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Iovino M, Messana T, Marucci S, Triggiani D, Giagulli VA, Guastamacchia E, Piazzolla G, De Pergola G, Lisco G, Triggiani V. Correction: The neurohypophyseal hormone oxytocin and eating behaviors: a narrative review. Hormones (Athens) 2024:10.1007/s42000-024-00540-3. [PMID: 38498233 DOI: 10.1007/s42000-024-00540-3] [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] [Indexed: 03/20/2024]
Affiliation(s)
- Michele Iovino
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - Tullio Messana
- Infantile Neuropsychiatry, IRCCS - Institute of Neurological Sciences, Bologna, Italy
| | - Simonetta Marucci
- Dip. "Scienze e Tecnologie per l'Uomo e l'ambiente", Università Campus Biomedico, Via Alvaro del Portillo, 21, Roma, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology IRCCS "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
- Department of Biomedical Science and Human Oncology, School of Medicine, University of Bari, Bari, Apulia, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy.
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Apulia, Italy
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Lisco G, Bartolomeo N, De Tullio A, De Pergola G, Guastamacchia E, Jirillo E, Piazzolla G, Triggiani V, Giagulli VA. Long-acting glucagon-like peptide 1 receptor agonists boost erectile function in men with type 2 diabetes mellitus complaining of erectile dysfunction: A retrospective cohort study. Andrology 2024; 12:633-642. [PMID: 37615353 DOI: 10.1111/andr.13519] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 08/25/2023]
Abstract
INTRODUCTION The pharmacological management of erectile dysfunction (ED) in type 2 diabetes (T2D) is challenging as ED has a multifactorial etiology. The therapeutic potential of certain antihyperglycemic medications, such as glucagon-like peptide 1 receptor agonists (GLP-1RAs), has yet to be entirely studied in this setting. MATERIAL AND METHODS A retrospective cohort study was conducted on 108 outpatients (median age 60 [56, 65] years) with T2D complaining of ED. Data were extracted from a database referring to patients with a 1-year follow-up on stable treatment with metformin alone (n = 45) and GLP-1RAs as an add-on to metformin (n = 63). Erectile function was assessed by the 5-item International Index of Erectile Function (IIEF5) at baseline and after 1 year of stable treatment . Values were compared between baseline (T0) and after 12 months of treatment (T12). RESULTS ED was confirmed in all at baseline, with an IIEF5 score range between 13 and 19 points. After 12 months of treatment, glucose management was better in patients treated with GLP-1RAs plus metformin (HbA1c T0: 8.3 ± 0.2 vs. HbA1c T12: 7% ± 0.3%, p < 0.0001) than in those on metformin alone (HbA1c T0: 7 ± 0.5 vs. HbA1c T12: 7.3 ± 0.4, p = 0.0007). GLP-1RAs plus metformin over metformin alone resulted in a significant weight loss (-5.82 ± 0.69 kg, p < 0.0001), reduction in waist circumference (-4.99 ± 0.6 cm, p < 0.0001), improvement in HbA1c (-0.56% ± 0.13%, p < 0.0001), and fasting plasma glucose (-25.54 ± 3.09 mg/dL, p < 0.0001), increase in total (+41.41 ± 6.11 ng/dL, p < 0.0001) and free (0.44 ± 0.09 ng/dL, p < 0.0001) testosterone levels, and gain in self-reported erectile function (IIEF5 score: +2.26 ± 0.26, p < 0.0001). The gain in the IIEF5 score was more relevant in patients with higher baseline IIEF5 score (estimated coefficient: 0.16 ± 0.08, p = 0.045), those having carotid stenosis (0.50 ± 0.24, p = 0.045), and showing weight loss from baseline (-0.08 ± 0.03, p = 0.013). The leading determinant of the final IIEF5 score was a 1-year treatment with GLP-1RAs plus metformin over metformin alone (2.74 ± 0.53, p < 0.0001). DISCUSSION GLP-1RAs plus metformin over metformin alone improved ED regardless of different background characteristics of patients and partially irrespective of therapeutic targets achieved after 12 months of treatment. GLP-1RAs may have induced positive vasculature effects, resulting in improved erectile function in T2D. CONCLUSION Due to the retrospective nature of the study, a potential cause-effect relationship between the use of GLP-1RAs plus metformin over metformin alone in improving ED cannot be verified and confirmed. Randomized clinical trials are needed to provide evidence supporting the use of GLP-1RAs for treating ED in T2D.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Bartolomeo
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, University of Bari, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Santa Maria Hospital, GVM Care & Research, Bari, Italy
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Iovino M, Messana T, Marucci S, Triggiani D, Giagulli VA, Guastamacchia E, Piazzolla G, De Pergola G, Lisco G, Triggiani V. The neurohypophyseal hormone oxytocin and eating behaviors: a narrative review. Hormones (Athens) 2024; 23:15-23. [PMID: 37979096 PMCID: PMC10847364 DOI: 10.1007/s42000-023-00505-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/03/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The neuropeptide oxytocin (OT) is crucial in several conditions, such as lactation, parturition, mother-infant interaction, and psychosocial function. Moreover, OT may be involved in the regulation of eating behaviors. METHODS This review briefly summarizes data concerning the role of OT in eating behaviors. Appropriate keywords and medical subject headings were identified and searched for in PubMed/MEDLINE. References of original articles and reviews were screened, examined, and selected. RESULTS Hypothalamic OT-secreting neurons project to different cerebral areas controlling eating behaviors, such as the amygdala, area postrema, nucleus of the solitary tract, and dorsal motor nucleus of the vagus nerve. Intracerebral/ventricular OT administration decreases food intake and body weight in wild and genetically obese rats. OT may alter food intake and the quality of meals, especially carbohydrates and sweets, in humans. DISCUSSION OT may play a role in the pathophysiology of eating disorders with potential therapeutic perspectives. In obese patients and those with certain eating disorders, such as bulimia nervosa or binge/compulsive eating, OT may reduce appetite and caloric consumption. Conversely, OT administered to patients with anorexia nervosa may paradoxically stimulate appetite, possibly by lowering anxiety which usually complicates the management of these patients. Nevertheless, OT administration (e.g., intranasal route) is not always associated with clinical benefit, probably because intranasally administered OT fails to achieve therapeutic intracerebral levels of the hormone. CONCLUSION OT administration could play a therapeutic role in managing eating disorders and disordered eating. However, specific studies are needed to clarify this issue with regard to dose-finding and route and administration time.
