garzi
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera-Universitaria Policlinico Umberto I, Rome, Italy
| | - Sabrina Gianese
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Valentina Soccodato
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera-Universitaria Policlinico Umberto I, Rome, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Giulio Tessarin
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Nicholas Landini
- Radiology Unit, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Stefania Vio
- Radiology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Marcello Rattazzi
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Giovanna Fabio
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Carlo Agostini
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
29
|
Cinetto F, Scarpa R, Carrabba M, Firinu D, Lougaris V, Buso H, Garzi G, Gianese S, Soccodato V, Punziano A, Lagnese G, Tessarin G, Costanzo G, Landini N, Vio S, Bondioni MP, Consonni D, Marasco C, Del Giacco S, Rattazzi M, Vacca A, Plebani A, Fabio G, Spadaro G, Agostini C, Quinti I, Milito C. Granulomatous Lymphocytic Interstitial Lung Disease (GLILD) in Common Variable Immunodeficiency (CVID): A Multicenter Retrospective Study of Patients From Italian PID Referral Centers. Front Immunol 2021; 12:627423. [PMID: 33777011 PMCID: PMC7987811 DOI: 10.3389/fimmu.2021.627423] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/15/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Granulomatous and Lymphocytic Interstitial Lung Diseases (GLILD) is a severe non-infectious complication of Common Variable Immunodeficiency (CVID), often associated with extrapulmonary involvement. Due to a poorly understood pathogenesis, GLILD diagnosis and management criteria still lack consensus. Accordingly, it is a relevant cause of long-term loss of respiratory function and is closely associated with a markedly reduced survival. The aim of this study was to describe clinical, immunological, laboratory and functional features of GLILD, whose combination in a predictive model might allow a timely diagnosis. Methods: In a multicenter retrospective cross-sectional study we enrolled 73 CVID patients with radiologic features of interstitial lung disease (ILD) associated to CVID (CVID-ILD) and 125 CVID patients without ILD (controls). Of the 73 CVID-ILD patients, 47 received a definite GLILD diagnosis while 26 received a clinical-radiologic diagnosis of CVID related ILD defined as uILD. Results: In GLILD group we found a higher prevalence of splenomegaly (84.8 vs. 39.2%), autoimmune cytopenia (59.6 vs. 6.4%) and bronchiectasis (72.3 vs. 28%), and lower IgA and IgG serum levels at CVID diagnosis. GLILD patients presented lower percentage of switched-memory B cells and marginal zone B cells, and a marked increase in the percentage of circulating CD21lo B cells (14.2 vs. 2.9%). GLILD patients also showed lower total lung capacity (TLC 87.5 vs. 5.0%) and gas transfer (DLCO 61.5 vs. 5.0%) percent of predicted. By univariate logistic regression analysis, we found IgG and IgA levels at CVID diagnosis, presence of splenomegaly and autoimmune cytopenia, CD21lo B cells percentage, TLC and DCLO percent of predicted to be associated to GLILD. The joint analysis of four variables (CD21lo B cells percentage, autoimmune cytopenia, splenomegaly and DLCO percent of predicted), together in a multiple logistic regression model, yielded an area under the ROC curve (AUC) of 0.98 (95% CI: 0.95-1.0). The AUC was only slightly modified when pooling together GLILD and uILD patients (0.92, 95% CI: 0.87-0.97). Conclusions: we propose the combination of two clinical parameters (splenomegaly and autoimmune cytopenia), one lung function index (DLCO%) and one immunologic variable (CD21lo%) as a promising tool for early identification of CVID patients with interstitial lung disease, limiting the use of aggressive diagnostic procedures.
Collapse
Affiliation(s)
- Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Maria Carrabba
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Helena Buso
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Giulia Garzi
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera-Universitaria Policlinico Umberto I, Rome, Italy
| | - Sabrina Gianese
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Valentina Soccodato
- Regional Reference Centre for Primary Immune Deficiencies, Azienda Ospedaliera-Universitaria Policlinico Umberto I, Rome, Italy
| | - Alessandra Punziano
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Gianluca Lagnese
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Giulio Tessarin
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Giulia Costanzo
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Nicholas Landini
- Radiology Unit, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Stefania Vio
- Radiology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | | | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Monserrato, Italy
| | - Marcello Rattazzi
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, University of Brescia, Brescia, Italy.,ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Giovanna Fabio
- Internal Medicine Department, Rare Disease Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences-Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Carlo Agostini
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, AULSS2 Marca Trevigiana, Treviso, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
30
|
Cinetto F, Neri R, Vianello F, Visentin A, Barilà G, Gianese S, Lanciarotta A, Milito C, Rattazzi M, Piazza F, Trentin L, Zambello R, Agostini C, Scarpa R. Subcutaneous immunoglobulins replacement therapy in secondary antibody deficiencies: Real life evidence as compared to primary antibody deficiencies. PLoS One 2021; 16:e0247717. [PMID: 33661940 PMCID: PMC7932095 DOI: 10.1371/journal.pone.0247717] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 02/12/2021] [Indexed: 12/31/2022] Open
Abstract
Secondary antibody deficiencies (SAD) may require immunoglobulin replacement therapy (IgRT). While the intravenous route (IVIG) is broadly considered effective in SAD, the use of subcutaneous immunoglobulins (SCIG) is mainly adopted from the experience in primary antibody deficiencies (PAD), where SCIG have been shown to perform as effective as IVIG. However, evidence-based data on SCIG administration in SAD patients are still insufficient. Herein we retrospectively evaluated the efficacy and safety profile of SCIG treatment in 131 SAD patients as compared to a group of 102 PAD patients. We found SCIG being equally effective in reducing annual infectious rate both in SAD and PAD patients. However, SAD patients required lower SCIG dosage and lower IgG through level to achieve similar biological effect in terms of infection burden, at the steady state. SAD patients also showed better correlation between SCIG dose and serum IgG achieved value. Furthermore, within SAD, SCIG were found to work irrespective of the underlying disease. Especially in Non-Hodgkin Lymphoma patients, whose indication to IgRT is still not included in all guidelines and for whom evidence-based data are still lacking, SCIG were as effective as in Chronic Lymphocytic Leukemia or Multiple Myeloma patients, and SCIG discontinuation, without evidence of B cell recovery, led to IgG decline and relapsed infections. Finally, treatment tolerance in SAD patients was comparable to the PAD cohort. Globally, our data suggest that SCIG, as already appreciated in PAD, represent a valuable option in SAD patients, independent on the disease leading to antibody deficiency.
Collapse
Affiliation(s)
- Francesco Cinetto
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Formerly Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| | - Raffaella Neri
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Formerly Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| | - Fabrizio Vianello
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Andrea Visentin
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Gregorio Barilà
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Sabrina Gianese
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| | - Alison Lanciarotta
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Marcello Rattazzi
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| | - Francesco Piazza
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Livio Trentin
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Renato Zambello
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
| | - Carlo Agostini
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Formerly Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
- * E-mail:
| | - Riccardo Scarpa
- Department of Medicine–DIMED, University of Padua, Padua, Italy
- Formerly Haematology and Clinical Immunology Unit, University of Padua, Padua, Italy
- Regional Center for Rare Immunological Diseases, Internal Medicine 1, Treviso Hospital, University of Padua, Padua, Italy
| |
Collapse
|
31
|
De Lucchi L, Nardin C, Sponchiado A, Raggi D, Faggin E, Martini E, Pagliara V, Callegari E, Caberlotto L, Plebani M, Pauletto P, Cinetto F, Agostini C, Villalta S, Rattazzi M. Serum uric acid levels and the risk of recurrent venous thromboembolism. J Thromb Haemost 2021; 19:194-201. [PMID: 33078502 DOI: 10.1111/jth.15139] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 08/31/2023]
Abstract
Essentials Increase in serum uric acid (SUA) levels has been widely associated with higher risk of cardiovascular disease. We investigated the link between SUA levels and the risk of venous thromboembolism (VTE) recurrence. Patients with SUA levels ≥ 4.38 mg/dL showed a three-fold increase in the risk of VTE recurrence. Elevated SUA levels are associated with increased risk of recurrent VTE independently from traditional risk factors. ABSTRACT: Background The link between serum uric acid (SUA) and the risk of cardiovascular disease is well established. However, the impact of SUA levels on the risk of venous thromboembolism (VTE) recurrence is unknown. Objectives To investigate the association between SUA and the risk of VTE recurrence. Patients and Methods We performed a monocenter, prospective study on 280 patients with a previous episode of VTE that completed the oral anticoagulant period. SUA levels at enrollment were correlated with the risk of VTE recurrence (mean follow-up 71.1 ± 29.2 months). Results Patients were stratified according to SUA tertiles distribution at baseline (tertiles cut-off: I ≤ 4.37 mg/dL, II 4.38--5.54 mg/dL, III ≥ 5.55 mg/dL). Fifty episodes of VTE recurrence occurred during the follow-up and Kaplan-Meier survival analysis showed that subjects in the lower tertile of SUA distribution had significantly lower risk of future VTE recurrence (P = .003). No differences were seen among patients belonging to the second and the third tertile of SUA distribution. A multivariate Cox regression analysis showed that higher tertiles of SUA distribution had about three-fold increase in the risk of VTE recurrence as compared to subjects with SUA ≤ 4.37, independently from potential confounders (hazard ratio [HR] 3.04, 95% confidence interval [CI] 1.15--8.05 P = .025). Moreover, we observed that the adjusted hazard of VTE recurrence increased by 30% for each additional unit of SUA (mg/dL; HR 1.30, 95% CI 1.01--1.22, P = .040). Conclusion Elevated SUA levels are associated with increased risk of future VTE recurrence independently from traditional risk factors.
Collapse
Affiliation(s)
- Lara De Lucchi
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Chiara Nardin
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | | | - Davide Raggi
- Department of Economics, University of Bologna, Bologna, Italy
| | | | - Elena Martini
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Valeria Pagliara
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Elena Callegari
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
| | - Livio Caberlotto
- Laboratory Medicine, Ca' Foncello University Hospital, Treviso, Italy
| | - Mario Plebani
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Paolo Pauletto
- ORAS Rehabilitation Hospital, Motta di Livenza, Treviso, Italy
| | - Francesco Cinetto
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Carlo Agostini
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Sabina Villalta
- Medicina Generale, Castelfranco Veneto Hospital, Castelfranco Veneto, Italy
| | - Marcello Rattazzi
- Medicina Generale I^, Ca' Foncello University Hospital, Treviso, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| |
Collapse
|
32
|
Dell'Edera A, Borghesan F, Favero E, Rattazzi M, Scarpa R, Tartaglia L, Agostini C, Cinetto F. Venom immunotherapy during COVID-19 pandemic: Experience from a University Allergy Center in Northern Italy. World Allergy Organ J 2020; 13:100489. [PMID: 33224428 PMCID: PMC7664475 DOI: 10.1016/j.waojou.2020.100489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022] Open
Abstract
During the ongoing pandemic of Coronavirus Disease 2019 (COVID-19) allergic patients need to continue their constant and proper treatment, including allergen-specific immunotherapy. These patients are expected to be at a higher risk for exacerbation of lung inflammation during viral infection. We investigated the putative interplay existing between allergen-specific immunotherapy and COVID-19 infection in a Hymenoptera venom-allergic population. We evaluated the frequency and severity of COVID-19 infection in a cohort of 211 subjects referring to our center for the regular administration of venom immunotherapy (VIT). Our result showed that the median age of our cohort is similar to the one that in our region has been associated with a high incidence of COVID-19 infection, increased hospitalization, and mortality rates. We reported only an isolated positivity of COVID-19 in the overall group; whereas none suffered from upper airway symptoms associated with COVID-19 (fever, cough, dyspnoea, sore throat, anosmia, and/or ageusia). Even though the demographic characteristics pose a substantial risk for such a population, we suggest that a regular administration of VIT may help in the development of an immunological milieu able to down modulate the Th1/Th17 environment that has been linked to inflammatory manifestations of COVID-19. To the best of our knowledge, this is the first description of the incidence of COVID-19 infection in Hymenoptera venom allergic patients treated with VIT, suggesting indirectly that venom immune tolerance-inducing treatment may be capable of reducing the aberrant inflammatory response induced by the virus in this specific population.
Collapse
Affiliation(s)
- Alessandro Dell'Edera
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Franco Borghesan
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Elisabetta Favero
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Marcello Rattazzi
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Leonardo Tartaglia
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Agostini
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| | - Francesco Cinetto
- Allergy and Clinical Immunology Center, University of Padua, Department of Internal Medicine, Internal Medicine I Unit, Ca' Foncello Hospital, Treviso, Italy
| |
Collapse
|
33
|
Felice C, Nardin C, Di Tanna GL, Grossi U, Bernardi E, Scaldaferri L, Romagnoli M, Tonon L, Cavasin P, Novello S, Scarpa R, Farnia A, De Menis E, Rigoli R, Cinetto F, Pauletto P, Agostini C, Rattazzi M. Use of RAAS Inhibitors and Risk of Clinical Deterioration in COVID-19: Results From an Italian Cohort of 133 Hypertensives. Am J Hypertens 2020; 33:944-948. [PMID: 32511678 PMCID: PMC7314218 DOI: 10.1093/ajh/hpaa096] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 06/05/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The effect of chronic use of renin-angiotensin-aldosterone system (RAAS) inhibitors on the severity of COVID-19 infection is still unclear in patients with hypertension. We aimed to investigate the association between chronic use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs) and COVID-19-related outcomes in hypertensive patients. METHODS A single-center study was conducted on 133 consecutive hypertensive subjects presenting to the emergency department with acute respiratory symptoms and/or fever who were diagnosed with COVID-19 infection between 9 and 31 March 2020. RESULTS All patients were grouped according to their chronic antihypertensive medications (ACEIs, N = 40; ARBs, N = 42; not on RAAS inhibitors, N = 51). There was no statistical difference between ACEIs and ARBs groups in terms of hospital admission rate, oxygen therapy, and need for noninvasive ventilation. Patients chronically treated with RAAS inhibitors showed a significantly lower rate of admission to semi-intensive/intensive care units, when compared with the non-RAAS population (odds ratio (OR) 0.25, confidence interval (CI) 95% 0.09-0.66, P = 0.006). Similarly, the risk of mortality was lower in the former group, although not reaching statistical significance (OR 0.56, CI 95% 0.17-1.83, P = 0.341). CONCLUSIONS Our data suggest that chronic use of RAAS inhibitors does not negatively affect clinical course of COVID-19 in hypertensive patients. Further studies are needed to confirm this finding and determine whether RAAS inhibitors may have a protective effect on COVID-19-related morbidity and mortality.
Collapse
Affiliation(s)
- Carla Felice
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Chiara Nardin
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Gian Luca Di Tanna
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Ugo Grossi
- Department of Surgical, Oncologic and Gastroenterological Sciences (DISCOG), Ca’ Foncello Hospital, Treviso, University of Padua, Padua, Italy
| | - Enrico Bernardi
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Luca Scaldaferri
- Acute and Emergency Department, Ca’ Foncello Hospital, Treviso, Italy
| | - Micaela Romagnoli
- Department of Specialistic and Laboratory Medicine Pulmonology Unit, Ca’ Foncello Hospital, Treviso, Italy
| | - Luca Tonon
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Paola Cavasin
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Simone Novello
- Department of Surgical, Oncologic and Gastroenterological Sciences (DISCOG), Ca’ Foncello Hospital, Treviso, University of Padua, Padua, Italy
| | - Riccardo Scarpa
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Antonio Farnia
- Department of Anesthesia and Intensive Care, Ca’ Foncello Hospital, Treviso, Italy
| | - Ernesto De Menis
- Department of Medicine, Medicina Generale II^, Ca’ Foncello Hospital, Treviso, Italy
| | - Roberto Rigoli
- Department of Specialistic and Laboratory Medicine, Microbiology Unit, Ca’ Foncello Hospital, Treviso, Italy
| | - Francesco Cinetto
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Paolo Pauletto
- O.R.A.S. SpA, Ospedale Riabilitativo di Alta Specializzazione, Motta Di Livenza, Italy
| | - Carlo Agostini
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| | - Marcello Rattazzi
- Department of Medicine—DIMED, Medicina Generale I^, Ca’ Foncello Hospital, Treviso, University of Padova, Padua, Italy
| |
Collapse
|
34
|
Masala C, Firinu D, Piras R, Deidda M, Cinetto F, Del Giacco S. Olfactory Function Is Impaired in Patients with Mastocytosis. J Allergy Clin Immunol Pract 2020; 9:1359-1364. [PMID: 33059098 DOI: 10.1016/j.jaip.2020.09.061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mastocytosis is a clinically heterogeneous disorder associated with abnormal mast cell accumulation in different organs. No data are available as regards the assessment of olfactory function and its association with mastocytosis. OBJECTIVE The aim of the study was first to investigate odor threshold, discrimination, and identification in patients with mastocytosis compared with age-matched healthy controls (HC), and furthermore, to correlate olfactory function with the other clinical symptoms of mastocytosis. METHODS Eighty-one participants were enrolled: 41 patients with mastocytosis (23 males and 18 females; mean age, 47.95 years; standard deviation [SD], 14.7 years) were compared with 40 HC (23 males and 17 females; mean age, 47.88 years; SD, 14.6 years). Olfactory function among participants was evaluated using the "Sniffin' Sticks" test for odor detection threshold (OT), odor discrimination (OD), and odor identification (OI). RESULTS Patients with systemic mastocytosis showed a significant decrease in the total olfactory function (Threshold-Discrimination-Identification [TDI] score), OT, OD, and OI compared with HC. A significant negative correlation was observed only between TDI score and serum tryptase concentration (μg/L). No correlation was observed between disease duration versus OT, OD, OI, and TDI score. CONCLUSIONS Our results suggest that the olfactory function is impaired in patients compared with HC; a significant negative correlation was found between TDI score and the level of serum tryptase. Olfactory dysfunction in mastocytosis may be considered among the clinical manifestations contributing to the burden of this disease.