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Affiliation(s)
- Michele Iovino
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
| | - Tullio Messana
- Infantile Neuropsychiatry, IRCCS - Institute of Neurological Sciences, Bologna, Italy
| | - Simonetta Marucci
- Università Campus Biomedico, Dip. "Scienze e Tecnologie per l'Uomo e l'ambiente", Via Alvaro del Portillo, 21, Roma, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology IRCCS "Saverio de Bellis", Research Hospital, Castellana Grotte, Bari, Italy
- Department of Biomedical Science and Human Oncology, University of Bari, School of Medicine, Bari, Apulia, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy.
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari "Aldo Moro", School of Medicine, Bari, Apulia, Italy
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Scavo MP, Lisco G, Depalo N, Rizzi F, Volpe S, Arrè V, Carrieri L, Notarnicola M, De Nunzio V, Curri ML, De Pergola G, Piazzolla G, Giannelli G. Semaglutide Modulates Extracellular Matrix Production of LX-2 Cells via Exosomes and Improves Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). Int J Mol Sci 2024; 25:1493. [PMID: 38338770 PMCID: PMC10855465 DOI: 10.3390/ijms25031493] [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: 12/18/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Metabolic dysfunction-associated steatotic liver disease (MASLD) is closely related to some metabolic disorders, such as central obesity and type 2 diabetes (T2D). Glucagon-like peptide 1 receptor agonists (GLP-1RAs), such as semaglutide, may have therapeutic roles in MASLD associated with T2D. This study aims to investigate the molecular mechanisms underlying the effectiveness of semaglutide on MASLD in terms of progression from liver steatosis to fibrosis. We characterized exosomes from ten patients with type 2 diabetes (T2D) before (T0) and after 12 months (T12) of treatment with once-weekly subcutaneous semaglutide. Six of ten patients were considered responders to therapy (R) based on MASLD severity downgrading by at least one class according to a validated ultrasonographic (US) score. Normal hepatocytes (HEPA-RG) and stellate (LX-2) cells were challenged with exosomes from R and NR patients, isolated before and after 12 months of therapy. Exosomes from both R and NR patients isolated at T0 significantly affected LX-2 viability. After 12 months of treatment, only those isolated from R patients restored cell viability, whereas those from NR patients did not. No effects were observed on HEPA-RG cells. Exosomes at T12 from R but not from NR patients significantly decreased the production of α-SMA, a marker of LX-2 activation, a liver stellate cell model, and ph-SMAD2 and CTGF, involved in fibrosis processes. TGF-β1 was not modulated by the exosomes of R and NR patients. As a downstream effect, Vimentin, Collagen 1A1, and Fibronectin extracellular matrix components were also downregulated, as measured by droplets digital PCR. In conclusion, these results shed light on the potential effectiveness of semaglutide in improving liver fibrosis in MASLD.
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Affiliation(s)
- Maria Principia Scavo
- Laboratory of Personalized Medicine, National Institute of Gastroenterology, IRCCS DeBellis, 70013 Castellana Grotte, BA, Italy; (V.A.); (L.C.)
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy; (G.L.); (S.V.); (G.P.)
| | - Nicoletta Depalo
- Institute for Chemical-Physical Processes, Italian National Research Council (IPCF)-CNR SS Bari, Via Orabona 4, 70125 Bari, BA, Italy; (N.D.); (F.R.)
| | - Federica Rizzi
- Institute for Chemical-Physical Processes, Italian National Research Council (IPCF)-CNR SS Bari, Via Orabona 4, 70125 Bari, BA, Italy; (N.D.); (F.R.)
| | - Sara Volpe
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy; (G.L.); (S.V.); (G.P.)
| | - Valentina Arrè
- Laboratory of Personalized Medicine, National Institute of Gastroenterology, IRCCS DeBellis, 70013 Castellana Grotte, BA, Italy; (V.A.); (L.C.)
| | - Livianna Carrieri
- Laboratory of Personalized Medicine, National Institute of Gastroenterology, IRCCS DeBellis, 70013 Castellana Grotte, BA, Italy; (V.A.); (L.C.)
| | - Maria Notarnicola
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, IRCCS “S. de Bellis” Research Hospital, 70013 Castellana Grotte, BA, Italy; (M.N.); (V.D.N.)