Collapse
Affiliation(s)
- Carla Masala
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Davide Firinu
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Raffaella Piras
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Margherita Deidda
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Internal Medicine I, Ca' Foncello Hospital, Treviso, Italy
| | - Stefano Del Giacco
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy.
| |
Collapse
|
35
|
Masala C, Firinu D, Piras R, Deidda M, Cinetto F, Del Giacco S. Olfactory Function Is Impaired in Patients with Mastocytosis. J Allergy Clin Immunol Pract 2020. [PMID: 33059098 DOI: 10.1016/j.jaip.2020.09.061.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mastocytosis is a clinically heterogeneous disorder associated with abnormal mast cell accumulation in different organs. No data are available as regards the assessment of olfactory function and its association with mastocytosis. OBJECTIVE The aim of the study was first to investigate odor threshold, discrimination, and identification in patients with mastocytosis compared with age-matched healthy controls (HC), and furthermore, to correlate olfactory function with the other clinical symptoms of mastocytosis. METHODS Eighty-one participants were enrolled: 41 patients with mastocytosis (23 males and 18 females; mean age, 47.95 years; standard deviation [SD], 14.7 years) were compared with 40 HC (23 males and 17 females; mean age, 47.88 years; SD, 14.6 years). Olfactory function among participants was evaluated using the "Sniffin' Sticks" test for odor detection threshold (OT), odor discrimination (OD), and odor identification (OI). RESULTS Patients with systemic mastocytosis showed a significant decrease in the total olfactory function (Threshold-Discrimination-Identification [TDI] score), OT, OD, and OI compared with HC. A significant negative correlation was observed only between TDI score and serum tryptase concentration (μg/L). No correlation was observed between disease duration versus OT, OD, OI, and TDI score. CONCLUSIONS Our results suggest that the olfactory function is impaired in patients compared with HC; a significant negative correlation was found between TDI score and the level of serum tryptase. Olfactory dysfunction in mastocytosis may be considered among the clinical manifestations contributing to the burden of this disease.
Collapse
Affiliation(s)
- Carla Masala
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Davide Firinu
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Raffaella Piras
- Department of Biomedical Sciences, Physiology Section, University of Cagliari, Monserrato, Cagliari, Italy
| | - Margherita Deidda
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padova, Italy; Internal Medicine I, Ca' Foncello Hospital, Treviso, Italy
| | - Stefano Del Giacco
- Allergy and Clinical Immunology Unit, Department of Medical Sciences and Public Health, University Hospital "Duilio Casula," Monserrato, Cagliari, Italy.
| |
Collapse
|
36
|
Pulvirenti F, Milito C, Cavaliere FM, Mezzaroma I, Cinetto F, Quinti I. IGA Antibody Induced by Immunization With Pneumococcal Polysaccharides Is a Prognostic Tool in Common Variable Immune Deficiencies. Front Immunol 2020; 11:1283. [PMID: 32695106 PMCID: PMC7336165 DOI: 10.3389/fimmu.2020.01283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 05/20/2020] [Indexed: 12/02/2022] Open
Abstract
The evaluation of the response to vaccination in patients with inborn errors of immunity is a tool to evaluate T-dependent and T-independent antibody residual function of B lymphocytes and it is part of the diagnostic definition for Common Variable Immune Deficiencies. Currently used classifications for Common Variable Immune Deficiencies patients are based on the frequency of B cell subsets, and have been proven as a valid instrument for identification of patients at higher risk of infectious and non-infectious complications. This 6-years period observational study delineated the measurement of specific IgA antibodies induced by a 23-valent pneumococcal polysaccharides vaccine by a standardized ELISA for the quantification of IgA antibodies to all 23 pneumococcal serotypes as an additional prognostic marker in 74 CVID patients. The inability to mount an IgA-mediated response against the pneumococcal polysaccharide antigens or the inability to maintain the antibody response over time identified poor IgA CVID responders with severe immunological impairment, great risk of co-morbidities, and poor prognosis. The division of CVID patient into specific IgA-non responders and IgA-responders discriminated better than other CVID classifications for infectious risk, while it overlapped for non-infectious complications. Our study suggested to add the evaluation of the antibody response by the 23-valent IgA assay in the clinical monitoring of CVID patients.
Collapse
Affiliation(s)
- Federica Pulvirenti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| | | | - Ivano Mezzaroma
- Department of Translational and Precision, "Sapienza" University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padua, Italy.,Internal Medicine I, Ca' Foncello Hospital, Treviso, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Rome, Rome, Italy
| |
Collapse
|
37
|
Scarpa R, Pulvirenti F, Pecoraro A, Vultaggio A, Marasco C, Ria R, Altinier S, Compagno N, Firinu D, Plebani M, De Carli M, Matucci A, Vianello F, Vacca A, Spadaro G, Quinti I, Agostini C, Milito C, Cinetto F. Serum Free Light Chains in Common Variable Immunodeficiency Disorders: Role in Differential Diagnosis and Association With Clinical Phenotype. Front Immunol 2020. [PMID: 32296413 DOI: 10.3389/fimmu.2020.00319.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We report on an observational, multicenter study of 345 adult CVID patients, designed to assess the diagnostic value and the clinical association of serum free light chain (sFLC) pattern in Common Variable Immunodeficiency disorders (CVID). Sixty CVID patients were tested twice in order to assess intraindividual variability of sFLC. As control groups we included 138 patients affected by undefined primary antibody defects (UAD), lymphoproliferative diseases (LPDs), and secondary antibody deficiencies not related to hematological malignancies (SID). CVID patients presented lower κ and λ chain concentration compared to controls, showing low intraindividual sFLC variability. On the basis of the sFLC pattern, patients were classified into four groups: κ-λ+, κ+λ-, κ-λ-, κ+λ+. The most common pattern in CVID patients was κ-λ- (51%), followed by κ-λ+, (25%), κ+λ+ (22%), and κ+λ- (3%). In UAD, LPD, and SID groups κ+λ+ was the most common pattern observed. By analyzing the possible association between sFLC patterns and disease-related complications of CVID, we observed that patients belonging to the κ-λ- group presented more commonly unexplained enteropathy compared to the κ+λ+ group and showed higher frequency of bronchiectasis and splenomegaly compared to both the κ-λ+ and κ+λ+ patients. When compared to the other groups, κ-λ- had also lower serum IgG, IgA, and IgM concentrations at diagnosis, lower frequency of CD27+IgD-IgM- switched memory B cells, and higher frequency of CD21low B cells, receiving earlier CVID diagnosis. Thus, lower levels of sFLC might be an epiphenomenon of impairment in B cell differentiation, possibly leading κ-λ- patients to a higher risk for bacterial infections and chronic lung damage. Based on these results, we suggest adding sFLC assay to the diagnostic work-up of hypogammaglobulinemia and during follow-up. The assay may be useful to differentiate CVID from other causes of hypogammaglobulinemia and to early detect monoclonal lymphoproliferation occurring over years. Moreover, since the sFLC pattern seems to be related to disease phenotypes and clinical manifestations of CVID and after confirmation by further studies, sFLC assay might be considered a promising prognostic tool for identifying patients at higher risk of developing enteropathy and chronic lung damage or splenomegaly. This will allow designing a tailored follow-up for CVID patients.
Collapse
Affiliation(s)
- Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Federica Pulvirenti
- Department of Infectious Diseases and Internal Medicine, University Hospital Policlinico Umberto I, Rome, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Sara Altinier
- Department of Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Nicolò Compagno
- Hematology and Clinical Immunology, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Plebani
- Department of Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Marco De Carli
- Department of Internal Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Fabrizio Vianello
- Hematology and Clinical Immunology, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Infectious Diseases and Internal Medicine, University Hospital Policlinico Umberto I, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Agostini
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| |
Collapse
|
38
|
Scarpa R, Pulvirenti F, Pecoraro A, Vultaggio A, Marasco C, Ria R, Altinier S, Compagno N, Firinu D, Plebani M, De Carli M, Matucci A, Vianello F, Vacca A, Spadaro G, Quinti I, Agostini C, Milito C, Cinetto F. Serum Free Light Chains in Common Variable Immunodeficiency Disorders: Role in Differential Diagnosis and Association With Clinical Phenotype. Front Immunol 2020; 11:319. [PMID: 32296413 PMCID: PMC7136404 DOI: 10.3389/fimmu.2020.00319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/10/2020] [Indexed: 12/12/2022] Open
Abstract
We report on an observational, multicenter study of 345 adult CVID patients, designed to assess the diagnostic value and the clinical association of serum free light chain (sFLC) pattern in Common Variable Immunodeficiency disorders (CVID). Sixty CVID patients were tested twice in order to assess intraindividual variability of sFLC. As control groups we included 138 patients affected by undefined primary antibody defects (UAD), lymphoproliferative diseases (LPDs), and secondary antibody deficiencies not related to hematological malignancies (SID). CVID patients presented lower κ and λ chain concentration compared to controls, showing low intraindividual sFLC variability. On the basis of the sFLC pattern, patients were classified into four groups: κ−λ+, κ+λ−, κ−λ−, κ+λ+. The most common pattern in CVID patients was κ−λ− (51%), followed by κ−λ+, (25%), κ+λ+ (22%), and κ+λ− (3%). In UAD, LPD, and SID groups κ+λ+ was the most common pattern observed. By analyzing the possible association between sFLC patterns and disease-related complications of CVID, we observed that patients belonging to the κ−λ− group presented more commonly unexplained enteropathy compared to the κ+λ+ group and showed higher frequency of bronchiectasis and splenomegaly compared to both the κ−λ+ and κ+λ+ patients. When compared to the other groups, κ−λ− had also lower serum IgG, IgA, and IgM concentrations at diagnosis, lower frequency of CD27+IgD–IgM– switched memory B cells, and higher frequency of CD21low B cells, receiving earlier CVID diagnosis. Thus, lower levels of sFLC might be an epiphenomenon of impairment in B cell differentiation, possibly leading κ−λ− patients to a higher risk for bacterial infections and chronic lung damage. Based on these results, we suggest adding sFLC assay to the diagnostic work-up of hypogammaglobulinemia and during follow-up. The assay may be useful to differentiate CVID from other causes of hypogammaglobulinemia and to early detect monoclonal lymphoproliferation occurring over years. Moreover, since the sFLC pattern seems to be related to disease phenotypes and clinical manifestations of CVID and after confirmation by further studies, sFLC assay might be considered a promising prognostic tool for identifying patients at higher risk of developing enteropathy and chronic lung damage or splenomegaly. This will allow designing a tailored follow-up for CVID patients.
Collapse
Affiliation(s)
- Riccardo Scarpa
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Federica Pulvirenti
- Department of Infectious Diseases and Internal Medicine, University Hospital Policlinico Umberto I, Rome, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Roberto Ria
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Sara Altinier
- Department of Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Nicolò Compagno
- Hematology and Clinical Immunology, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Mario Plebani
- Department of Laboratory Medicine of the University Hospital of Padova, Padova, Italy
| | - Marco De Carli
- Department of Internal Medicine, Azienda Sanitaria Universitaria Integrata di Udine, Udine, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Fabrizio Vianello
- Hematology and Clinical Immunology, Department of Medicine-DIMED, University of Padova, Padova, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Isabella Quinti
- Department of Infectious Diseases and Internal Medicine, University Hospital Policlinico Umberto I, Rome, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlo Agostini
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, Padova, Italy.,Rare Disease Referral Center, Internal Medicine 1, Ca' Foncello Hospital, ULSS2 Marca Trevigiana, Treviso, Italy
| |
Collapse
|
39
|
Milito C, Cinetto F, Megna V, Spadaro G, Quinti I, Liberatore M. The Usefulness of Scintigraphic Studies in the Assessment of Asymptomatic Bowel Disease in Patients with Primary Antibody Diseases. J Clin Med 2020; 9:jcm9040949. [PMID: 32235478 PMCID: PMC7230964 DOI: 10.3390/jcm9040949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 12/03/2022] Open
Abstract
Enteropathy may be the first presentation of immunodeficiency or it may occur during the course of the disease and in association with malabsorption in patients affected by primary antibody diseases. For these patients, immunoglobulin G (IgG) replacement therapy prevents infectious and non-infectious complications. Nonetheless some patients cannot achieve optimal IgG trough levels, even when treated with high Ig doses in absence of protein-losing syndromes. We investigated seven patients affected by common variable immunodeficiencies (CVIDs) and treated with high Ig doses (600–800 mg/kg/month) showing low IgG trough level. Patients underwent abdominal scintigraphy with human polyclonal immunoglobulin G labeled with 99mTc and with white blood cells labeled by 111 Indium-oxinate to investigate asymptomatic bowel inflammation. A concentration of labeled leukocytes in abdominal segments greater than that observed with human polyclonal immunoglobulin G was evident only in one patient. In five patients a slight concentration of both radiopharmaceuticals was reported, due to mild intestinal inflammatory response. These data might be related to mild increase of capillary permeability in the absence of inflammation leukocyte mediated. This study discloses a new cause of IgG-accelerated catabolism due to inflammatory bowel conditions without diarrhea in CVID patients.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
- Correspondence: ; Tel.: +39-0649972007
| | - Francesco Cinetto
- Department of Medicine-DIMED, University of Padova, 35122 Padova, Italy;
- Internal Medicine I, Ca’ Foncello Hospital, 31100 Treviso, Italy
| | - Valentina Megna
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, 0161 Rome, Italy; (V.M.); (M.L.)
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Interdepartmental Center for Research in Basic and Clinical Immunology Sciences, University of Naples Federico II, 80131 Naples, Italy;
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, 00185 Rome, Italy;
| | - Mauro Liberatore
- Department of Radiological, Oncological and Pathological Anatomy Sciences, Sapienza University of Rome, 0161 Rome, Italy; (V.M.); (M.L.)
| |
Collapse
|
40
|
Lougaris V, Soresina A, Baronio M, Montin D, Martino S, Signa S, Volpi S, Zecca M, Marinoni M, Baselli LA, Dellepiane RM, Carrabba M, Fabio G, Putti MC, Cinetto F, Lunardi C, Gazzurelli L, Benvenuto A, Bertolini P, Conti F, Consolini R, Ricci S, Azzari C, Leonardi L, Duse M, Pulvirenti F, Milito C, Quinti I, Cancrini C, Finocchi A, Moschese V, Cirillo E, Crescenzi L, Spadaro G, Marasco C, Vacca A, Cardinale F, Martire B, Trizzino A, Licciardello M, Cossu F, Di Matteo G, Badolato R, Ferrari S, Giliani S, Pession A, Ugazio A, Pignata C, Plebani A. Long-term follow-up of 168 patients with X-linked agammaglobulinemia reveals increased morbidity and mortality. J Allergy Clin Immunol 2020; 146:429-437. [PMID: 32169379 DOI: 10.1016/j.jaci.2020.03.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 02/26/2020] [Accepted: 03/02/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND X-linked agammaglobulinemia (XLA) is the prototype of primary humoral immunodeficiencies. Long-term follow-up studies regarding disease-related complications and outcome are scarce. OBJECTIVE Our aim was to describe the natural history of XLA. METHODS A nationwide multicenter study based on the Italian Primary Immunodeficiency Network registry was established in 2000 in Italy. Affected patients were enrolled by documenting centers, and the patients' laboratory, clinical, and imaging data were recorded on an annual base. RESULTS Data on the patients (N = 168) were derived from a cumulative follow-up of 1370 patient-years, with a mean follow-up of 8.35 years per patient. The mean age at diagnosis decreased after establishment of the Italian Primary Immunodeficiency Network registry (84 months before vs 23 months after). Respiratory, skin, and gastrointestinal manifestations were the most frequent clinical symptoms at diagnosis and during long-term follow-up. Regular immunoglobulin replacement treatment reduced the incidence of invasive infections. Affected patients developed chronic lung disease over time (47% after 40 years of follow-up) in the presence of chronic sinusitis (84%). Malignancies were documented in a minority of cases (3.7%). Overall survival for affected patients was significantly reduced when compared with that for the healthy male Italian population, and it further deteriorated in the presence of chronic lung disease. CONCLUSIONS This is the first detailed long-term follow-up study for patients with XLA, revealing that although immunoglobulin replacement treatment reduces the incidence of invasive infections, it does not appear to influence the development of chronic lung disease. The overall survival of affected patients is reduced. Further studies are warranted to improve patients' clinical management and increase awareness among physicians.