| | - Valentina De Nunzio
- Laboratory of Nutritional Biochemistry, National Institute of Gastroenterology, IRCCS “S. de Bellis” Research Hospital, 70013 Castellana Grotte, BA, Italy; (M.N.); (V.D.N.)
| | - Maria Lucia Curri
- Dipartimento di Chimica, Università degli Studi di Bari Aldo Moro, Via Orabona 4, 70125 Bari, BA, Italy;
| | - Giovanni De Pergola
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, BA, Italy;
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, BA, Italy; (G.L.); (S.V.); (G.P.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology IRCCS “De Bellis,” Via Turi 27, 70013 Castellana Grotte, BA, Italy;
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Castelnuovo G, Capodaglio P, De Amicis R, Gilardini L, Mambrini SP, Pietrabissa G, Cavaggioni L, Piazzolla G, Galeone C, Garavaglia G, Bertoli S. Study protocol of a clinical randomized controlled trial on the efficacy of an innovative Digital thErapy to proMote wEighT loss in patients with obesity by incReasing their Adherence to treatment: the DEMETRA study. Front Digit Health 2023; 5:1159744. [PMID: 38098734 PMCID: PMC10720313 DOI: 10.3389/fdgth.2023.1159744] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 11/13/2023] [Indexed: 12/17/2023] Open
Abstract
Despite the increasing importance of innovative medications and bariatric surgery for the treatment of obesity, lifestyle interventions (diet and physical activity) remain the first-line therapy for this disease. The use of digital devices in healthcare aims to respond to the patient's needs, in order to make obesity treatment more accessible, so our study aims to assess the safety and efficacy of a Digital Therapy for Obesity App (DTxO) for achieving weight loss and its maintenance in patients affected with obesity undergoing an experimental non-pharmacological treatment. Here we present the study protocol of a prospective, multicenter, pragmatic, randomized, double-arm, placebo-controlled, parallel, single-blind study on obese patients who will be treated with a new digital therapy to obtain an improvement in their disease condition through the application of different simultaneous strategies (a dietary regimen and personalized advice program, a tailored physical exercise program, a cognitive-behavioural assessment and program, alerts and reminders, dedicated section on prescribed drugs intake, and chat and online visits with clinical professionals). We believe that DTxO will offer a promising intervention channel and self-regulation tool holding the potentiality to decrease treatment burden and treat more patients thanks to the partial replacement of traditional medical consultation with digital or telephone management, improving self- engagement and reducing the high demands the "obesity pandemic" for both patients and national health services in terms of time, cost, and effort. Clinical trial registration: clinicaltrials.gov, identifier, NCT05394779.
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Affiliation(s)
- Gianluca Castelnuovo
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Paolo Capodaglio
- Orthopaedic Rehabilitation Unit and Research Lab in Biomechanics, Rehabilitation and Ergonomics, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
- Department of Surgical Sciences, Physical and Rehabilitation Medicine, University of Turin, Turin, Italy
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Luisa Gilardini
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Sara Paola Mambrini
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Division of Nutritional Rehabilitation, IRCCS Istituto Auxologico Italiano, Piancavallo, Italy
| | - Giada Pietrabissa
- Clinical Psychology Lab, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Luca Cavaggioni
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Carlotta Galeone
- Bicocca Applied Statistics Center (B-ASC), Università degli Studi di Milano-Bicocca, Milan, Italy
- Biostatistics & Outcome Research, Statinfo, Milan, Italy
| | | | - Simona Bertoli
- International Center for the Assessment of Nutritional Status and the Development of Dietary Intervention Strategies (ICANS-DIS), Department of Food, Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
- Obesity Unit and Laboratory of Nutrition and Obesity Research, Department of Endocrine and Metabolic Diseases, IRCCS Istituto Auxologico Italiano, Milan, Italy
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Lisco G, De Tullio A, Disoteo O, Piazzolla G, Guastamacchia E, Sabbà C, De Geronimo V, Papini E, Triggiani V. Glucagon-like peptide 1 receptor agonists and thyroid cancer: is it the time to be concerned? Endocr Connect 2023; 12:e230257. [PMID: 37656509 PMCID: PMC10563602 DOI: 10.1530/ec-23-0257] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 09/01/2023] [Indexed: 09/03/2023]
Abstract
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) have changed considerably the management of type 2 diabetes (T2D). However, recently published data from retrospective cohort studies suggest that chronic exposure to GLP-1RAs in T2D may increase the risk of papillary and medullary thyroid cancer. In this perspective, the role of the incretin system in thyroid carcinogenesis has been reviewed and critically commented on, aiming to understand if the time has arrived to be concerned about the risk. Although evidence suggested, speculative hypotheses should be verified, and further studies are urgently needed to clarify the issue.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Olga Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
| | | | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Rome, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari "Aldo Moro", Piazza Giulio Cesare, Bari, Italy
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Crudele L, Novielli F, De Matteis C, Petruzzelli S, Suppressa P, Berardi E, Antonica G, Piazzolla G, Sabbà C, Graziano G, Moschetta A. Thyroid nodule malignancy is associated with increased non-invasive hepatic fibrosis scores in metabolic subjects. Front Oncol 2023; 13:1233083. [PMID: 37965446 PMCID: PMC10641401 DOI: 10.3389/fonc.2023.1233083] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction Thyroid cancer incidence is increasing, and adiposity-related conditions are gaining space in its pathogenesis. In this study, we aimed to detect any anthropometric, biohumoral, and clinical features that might be associated with thyroid nodule malignancy, potentially representing novel non-invasive markers of thyroid cancer. Materials and methods The study was conducted in a group of 142 consecutive outpatients (47 men and 95 women) who underwent fine-needle aspiration biopsy/cytology (FNAB/C) due to suspicion of malignancy from January 2018 to September 2022. We compared lipid and glycemic blood profiles as well as non-invasive liver fibrosis indexes such as aspartate aminotransferase (AST) to alanine aminotransferase (ALT) ratio (AAR), AST to platelet ratio index (APRI), and fibrosis index based on four factors (FIB-4) between patients with benign and malignant newly diagnosed nodules. Then, we performed receiver operating characteristic (ROC) analysis to assess their best cutoff values for discrimination of malignant nodules and chi-squared test to evaluate the association of specific dysmetabolic conditions with malignancy. To understand whether and to what degree dysmetabolic conditions increased the risk of thyroid nodule malignancy, we also calculated the odds ratio (OR) of the main biomarkers. Results After FNAB/C, 121 (85%) patients were diagnosed with benign thyroid nodules, while 21 (15%) individuals were diagnosed with thyroid cancer. Comparing patients with benign and malignant nodules, we found that individuals with thyroid cancer exhibited increased body mass index (BMI) (p = 0.048) and fasting plasma glucose (p = 0.046). Intriguingly, considering non-invasive scores for liver fibrosis, subjects with thyroid cancer presented increased AAR (p < 0.001) and APRI (p = 0.007), and these scores were associated with malignancy (p < 0.005) with OR = 7.1 and OR = 5, respectively. Moreover, we showed that only in the cancer group, low levels of vitamin D correlated with stigmata of impaired metabolism. Discussion In our study, AAR and APRI scores were associated with thyroid nodule malignancy and could be used to predict it and to speed up the diagnostic process. From a pathogenic point of view, we speculated that metabolic-associated fatty liver disease (MAFLD) along with hyperglycemia and vitamin D deficiency may represent putative drivers of thyroid carcinogenesis.
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Affiliation(s)
- Lucilla Crudele
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Fabio Novielli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Carlo De Matteis
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Stefano Petruzzelli
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Patrizia Suppressa
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Elsa Berardi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Gianfranco Antonica
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppina Piazzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Giusi Graziano
- Center for Outcomes Research and Clinical Epidemiology (CORESEARCH), Pescara, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- IINBB National Institute for Biostructure and Biosystems, Roma, Italy
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De Nucci S, Bonfiglio C, Donvito R, Di Chito M, Cerabino N, Rinaldi R, Sila A, Shahini E, Giannuzzi V, Pesole PL, Coletta S, Lanzilotta E, Piazzolla G, Cozzolongo R, Giannelli G, De Pergola G. Effects of an Eight Week Very Low-Calorie Ketogenic Diet (VLCKD) on White Blood Cell and Platelet Counts in Relation to Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) in Subjects with Overweight and Obesity. Nutrients 2023; 15:4468. [PMID: 37892542 PMCID: PMC10610501 DOI: 10.3390/nu15204468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Obesity and metabolic dysfunction-associated steatotic liver disease (MASLD) are frequently associated conditions characterized by low-grade inflammation. Very low-calorie ketogenic diet (VLCKD) strategies are commonly used to simultaneously obtain weight loss and an improvement of liver steatosis. We evaluated the efficacy of 8 weeks' VLCKD in decreasing the white blood cell (WBC) and platelet (PLT) counts, as well as liver steatosis and fibrosis, diagnosed using transient elastography (FibroScan). Metabolic and anthropometric parameters commonly associated with MASLD were also evaluated. This study included 87 participants; 58 women and 29 men aged between 18 and 64 years with overweight (18%) or obesity (82%), but not taking any medication. Anthropometric measurements, bioimpedance analysis, and biochemical assays were performed before and after the dietary intervention. BMI (kg/m2) (p-value < 0.001), waist circumference (cm) (p-value < 0.001), and fat mass (kg) (p-value < 0.001) were significantly decreased following VLCKD. After VLCKD, the FibroScan parameter CAP (db/m), which measures the accumulation of fatty liver, significantly decreased (p-value < 0.001), as did liver stiffness (kPA), the FibroScan parameter quantifying liver fibrosis (p-value < 0.05). Seemingly, WBC (p-value < 0.001) and PLT (p-value < 0.001) counts were lowered by VLCKD in the whole group; however, the decrease in WBC and platelet counts were significant only in patients with steatosis (CAP ≥ 215 dB/m). Fasting blood glucose (p-value < 0.001), insulin (p-value < 0.001), HbA1c (p-value < 0.001), triglycerides (p-value < 0.001), total cholesterol (p-value < 0.001), LDL-cholesterol (p-value < 0.001), HDL-cholesterol (p-value < 0.001); γGT (p-value < 0.001) blood levels and insulin resistance (as measured by HOMAIR) (p-value < 0.001); and systolic (p-value < 0.001), and diastolic (p-value < 0.001) blood pressure levels, were all significantly lower after VLCKD. In contrast, blood levels of vitamin D were higher following the diet (p-value < 0.001). We conclude that treating subjects with overweight and obesity with VLCKD is followed by a simultaneous reduction in WBCs and platelets, the expression of low-grade inflammation, and of liver steatosis and fibrosis. Therefore, we can hypothesize that VLCKD decreases general and liver low-grade inflammation, thus improving liver health.