Collapse
Affiliation(s)
- Vassilios Lougaris
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy.
| | | | - Manuela Baronio
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Davide Montin
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Silvana Martino
- Division of Pediatric Immunology and Rheumatology, Department of Public Health and Pediatrics, Regina Margherita Children Hospital, University of Turin, Turin, Italy
| | - Sara Signa
- Centro Malattie Autoinfiammatorie e Immunodeficienze-Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Genova, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genoa, Italy
| | - Stefano Volpi
- Centro Malattie Autoinfiammatorie e Immunodeficienze-Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Genova, and Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili, Università di Genova, Genoa, Italy
| | - Marco Zecca
- Department of Pediatric Hematology of Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Maddalena Marinoni
- Paediatric Department, ASST-Sette Laghi, F. Del Ponte Hospital, Varese, Italy
| | - Lucia Augusta Baselli
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Rosa Maria Dellepiane
- Department of Pediatrics, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Maria Carrabba
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Caterina Putti
- Department of Women's and Children's Health, Pediatric Hematology-Oncology Unit, University of Padova, Padua, Italy
| | - Francesco Cinetto
- Padua University, Department of Medicine (DIMED), Internal Medicine I and Rare Disease Center for Immunologic, Rheumatologic and Respiratory Diseases, Ca' Foncello Hospital, Treviso, Italy
| | | | - Luisa Gazzurelli
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Alessio Benvenuto
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Patrizia Bertolini
- Paediatric Hematology Oncology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Francesca Conti
- Unit of Pediatrics, University of Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Rita Consolini
- Section of Pediatrics Immunology and Rheumatology, Department of Pediatrics, University of Pisa, Pisa, Italy
| | - Silvia Ricci
- Department of Pediatric Immunology, Jeffrey Modell Center for Primary Immunodeficiency, Anna Meyer's Hospital, University of Florence, Florence, Italy
| | - Chiara Azzari
- Department of Pediatric Immunology, Jeffrey Modell Center for Primary Immunodeficiency, Anna Meyer's Hospital, University of Florence, Florence, Italy
| | - Lucia Leonardi
- Pediatrics Department, Umberto I Hospital, Sapienza University, Roma, Italy
| | - Marzia Duse
- Pediatrics Department, Umberto I Hospital, Sapienza University, Roma, Italy
| | - Federica Pulvirenti
- Department of Molecular Medicine, Sapienza University of Roma, and Unit of Primary Immunodeficiencies in Adults, Department of Infective diseases and Internal Medicine, Policlinico Umberto I, Rome, Italy
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Roma, and Unit of Primary Immunodeficiencies in Adults, Department of Infective diseases and Internal Medicine, Policlinico Umberto I, Rome, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Roma, and Unit of Primary Immunodeficiencies in Adults, Department of Infective diseases and Internal Medicine, Policlinico Umberto I, Rome, Italy
| | - Caterina Cancrini
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, and the Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Finocchi
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, and the Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Viviana Moschese
- Department of Pediatrics, Policlinico Tor Vergata, Tor Vergata University, Rome, Italy
| | - Emilia Cirillo
- Pediatric Section, Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Ludovica Crescenzi
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences, Allergy and Clinical Immunology Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Carolina Marasco
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Section of Internal Medicine and Clinical Oncology, University of Bari Medical School, Bari, Italy
| | - Fabio Cardinale
- Department of Pediatrics and Emergency, Pediatric Allergy and Pulmunology Unit, Azienda Ospedaliera-Universitaria Consorziale-Policlinico, Ospedale Pediatrico Giovanni XXIII, Bari, Italy
| | | | - Antonino Trizzino
- Department of Pediatric Hematology and Oncology, ARNAS Civico Di Cristina and Benfratelli Hospital, Palermo, Italy
| | - Maria Licciardello
- Haematology of Oncology Unit, Department of Pediatrics, University of Catania- Catania, Italy
| | - Fausto Cossu
- Second Pediatric Clinic, Antonio Cao Hospital, University of Cagliari, Cagliari, Italy
| | - Gigliola Di Matteo
- University Department of Pediatrics, Unit of Immune and Infectious Diseases, Bambino Gesù Children's Hospital, University of Rome Tor Vergata, and the Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Raffaele Badolato
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy
| | - Simona Ferrari
- Unit of Medical Genetics, St. Orsola University Hospital, University of Bologna, Bologna, Italy
| | - Silvia Giliani
- Department of Molecular and Translational Medicine, A. Nocivelli Institute for Molecular Medicine, University of Brescia, Brescia, Italy
| | - Andrea Pession
- Unit of Pediatrics, University of Bologna, St. Orsola University Hospital, Bologna, Italy
| | - Alberto Ugazio
- Institute of Child and Adolescent Health, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Claudio Pignata
- Pediatric Section, Department of Translational Medical Science, Federico II University, Naples, Italy
| | - Alessandro Plebani
- Pediatrics Clinic and Institute for Molecular Medicine A. Nocivelli, Department of Clinical and Experimental Sciences, University of Brescia and ASST-Spedali Civili di Brescia, Brescia, Italy.
| |
Collapse
|
41
|
Contini C, Firinu D, Serrao S, Manconi B, Olianas A, Cinetto F, Cossu F, Castagnola M, Messana I, Del Giacco S, Cabras T. RP-HPLC-ESI-IT Mass Spectrometry Reveals Significant Variations of the Human Salivary Protein Profile Associated with Predominantly Antibody Deficiencies. J Clin Immunol 2020. [PMID: 31916122 DOI: 10.1007/s10875-020-00743-4.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE Present study is designed to discover potential salivary biomarkers associated with predominantly antibody deficiencies, which include a large spectrum of disorders sharing failure of antibody production, and B cell defects resulting in recurrent infections, autoimmune and inflammatory manifestations, and tumor susceptibility. Understanding and clinical classification of these syndromes is still challenging. METHODS We carried out a study of human saliva based on liquid chromatography-mass spectrometry measurements of intact protein mass values. Salivary protein profiles of patients (n = 23) and healthy controls (n = 30) were compared. RESULTS Patients exhibited lower abundance of α-defensins 1-4, cystatins S1 and S2, and higher abundance of glutathionylated cystatin B and cystatin SN than controls. Patients could be clustered in two groups on the basis of different levels of cystatin SN, S1 and S2, suggesting that these proteins may play different roles in the disease. CONCLUSIONS Quantitative variations of these pro-inflammatory and antimicrobial peptides/proteins may be related to immunodeficiency and infectious condition of the patients. The high incidence of tumors in the group with the highest level of cystatin SN, which is recognized as tumoral marker, appeared an intriguing result deserving of future investigations. Data are available via ProteomeXchange with identifier PXD012688.
Collapse
Affiliation(s)
- Cristina Contini
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Univ. Monserrato, ss 554, 09042, Monserrato, CA, Italy
| | - Davide Firinu
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Univ. Monserrato, Monserrato, 09042, CA, Italy
| | - Simone Serrao
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Univ. Monserrato, ss 554, 09042, Monserrato, CA, Italy
| | - Barbara Manconi
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Univ. Monserrato, ss 554, 09042, Monserrato, CA, Italy.