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Affiliation(s)
- Sara De Nucci
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Caterina Bonfiglio
- Laboratory of Epidemiology and Statistics, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Rosanna Donvito
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Martina Di Chito
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Nicole Cerabino
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Roberta Rinaldi
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Annamaria Sila
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
| | - Endrit Shahini
- Department of Gastroenterology, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy; (E.S.)
| | - Vito Giannuzzi
- Department of Gastroenterology, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy; (E.S.)
| | - Pasqua Letizia Pesole
- Core Facility Biobank, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Sergio Coletta
- Core Facility Biobank, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Elsa Lanzilotta
- Laboratory of Clinical Pathology, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy;
| | - Raffaele Cozzolongo
- Department of Gastroenterology, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy; (E.S.)
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology “Saverio de Bellis”, IRCCS Hospital, Castellana Grotte, 70013 Bari, Italy;
| | - Giovanni De Pergola
- Center of Nutrition for the Research and the Care of Obesity and Metabolic Diseases, National Institute of Gastroenterology IRCCS “Saverio de Bellis”, 70013 Castellana Grotte, Italy (R.R.)
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Petruzzi M, Della Vella F, Squicciarini N, Lilli D, Campus G, Piazzolla G, Lucchese A, van der Waal I. Diagnostic delay in autoimmune oral diseases. Oral Dis 2023; 29:2614-2623. [PMID: 36565434 DOI: 10.1111/odi.14480] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/27/2022] [Accepted: 12/20/2022] [Indexed: 12/25/2022]
Abstract
Autoimmune diseases (ADs) affect about 5% of the general population, causing various systemic and/or topical clinical manifestations. The oral mucosa is often affected, sometimes as the only involved site. The misdiagnosis of oral ADs is an underreported issue. This narrative review focuses on diagnostic delay (DD) in oral ADs (oral lichen planus [OLP], oral Pemphigus Vulgaris, mucous membrane pemphigoid, oral lupus erythematosus, orofacial granulomatosis, oral erythema multiforme [EM], and Sjogren syndrome). Extensive literature research was conducted via MEDLINE, Embase and Google Scholar databases for articles reporting the time spent to achieve the correct diagnosis of oral ADs. Only 16 studies reported DD in oral ADs. Oral autoimmune vesiculobullous diseases are usually diagnosed after 8 months from the initial signs/symptoms, the Sjogren Syndrome diagnosis usually requires about 73 months. No data exist about the DD in OLP, oral lupus erythematosus, orofacial granulomatosis, and oral EM. The diagnosis of oral ADs can be difficult due to the non-specificity of their manifestations and the unawareness of dentists, physicians, and dental and medical specialists about these diseases. This can lead to a professional DD and a consequential treatment delay. The delay can be attributed to the physicians or/and the healthcare system (Professional Delay) or the patient (Patient's Delay).
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Affiliation(s)
- Massimo Petruzzi
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
| | - Fedora Della Vella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Nicola Squicciarini
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Davide Lilli
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", Bari, Italy
| | - Guglielmo Campus
- Department of Restorative, Preventive and Pediatric Dentistry, University of Bern, Bern, Switzerland
- Department of Surgery, Microsurgery and Medicine Sciences, School of Dentistry, University of Sassari, Sassari, Italy
- School of Dentistry, Sechenov University, Moscow, Russia
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine "G. Baccelli", University of Bari "Aldo Moro", Bari, Italy
| | - Alberta Lucchese
- Multidisciplinary Department of Medical and Dental Specialties, University of Campania-Luigi Vanvitelli, Naples, Italy
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Volpe S, Lisco G, Fanelli M, Racaniello D, Colaianni V, Lavarra V, Triggiani D, Crudele L, Triggiani V, Sabbà C, De Pergola G, Piazzolla G. Oral semaglutide improves body composition and preserves lean mass in patients with type 2 diabetes: a 26-week prospective real-life study. Front Endocrinol (Lausanne) 2023; 14:1240263. [PMID: 37780624 PMCID: PMC10534984 DOI: 10.3389/fendo.2023.1240263] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Oral semaglutide is the first glucagon-like peptide-1 receptor agonist (GLP-1RA) designed for oral administration; it offers a promising opportunity to facilitate an early approach to Type 2 Diabetes (T2D). The study aimed to evaluate, in a real-life setting, the effects of oral semaglutide on the body composition of patients with T2D after 26 weeks of therapy. Methods Thirty-two patients with T2D were evaluated at baseline (T0) and after three (T3) and six (T6) months of therapy with oral semaglutide. At each time point, body composition was assessed using a phase sensitive bioimpedance analyzer. Clinical, anthropometric and laboratory parameters, and the main biometric surrogates of liver steatosis and fibrosis, were also analyzed and compared. Results A significant and early reduction in anthropometric and glucometabolic parameters, alanine aminotransferase, Fatty Liver Index, and Fat Mass was observed. Visceral Adipose Tissue (VAT) decreased, while Fat Free Mass and Skeletal Muscle Mass (SMM) were preserved during therapy, resulting in a beneficial increase in the SMM/VAT ratio. Finally, an overall improvement in body fluid distribution was observed. Conclusion Our real-world data confirm the clinical efficacy of oral semaglutide and highlight its ability to improve the nutritional status of patients with T2D.
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Affiliation(s)
- Sara Volpe
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Margherita Fanelli
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Davide Racaniello
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Valentina Colaianni
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Valentina Lavarra
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Lucilla Crudele
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology—IRCCS “Saverio de Bellis”, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “A. Moro”, Bari, Italy
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Fiore V, Barucca A, Barraco S, Triggiani D, Carbotta G, Giagulli VA, Piazzolla G, Lisco G, Triggiani V. Hypothyroidism in older adults: A narrative review. Endocr Metab Immune Disord Drug Targets 2023; 23:EMIDDT-EPUB-134097. [PMID: 37641994 DOI: 10.2174/1871530323666230828110153] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 04/07/2023] [Accepted: 04/27/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION The prevalence of hypothyroidism increases along with aging, resulting in one of the most common comorbidities among patients over 75 years. The leading causes of hypothyroidism in older adults are iatrogenic, Hashimoto's thyroiditis, and medications. AIMS The narrative review aimed to discuss the clinical characteristics of hypothyroidism in older adults and the impact of hormonal replacement therapy on survival rates. RESULTS Thyroid function declines over time due to physiological changes in the thyroid stimulating hormone signaling, iodine absorption and metabolism, thyroid hormone metabolism, and activity at peripheral sites. A serum TSH value over the upper limit of the normal reference range is not necessarily attributable to hypothyroidism. However, an appropriate diagnostic work-up is required to rule out true hypothyroidism and discriminate the etiology (i.e., thyroid autoimmune diseases, iodine deficiency, drug-induced hypothyroidism). Levothyroxine treatment should be considered in cases of overt hypothyroidism. A complete risk-to-benefit assessment, particularly considering the overall health status, life expectancy, cognitive function, mood, and cardiovascular and neurological background, should be considered before treating subclinical hypothyroidism with more potential benefits in patients under 75 years old. Levothyroxine formulations facilitating hormone absorption and increasing compliance to long-term treatment should be preferred. TSH target should usually be set over 3 mIU/ml. CONCLUSION Defining optimal diagnostic approaches and targeted therapeutic strategies should be considered in the personalized management of aged patients with hypothyroidism.
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Affiliation(s)
- Vincenzo Fiore
- UOSD Diabetologia - Endocrinologia, ASL RM5, Rome, Italy
| | | | - S Barraco
- UOSD Diabetologia - Endocrinologia, ASL RM5, Rome, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Giovanni Carbotta
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
| | - Giuseppe Lisco
- UOSD Diabetologia - Endocrinologia, ASL RM5, Rome, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari A. Moro, Bari, Italy
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12
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Solfrizzi V, Scafato E, Custodero C, Piazzolla G, Capogna L, Procaccio A, Gandin C, Galluzzo L, Ghirini S, Matone A, Dibello V, Sardone R, Daniele A, Lozupone M, Panza F. Biopsychosocial frailty and mild cognitive impairment subtypes: Findings from the Italian project on the epidemiology of Alzheimer's disease (IPREA). Alzheimers Dement 2023; 19:3306-3315. [PMID: 36757048 DOI: 10.1002/alz.12944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Frailty is a critical intermediate status of the aging process including physical, cognitive, and psychosocial phenotypes. We operationalized a biopsychosocial frailty construct, estimating its association with mild cognitive impairment (MCI) and its subtypes. METHODS In 1980, older individuals from the population-based Italian PRoject on the Epidemiology of Alzheimer's disease (IPREA), we investigated cross-sectional associations among biopsychosocial frailty, MCI, and its subtypes. RESULTS Participants with biopsychosocial frailty showed an increased odds ratio (OR) of MCI [OR: 4.36; 95% confidence interval (CI): 2.60-7.29; Fisher's exact p < 0.01], particularly for nonamnestic MCI single domain (naMCI-SD, OR:3.28; 95% CI: 1.35-7.97; Fisher's exact p = 0.02) and for nonamnestic MCI multiple domain (naMCI-MD, OR:6.92; 95% CI: 3.37-14.21; Fisher's exact p < 0.01). No statistically significant associations between amnestic MCI single or multiple domain and biopsychosocial frailty were observed. DISCUSSION In a large, older Italian cohort, a biopsychosocial frailty phenotype was associated with MCI, in particular, could be associated with some of its subtypes, that is, naMCI-SD, and naMCI-MD.