| | - Alessandra Olianas
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Univ. Monserrato, ss 554, 09042, Monserrato, CA, Italy
| | - Francesco Cinetto
- Ca' Foncello Hospital - Treviso, Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Fausto Cossu
- Pediatric HSCT Unit, Pediatric Clinic of University, Ospedale Microcitemico, Cagliari, Italy
| | - Massimo Castagnola
- Proteomics and Metabolomics Laboratory, IRCCS - Fondazione Santa Lucia, Rome, Italy
| | - Irene Messana
- CNR-SCITEC Istituto di Scienze e Tecnologie Chimiche, c/o Istituto di Biochimica e Biochimica Clinica Università Cattolica, L.go F. Vito, 1, 00168, Rome, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Cittadella Univ. Monserrato, Monserrato, 09042, CA, Italy
| | - Tiziana Cabras
- Department of Life and Environmental Sciences, University of Cagliari, Cittadella Univ. Monserrato, ss 554, 09042, Monserrato, CA, Italy
| |
Collapse
|
42
|
Cinetto F, Scarpa R, Pulvirenti F, Quinti I, Agostini C, Milito C. Appropriate lung management in patients with primary antibody deficiencies. Expert Rev Respir Med 2019; 13:823-838. [PMID: 31361157 DOI: 10.1080/17476348.2019.1641085] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 12/22/2022]
Abstract
Introduction: Human primary immunodeficiency diseases (PIDs) include a broad spectrum of more than 350 disorders, involving different branches of the immune system and classified as 'rare diseases.' Predominantly antibody deficiencies (PADs) represent more than half of the PIDs diagnosed in Europe and are often diagnosed in the adulthood. Areas covered: Although PAD could first present with autoimmune or neoplastic features, respiratory infections are frequent and respiratory disease represents a relevant cause of morbidity and mortality. Pulmonary complications may be classified as infection-related (acute and chronic), immune-mediated, and neoplastic. Expert opinion: At present, no consensus guidelines are available on how to monitor and manage lung complications in PAD patients. In this review, we will discuss the available diagnostic, prognostic and therapeutic instruments and we will suggest an appropriate and evidence-based approach to lung diseases in primary antibody deficiencies. We will also highlight the possible role of promising new tools and strategies in the management of pulmonary complications. However, future studies are needed to reduce of diagnostic delay of PAD and to better understand lung diseases mechanisms, with the final aim to ameliorate therapeutic options that will have a strong impact on Quality of Life and long-term prognosis of PAD patients.
Collapse
Affiliation(s)
- Francesco Cinetto
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Riccardo Scarpa
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Federica Pulvirenti
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
| | - Isabella Quinti
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
| | - Carlo Agostini
- Department of Medicine - DIMED, University of Padova , Padova , Italy.,Internal Medicine I, Ca' Foncello Hospital , Treviso , Italy
| | - Cinzia Milito
- Department of Molecular Medicine, "Sapienza" University of Roma , Roma , Italy
| |
Collapse
|
43
|
Harari S, Caminati A, Confalonieri M, Poletti V, Vancheri C, Pesci A, Rogliani P, Luppi F, Agostini C, Rottoli P, Sanduzzi Zamparelli A, Sebastiani A, Della Porta R, Salton F, Messore B, Tomassetti S, Rosso R, Biffi A, Puxeddu E, Cerri S, Cinetto F, Refini RM, Bocchino M, Di Michele L, Specchia C, Albera C. The prognostic role of Gender-Age-Physiology system in idiopathic pulmonary fibrosis patients treated with pirfenidone. Clin Respir J 2019; 13:166-173. [PMID: 30675755 DOI: 10.1111/crj.12999] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 01/05/2019] [Accepted: 01/15/2019] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Gender, age, physiology (GAP) system have proven to be an easy tool for predicting disease stages and survival in idiopathic pulmonary fibrosis (IPF) patients. OBJECTIVE To validate mortality risk as determined by the GAP system in a real-life multicentre IPF population treated with pirfenidone. METHODS The study included patients who received pirfenidone for at least 6 months. The GAP calculator and the GAP index were determined. The primary outcome was all-cause mortality. The prognostic accuracy of the GAP system was evaluated with respect to calibration and discrimination. RESULTS AND CONCLUSION Sixty-eight IPF patients were enrolled in the study. The median follow-up was 2.4 years (range 0.1-7.4 years). A total of 22 deaths as first event (32%) and of 10 lung transplantation (15%) were recorded. The cumulative incidence of mortality at 1, 2 and 3 years was 10.4%, 22.4% and 38.4%, respectively. The differences between the predicted and observed mortality were not significant for the GAP index while the observed mortality become comparable to that predicted by the GAP calculator only in the third year of follow-up. The C-index for the GAP index was 0.74 (95% CI 0.57-0.93) while the C-statistic value for the GAP calculator was 0.77 (95% CI 0.59-0.95).
Collapse
Affiliation(s)
- Sergio Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe - MultiMedica, IRCCS, Milano, Italy
| | - Antonella Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe - MultiMedica, IRCCS, Milano, Italy
| | - Marco Confalonieri
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
| | - Venerino Poletti
- U.O. di Pneumologia Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni -L. Pierantoni, Forlì, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital (DK), Aarthus, Denmark
| | - Carlo Vancheri
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Alberto Pesci
- Respiratory Unit, Department of Health Science, University of Milano Bicocca, AO San Gerardo, Monza, Italy
| | - Paola Rogliani
- Respiratory Unit Policlinico Tor Vergata, Department of "Systems Medicine, University of Rome "Tor Vergata", Roma, Italy
| | - Fabrizio Luppi
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | - Carlo Agostini
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Paola Rottoli
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
| | - Alessandro Sanduzzi Zamparelli
- UOC II Pneumotisiologia, Scuola di specializzazione in malattie respiratorie Università degli Studi di Napoli Federico II A.O.R.N. Monaldi-Cotugno-CTO Piazzale Ettore Ruggieri, Napoli, Italy
| | - Alfredo Sebastiani
- UOS Interstiziopatie Polmonari Az Osp. S. Camillo-Forlanini, Roma, Italy
| | - Rossana Della Porta
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
| | - Francesco Salton
- Department of Pulmonology, University Hospital of Cattinara, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Trieste, Italy
| | - Barbara Messore
- Department of Clinical and Biological Sciences, Interstitial and Rare Lung Disease Unit AOU San Luigi Gonzaga, Orbassano, University of Turin, Turin, Italy
| | - Sara Tomassetti
- U.O. di Pneumologia Dipartimento dell'Apparato Respiratorio e del Torace, Ospedale G.P. Morgagni -L. Pierantoni, Forlì, Italy
| | - Roberta Rosso
- Regional Referral Centre for Rare Lung Disease, University of Catania, A.O.U. Policlinico-Vittorio Emanuele, Catania, Italy
| | - Alice Biffi
- Respiratory Unit, Department of Health Science, University of Milano Bicocca, AO San Gerardo, Monza, Italy
| | - Ermanno Puxeddu
- Respiratory Unit Policlinico Tor Vergata, Department of "Systems Medicine, University of Rome "Tor Vergata", Roma, Italy
| | - Stefania Cerri
- Center for Rare Lung Diseases, University Hospital Policlinico di Modena, Modena, Italy
| | | | - Rosa Metella Refini
- Respiratory Diseases and Lung Transplant Unit, Department of Internal and Specialist Medicine, AOUS, Siena, Italy
| | - Marialuisa Bocchino
- UOC II Pneumotisiologia, Scuola di specializzazione in malattie respiratorie Università degli Studi di Napoli Federico II A.O.R.N. Monaldi-Cotugno-CTO Piazzale Ettore Ruggieri, Napoli, Italy
| | - Loreta Di Michele
- UOS Interstiziopatie Polmonari Az Osp. S. Camillo-Forlanini, Roma, Italy
| | - Claudia Specchia
- Department of Molecular and Translational Medicine, University of Brescia, Brescia, Italy.,IRCCS MultiMedica, Milano, Italy
| | - Carlo Albera
- Department of Clinical and Biological Sciences, Interstitial and Rare Lung Disease Unit AOU San Luigi Gonzaga, Orbassano, University of Turin, Turin, Italy
| | | |
Collapse
|
44
|
Brescia G, Schiavon F, Nicolè L, Zanoletti E, Zanotti C, Padoan R, Felicetti M, Parrino D, Cinetto F, Cangiano D, Giacomelli L, Cappellesso R, Martini A, Fassina A, Marioni G. No Differences in Nasal Tissue Inflammatory Cells and Adhesion Molecules (iCAM-1 and vCAM-1) Based on the Comparison of EGPA With Eosinophilic Chronic Sinusitis With Polyposis. Am J Rhinol Allergy 2019; 33:395-402. [DOI: 10.1177/1945892419836819] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background An example of aggressive eosinophilic polyposis can be found in eosinophilic granulomatosis with polyangiitis (EGPA). Intercellular adhesion molecule-1 (iCAM-1) and vascular cell adhesion molecule-1 (vCAM-1) play a part in mediating the recruitment and adhesion of leukocytes to the vessel wall, and their blood-to-tissue migration under inflammatory conditions. Objective This prospective study compared 3 groups—patients with a definite diagnosis EGPA, non-EGPA patients with phenotypic features suggestive of EGPA, and patients with non-eosinophilic nasal polyposis (controls)—in terms of nasal tissue histology, iCAM-1 and vCAM-1 expression, and blood inflammatory cells. Methods A total of 58 adults underwent sinus surgery (13 patients with EGPA, 23 suspected of having EGPA, and 22 controls). Results Mean tissue eosinophil counts were significantly higher in EGPA patients and suspected cases of EGPA than in controls. Although iCAM-1 and vCAM-1 were diffusely expressed in sinonasal tissues, they did not differently stain EGPA, eosinophilic-type and non-eosinophilic polyposis. Blood basophil and eosinophil levels were high in both the EGPA and the suspected EGPA groups. Intergroup differences were found for eosinophils but not for basophils. Conclusions We do not have yet blood or tissue markers able to differentiate the early phase of EGPA from chronic rhinosinusitis with nasal polyps. Further investigations are mandatory considering EGPA patients at their initial diagnosis and before any treatment, in terms of nasal histology and blood inflammatory cells, to identify markers characterizing sinonasal mucosa inflammation and useful for an early diagnosis of EGPA.