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Affiliation(s)
- Vincenzo Solfrizzi
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Emanuele Scafato
- Osservatorio Nazionale Alcol, Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Custodero
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Giuseppina Piazzolla
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Lavinia Capogna
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Annagrazia Procaccio
- "Cesare Frugoni" Internal and Geriatric Medicine and Memory Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Claudia Gandin
- Osservatorio Nazionale Alcol, Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Lucia Galluzzo
- Department of Cardiovascular, Endocrine-Metabolic Diseases, and Aging, Istituto Superiore di Sanità (ISS), Rome, Italy
| | - Silvia Ghirini
- Osservatorio Nazionale Alcol, Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Alice Matone
- Osservatorio Nazionale Alcol, Centro Nazionale Dipendenze e Doping, Istituto Superiore di Sanità, Rome, Italy
| | - Vittorio Dibello
- Department of Orofacial Pain and Dysfunction, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rodolfo Sardone
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
| | - Antonio Daniele
- Department of Neuroscience, Catholic University of Sacred Heart, Rome, Italy
- Neurology Unit, IRCCS Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Madia Lozupone
- Department of Translational Biomedicine and Neuroscience "DiBrain", University of Bari Aldo Moro, Bari, Italy
| | - Francesco Panza
- Unit of Research Methodology and Data Sciences for Population Health, National Institute of Gastroenterology "Saverio de Bellis", Research Hospital, Bari, Italy
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Crudele L, Garcia-Irigoyen O, Cariello M, Piglionica M, Scialpi N, Florio M, Piazzolla G, Suppressa P, Sabbà C, Gadaleta RM, Moschetta A. Total serum FGF-21 levels positively relate to visceral adiposity differently from its functional intact form. Front Endocrinol (Lausanne) 2023; 14:1159127. [PMID: 37409233 PMCID: PMC10319105 DOI: 10.3389/fendo.2023.1159127] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/29/2023] [Indexed: 07/07/2023] Open
Abstract
Objective Increased Fibroblast Growth Factor-21 (FGF-21) circulating levels have been described in obesity. In this observational study, we analysed a group of subjects with metabolic disorders to unravel the putative link between visceral adiposity and FGF-21 serum levels. Methods Total and intact serum FGF-21 concentration was measured with an ELISA assay respectively in 51 and 46 subjects, comparing FGF-21 levels in dysmetabolic conditions. We also tested Spearman's correlations between FGF-21 serum levels and biochemical and clinical metabolic parameters. Results FGF-21 was not significantly increased in high-risk conditions such as visceral obesity, Metabolic Syndrome, diabetes, smoking, and atherosclerosis. Waist Circumference (WC), but not BMI, positively correlated with total FGF-21 levels (r=0.31, p <0.05), while HDL-cholesterol (r=-0.29, p <0.05) and 25-OH Vitamin D (r=-0.32, p <0.05) showed a significant negative correlation with total FGF-21. ROC analysis of FGF-21 in prediction of increased WC, showed that patients with total FGF-21 level over cut-off value of 161.47 pg/mL presented with impaired FPG. Conversely, serum levels of the intact form of FGF-21 did not correlate with WC and other metabolic biomarkers. Conclusion Our newly calculated cut-off for total FGF-21 according to visceral adiposity identified subjects with fasting hyperglycemia. However, waist circumference correlates with total FGF-21 serum levels but does not correlate with intact FGF-21, suggesting that functional FGF-21 does not necessarily relate with obesity and metabolic features.
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Affiliation(s)
- Lucilla Crudele
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Oihane Garcia-Irigoyen
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
| | - Marica Cariello
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Marilidia Piglionica
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Natasha Scialpi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Marilina Florio
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Giuseppina Piazzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Patrizia Suppressa
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
| | | | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
- National Institute for Biostructures and Biosystems (INBB), Rome, Italy
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De Nucci S, Castellana F, Zupo R, Lampignano L, Di Chito M, Rinaldi R, Giannuzzi V, Cozzolongo R, Piazzolla G, Giannelli G, Sardone R, De Pergola G. Corrigendum: Associations between serum biomarkers and non-alcoholic liver disease: results of a clinical study of Mediterranean patients with obesity. Front Nutr 2023; 10:1198144. [PMID: 37215206 PMCID: PMC10193945 DOI: 10.3389/fnut.2023.1198144] [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: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fnut.2022.1002669.].
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Affiliation(s)
- Sara De Nucci
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Martina Di Chito
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Roberta Rinaldi
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Vito Giannuzzi
- Department of Gastroenterology, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Raffaele Cozzolongo
- Department of Gastroenterology, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Internal Medicine Unit, University of Bari, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology-IRCCS “Saverio de Bellis”, Castellana Grotte, Italy
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De Matteis C, Crudele L, Battaglia S, Loconte T, Rotondo A, Ferrulli R, Gadaleta RM, Piazzolla G, Suppressa P, Sabbà C, Cariello M, Moschetta A. Identification of a Novel Score for Adherence to the Mediterranean Diet That Is Inversely Associated with Visceral Adiposity and Cardiovascular Risk: The Chrono Med Diet Score (CMDS). Nutrients 2023; 15:nu15081910. [PMID: 37111129 PMCID: PMC10141687 DOI: 10.3390/nu15081910] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 03/31/2023] [Accepted: 04/12/2023] [Indexed: 04/29/2023] Open
Abstract
Adherence to the Mediterranean diet (MedDiet) leads to reduction of mortality from all causes, especially in subjects with cardiovascular disease, obesity, and diabetes. Numerous scores have been proposed to evaluate the adherence to MedDiet, mainly focused on eating habits. In this study, we verified whether existing validated MedDiet scores, namely, MEDI-LITE and the Mediterranean Diet Score (MDS), could be associated with visceral adiposity. Failing to find a significant association with adiposity, we proposed the validation of a new, easy-to-use adherence questionnaire, the Chrono Med-Diet score (CMDS). CMDS contains eleven food categories, including chronobiology of dietary habits and physical activity. Compared to the MEDI-LITE score and MDS, low values of CMDS are linked to increased waist circumference (WC) and dysmetabolic conditions. CMDS was also inversely correlated with cardiovascular risk (CVR), as well as Fatty Liver Index (FLI). In conclusion, the CMDS is a novel questionnaire to study the adherence to the MedDiet that, focusing on type and timing of carbohydrates intake, has the peculiar capability of capturing subjects with abdominal obesity, thus being an easy-to-use instrument of personalized medicine.