Collapse
Affiliation(s)
- Giuseppe Brescia
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Franco Schiavon
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Lorenzo Nicolè
- Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Elisabetta Zanoletti
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Claudia Zanotti
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Roberto Padoan
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Mara Felicetti
- Rheumatology Division, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Daniela Parrino
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | - Francesco Cinetto
- Clinical Immunology and Hematology Unit, Department of Medicine—DIMED, Padova University, Padova, Italy
| | - Daniela Cangiano
- Clinical Trials and Biostatistics Unit, IRCSS Istituto Oncologico Veneto, Padova, Italy
| | | | | | - Alessandro Martini
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| | | | - Gino Marioni
- Otolaryngology Section, Department of Neuroscience—DNS, Padova University, Padova, Italy
| |
Collapse
|
45
|
Milito C, Pulvirenti F, Cinetto F, Lougaris V, Soresina A, Pecoraro A, Vultaggio A, Carrabba M, Lassandro G, Plebani A, Spadaro G, Matucci A, Fabio G, Dellepiane RM, Martire B, Agostini C, Abeni D, Tabolli S, Quinti I. Double-blind, placebo-controlled, randomized trial on low-dose azithromycin prophylaxis in patients with primary antibody deficiencies. J Allergy Clin Immunol 2019; 144:584-593.e7. [PMID: 30910492 DOI: 10.1016/j.jaci.2019.01.051] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 01/17/2019] [Accepted: 01/23/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Lacking protective antibodies, patients with primary antibody deficiencies (PADs) experience frequent respiratory tract infections, leading to chronic pulmonary damage. Macrolide prophylaxis has proved effective in patients with chronic respiratory diseases. OBJECTIVE We aimed to test the efficacy and safety of orally administered low-dose azithromycin prophylaxis in patients with PADs. METHODS We designed a 3-year, double-blind, placebo-controlled, randomized clinical trial to test whether oral azithromycin (250 mg administered once daily 3 times a week for 2 years) would reduce respiratory exacerbations in patients with PADs and chronic infection-related pulmonary diseases. The primary end point was the number of annual respiratory exacerbations. Secondary end points included time to first exacerbation, additional antibiotic courses, number of hospitalizations, and safety. RESULTS Eighty-nine patients received azithromycin (n = 44) or placebo (n = 45). The number of exacerbations was 3.6 (95% CI, 2.5-4.7) per patient-year in the azithromycin arm and 5.2 (95% CI, 4.1-6.4) per patient-year in the placebo arm (P = .02). In the azithromycin group the hazard risk for having an acute exacerbation was 0.5 (95% CI, 0.3-0.9; P = .03), and the hazard risk for hospitalization was 0.5 (95% CI, 0.2-1.1; P = .04). The rate of additional antibiotic treatment per patient-year was 2.3 (95% CI, 2.1-3.4) in the intervention group and 3.6 (95% CI, 2.9-4.3) in the placebo group (P = .004). Haemophilus influenzae and Streptococcus pneumoniae were the prevalent isolates, and they were not susceptible to macrolides in 25% of patients of both arms. Azithromycin's safety profile was comparable with that of placebo. CONCLUSION The study reached the main outcome centered on the reduction of exacerbation episodes per patient-year, with a consequent reduction in additional courses of antibiotics and risk of hospitalization.
Collapse
Affiliation(s)
- Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | | | - Vassilios Lougaris
- Department of Clinical and Experimental Sciences, University of Brescia, and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Annarosa Soresina
- Department of Pediatrics, University of Brescia, ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Pecoraro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Alessandra Vultaggio
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Maria Carrabba
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giuseppe Lassandro
- Department of Biomedicine and Evolutive Age, University of Bari, Bari, Italy
| | - Alessandro Plebani
- Department of Clinical and Experimental Sciences, University of Brescia, and ASST-Spedali Civili of Brescia, Brescia, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Andrea Matucci
- Immunoallergology Unit, Department Medical-Geriatric, AOU Careggi, Florence, Italy
| | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Rosa Maria Dellepiane
- Department of Pediatrics, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Baldassarre Martire
- Department of Biomedicine and Evolutive Age, University of Bari, Bari, Italy
| | - Carlo Agostini
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Damiano Abeni
- Health Services Research Unit IDI, IRCCS, Rome, Italy
| | | | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
46
|
Barilà G, Compagno N, Liço A, Berno T, Bonaldi L, Teramo A, Manni S, Branca A, Frigo AC, Cinetto F, Piazza F, Semenzato G, Zambello R. Severe infections unrelated to neutropenia impact on overall survival in multiple myeloma patients: results of a single centre cohort study. Br J Haematol 2019; 186:e13-e17. [PMID: 30854624 DOI: 10.1111/bjh.15849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Gregorio Barilà
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Nicolò Compagno
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Albana Liço
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Tamara Berno
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Laura Bonaldi
- Immunology and Molecular Oncology Unit, Veneto Institute of Oncology, IOV-IRCCS-Padua, Padua, Italy
| | - Antonella Teramo
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Sabrina Manni
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Antonio Branca
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Anna C Frigo
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Biostatistics, Epidemiology and Public Health Unit, Padua University School of Medicine, Padua, Italy
| | - Francesco Cinetto
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Francesco Piazza
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Gianpietro Semenzato
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| | - Renato Zambello
- Department of Medicine (DIMED), Haematology and Clinical Immunology Section, Padua University School of Medicine, Padua, Italy
| |
Collapse
|
47
|
Pulvirenti F, Cinetto F, Pecoraro A, Carrabba M, Crescenzi L, Neri R, Bonanni L, Fabio G, Agostini C, Spadaro G, Tabolli S, Farrugia A, Quinti I, Milito C. Health-Related Quality of Life in Patients with CVID Under Different Schedules of Immunoglobulin Administration: Prospective Multicenter Study. J Clin Immunol 2019; 39:159-170. [PMID: 30644015 PMCID: PMC6445807 DOI: 10.1007/s10875-019-0592-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 01/04/2019] [Indexed: 12/01/2022]
Abstract
Objective We assessed the health-related quality of life (HRQoL) in CVID adults receiving different schedules of immunoglobulin replacement therapy (IgRT) by intravenous (IVIG), subcutaneous (SCIG), and facilitated (fSCIG) preparations. For these patients, IgRT schedule was chosen after a period focused on identifying the most suitable individual option. Methods Three hundred twenty-seven participants were enrolled in a prospective, observational, 18-month study. Participants received IgRT for at least 2 years. The first 6 months were devoted to the educational process during which the choices related to IgRT were regularly re-assessed, and the shift to alternative regimen was permitted. During the following 12 months, clinical data were prospectively collected, and only patients who did not further modify their IgRT schedule were included in the analysis of HRQoL measured by CVID_QoL, a specific instrument, and by GHQ-12, a tool to assess minor psychiatric nonpsychotic disorders. Results Three hundred four patients were included in the analysis. CVID_QoL global score and its dimensions (emotional functioning, relational functioning, gastrointestinal symptoms) were similar in IVIG, SCIG, and fSCIG recipients. Patients receiving IgRT by different routes of administration reported similar capacity to make long-term plans, discomfort due to therapy, and concern to run out of medications. Multivariate analysis revealed the GHQ-12 status, but not the IgRT mode of administration, as the major factor impacting on treatment-related QoL items, and a significant impact of age on discomfort related to IgRT. Conclusions IgRT schedules do not impact the HRQoL in CVID if the treatment is established after an extensive educational period focused on individualizing the best therapeutic regimen. Electronic supplementary material The online version of this article (10.1007/s10875-019-0592-5) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
| | | | - Antonio Pecoraro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Maria Carrabba
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ludovica Crescenzi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Raffaella Neri
- Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Livia Bonanni
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Giovanna Fabio
- Department of Internal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carlo Agostini
- Department of Medicine DIMED, University of Padova, Padua, Italy
| | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Stefano Tabolli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Albert Farrugia
- Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.
| | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
48
|
Pulvirenti F, Pecoraro A, Cinetto F, Milito C, Valente M, Santangeli E, Crescenzi L, Rizzo F, Tabolli S, Spadaro G, Agostini C, Quinti I. Gastric Cancer Is the Leading Cause of Death in Italian Adult Patients With Common Variable Immunodeficiency. Front Immunol 2018; 9:2546. [PMID: 30455695 PMCID: PMC6230622 DOI: 10.3389/fimmu.2018.02546] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 10/16/2018] [Indexed: 01/15/2023] Open
Abstract
An increased prevalence of malignant lymphoma and of gastric cancer has been observed in large cohorts of patients with common variable immunodeficiency (CVID), the most frequently symptomatic primary immunodeficiency. Surveillance strategies for cancers in CVID should be defined based on epidemiological data. Risks and mortality for cancers among 455 Italian patients with CVID were compared to cancer incidence data from the Italian Cancer Registry database. CVID patients showed an increased cancer incidence for all sites combined (Obs = 133, SIR = 2.4; 95%CI = 1.7–3.5), due to an excess of non-Hodgkin lymphoma (Obs = 33, SIR = 14.3; 95%CI = 8.4–22.6) and of gastric cancer (Obs = 25; SIR = 6.4; 95%CI = 3.2–12.5). CVID patients with gastric cancer and lymphoma had a worse survival in comparison to cancer-free CVID (HR: 4.8, 95%CI: 4.2–44.4 and HR: 4.2, 95%CI: 2.8–44.4). Similar to what observed in other series, CVID-associated lymphomas were more likely to be of B cell origin and often occurred at extra-nodal sites. We collected the largest case-series of gastric cancers in CVID subjects. In contrast to other reports, gastric cancer was the leading cause of death in CVID. Standardized mortality ratio indicated a 10.1-fold excess mortality among CVID patients with gastric cancer. CVID developed gastric cancer 15 years earlier than the normative population, but they had a similar overall survival. Only CVID diagnosed at early stage gastric cancer survived >24 months. Stomach histology from upper endoscopy performed before cancer onset showed areas of atrophic gastritis, intestinal metaplasia or dysplasia. CVID patients might progress rapidly to an advanced cancer stage as shown by patients developing a III-IV stage gastric cancer within 1 year from an endoscopy without signs of dysplasia. Based on high rate of mortality due to gastric cancer in Italian CVID patients, we hereby suggest a strategy aimed at early diagnosis, based on regular upper endoscopy and on Helicobacter pylori infection treatment, recommending an implementation of national guidelines.
Collapse
Affiliation(s)
| | - Antonio Pecoraro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | | | - Cinzia Milito
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Michele Valente
- Department of Woman and Child Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Santangeli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Ludovica Crescenzi
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Francesca Rizzo
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - Giuseppe Spadaro
- Department of Translational Medical Sciences and Center for Basic and Clinical Immunology Research, University of Naples Federico II, Naples, Italy
| | - Carlo Agostini
- Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Isabella Quinti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
49
|
Ponsford MJ, Klocperk A, Pulvirenti F, Dalm VASH, Milota T, Cinetto F, Chovancova Z, Rial MJ, Sediva A, Litzman J, Agostini C, van Hagen M, Quinti I, Jolles S. Hyper-IgE in the allergy clinic--when is it primary immunodeficiency? Allergy 2018; 73:2122-2136. [PMID: 30043993 DOI: 10.1111/all.13578] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/22/2018] [Accepted: 07/05/2018] [Indexed: 12/29/2022]
Abstract
The 2017 International Union of Immunological Societies (IUIS) classification recognizes 3 hyper-IgE syndromes (HIES), including the prototypic Job's syndrome (autosomal dominant STAT3-loss of function) and autosomal recessive PGM3 and SPINK5 syndromes. Early diagnosis of PID can direct life-saving or transformational interventions; however, it remains challenging owing to the rarity of these conditions. This can result in diagnostic delay and worsen prognosis. Within increasing access to "clinical-exome" testing, clinicians need to be aware of the implication and rationale for genetic testing, including the benefits and limitations of current therapies. Extreme elevation of serum IgE has been associated with a growing number of PID syndromes including the novel CARD11 and ZNF341 deficiencies. Variable elevations in IgE are associated with defects in innate, humoral, cellular and combined immunodeficiency syndromes. Barrier compromise can closely phenocopy these conditions. The aim of this article was to update readers on recent developments at this important interface between allergy and immunodeficiency, highlighting key clinical scenarios which should draw attention to possible immunodeficiency associated with extreme elevation of IgE, and outline initial laboratory assessment and management.
Collapse
Affiliation(s)
| | - Adam Klocperk
- Department of Immunology; 2nd Faculty of Medicine; Charles University and Motol University Hospital; Prague Czech Republic
| | | | - Virgil A. S. H. Dalm
- Department of Internal Medicine; Division of Clinical Immunology and Department of Immunology; Erasmus MC; Rotterdam The Netherlands
| | - Tomas Milota
- Department of Immunology; 2nd Faculty of Medicine; Charles University and Motol University Hospital; Prague Czech Republic
| | - Francesco Cinetto
- Department of Medicine; Treviso Hospital; University of Padova; Padova Italy
| | - Zita Chovancova
- Department of Clinical Immunology and Allergology; St. Anne's University Hospital in Brno; Czech Republic
- Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Manuel J. Rial
- Department of Allergy; University Hospital Jiménez Díaz Foundation; Madrid Spain
| | - Anna Sediva
- Department of Immunology; 2nd Faculty of Medicine; Charles University and Motol University Hospital; Prague Czech Republic
| | - Jiri Litzman
- Department of Clinical Immunology and Allergology; St. Anne's University Hospital in Brno; Czech Republic
- Faculty of Medicine; Masaryk University; Brno Czech Republic
| | - Carlo Agostini
- Department of Medicine; Treviso Hospital; University of Padova; Padova Italy
| | - Martin van Hagen
- Department of Internal Medicine; Division of Clinical Immunology and Department of Immunology; Erasmus MC; Rotterdam The Netherlands
| | - Isabella Quinti
- Department of Molecular Medicine; Sapienza University of Rome; Rome Italy
| | | |
Collapse
|
50
|
Cinetto F, Scarpa R, Rattazzi M, Agostini C. The broad spectrum of lung diseases in primary antibody deficiencies. Eur Respir Rev 2018; 27:27/149/180019. [PMID: 30158276 PMCID: PMC9488739 DOI: 10.1183/16000617.0019-2018] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/13/2018] [Indexed: 12/17/2022] Open
Abstract
Human primary immunodeficiency diseases (PIDs) represent a heterogeneous group of more than 350 disorders. They are rare diseases, but their global incidence is more relevant than generally thought. The underlying defect may involve different branches of the innate and/or adaptive immune response. Thus, the clinical picture may range from severe phenotypes characterised by a broad spectrum of infections to milder infectious phenotypes due to more selective (and frequent) immune defects. Moreover, infections may not be the main clinical features in some PIDs that might present with autoimmunity, auto-inflammation and/or cancer. Primary antibody deficiencies (PADs) represent a small percentage of the known PIDs but they are the most frequently diagnosed, particularly in adulthood. Common variable immunodeficiency (CVID) is the most prevalent symptomatic PAD. PAD patients share a significant susceptibility to respiratory diseases that represent a relevant cause of morbidity and mortality. Pulmonary complications include acute and chronic infection-related diseases, such as pneumonia and bronchiectasis. They also include immune-mediated interstitial lung diseases, such as granulomatous-lymphocytic interstitial lung disease (GLILD) and cancer. Herein we will discuss the main pulmonary manifestations of PADs, the associated functional and imaging findings, and the relevant role of pulmonologists and chest radiologists in diagnosis and surveillance. The spectrum of lung complications in primary antibody deficiency ranges from asthma or COPD to extremely rare and specific ILDs. Early diagnosis of the underlying immune defect might significantly improve patients' lung disease, QoL and long-term prognosis.http://ow.ly/5cP230kZvOB
Collapse
Affiliation(s)
- Francesco Cinetto
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Riccardo Scarpa
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Marcello Rattazzi
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| | - Carlo Agostini
- Dept of Medicine - DIMED, University of Padova, Padova, Italy.,Medicina Interna I, Ca' Foncello Hospital, Treviso, Italy
| |
Collapse
|