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Grants
- EU-JPI HDL-INTIMIC -MIUR FATMAL Ministry of Education, Universities and Research
- MIUR-PON "R&I" 2014-2020 "BIOMIS" cod. ARS01_01220 Ministry of Education, Universities and Research
- POR Puglia FESR-FSE 2014- 2020, "INNOMA" cod. 4TCJLV4 Regione Puglia
- National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.3 - Call for tender No. 341 of 15 March 2022 of Italian Ministry of University and Research funded by the European Union - NextGeneration EU. Ministry of Education, Universities and Research
- Project code PE00000003, Concession Decree No. 1550 of 11 October 2022 adopted by the Italian Ministry of University and Research, CUP D93C22000890001, Project title "ON Foods - Research and innovation network on food and nutri-tion Sustainability, Safety Ministry of Education, Universities and Research
- National Recovery and Resilience Plan (NRRP), Mission 4 Component 2 Investment 1.3 - Call for tender No. 341 of 15 March 2022 of Italian Ministry of University and Research funded by the European Union - NextGeneration EU; Award Number: Project code PE000 Ministry of Education, Universities and Research
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Affiliation(s)
- Carlo De Matteis
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Lucilla Crudele
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Stefano Battaglia
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Tiziana Loconte
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Arianna Rotondo
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Roberta Ferrulli
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | | | - Giuseppina Piazzolla
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Patrizia Suppressa
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Marica Cariello
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari "Aldo Moro", 70124 Bari, Italy
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16
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Lisco G, De Tullio A, Triggiani D, Zupo R, Giagulli VA, De Pergola G, Piazzolla G, Guastamacchia E, Sabbà C, Triggiani V. Iodine Deficiency and Iodine Prophylaxis: An Overview and Update. Nutrients 2023; 15:nu15041004. [PMID: 36839362 PMCID: PMC9967346 DOI: 10.3390/nu15041004] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
The thyroid gland requires iodine to synthesize thyroid hormones, and iodine deficiency results in the inadequate production of thyroxine and related thyroid, metabolic, developmental, and reproductive disorders. Iodine requirements are higher in infants, children, and during pregnancy and lactation than in adult men and non-pregnant women. Iodine is available in a wide range of foods and water and is susceptible to almost complete gastric and duodenal absorption as an iodide ion. A healthy diet usually provides a daily iodine consumption not exceeding 50% of the recommended intake. Iodine supplementation is usually necessary to prevent iodine deficiency disorders (IDDs), especially in endemic areas. The community-based strategy of iodine fortification in salt has eradicated IDDs, such as endemic goiter and cretinism, in countries providing adequate measures of iodine prophylaxis over several decades in the 20th century. Iodized salt is the cornerstone of iodine prophylaxis in endemic areas, and the continuous monitoring of community iodine intake and its related clinical outcomes is essential. Despite the relevant improvement in clinical outcomes, subclinical iodine deficiency persists even in Western Europe, especially among girls and women, being an issue in certain physiological conditions, such as pregnancy and lactation, and in people consuming unbalanced vegetable-based or salt-restricted diets. Detailed strategies to implement iodine intake (supplementation) could be considered for specific population groups when iodized salt alone is insufficient to provide adequate requirements.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, 70013 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
- Correspondence:
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17
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Basile P, Guaricci AI, Piazzolla G, Volpe S, Vozza A, Benedetto M, Carella MC, Santoro D, Monitillo F, Baggiano A, Mushtaq S, Fusini L, Fazzari F, Forleo C, Ribecco N, Pontone G, Sabbà C, Ciccone MM. Improvement of Left Ventricular Global Longitudinal Strain after 6-Month Therapy with GLP-1RAs Semaglutide and Dulaglutide in Type 2 Diabetes Mellitus: A Pilot Study. J Clin Med 2023; 12:jcm12041586. [PMID: 36836121 PMCID: PMC9962489 DOI: 10.3390/jcm12041586] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 02/19/2023] Open
Abstract
(1) Background: Glucagone-Like Peptide-1 Receptor Agonists (GLP-1 RAs) (GLP-1 RAs) are incretine-based medications recommended in the treatment of type 2 Diabetes Mellitus (DM2) with atherosclerotic cardiovascular disease (ASCVD) or high or very high cardiovascular (CV) risk. However, knowledge of the direct mechanism of GLP-1 RAs on cardiac function is modest and not yet fully elucidated. Left ventricular (LV) Global Longitudinal Strain (GLS) with Speckle Tracking Echocardiography (STE) represents an innovative technique for the evaluation of myocardial contractility. (2) Methods: an observational, perspective, monocentric study was conducted in a cohort of 22 consecutive patients with DM2 and ASCVD or high/very high CV risk, enrolled between December 2019 and March 2020 and treated with GLP-1 RAs dulaglutide or semaglutide. The echocardiographic parameters of diastolic and systolic function were recorded at baseline and after six months of treatment. (3) Results: the mean age of the sample was 65 ± 10 years with a prevalence of the male sex (64%). A significant improvement in the LV GLS (mean difference: -1.4 ± 1.1%; p value < 0.001) was observed after six months of treatment with GLP-1 RAs dulaglutide or semaglutide. No relevant changes were seen in the other echocardiographic parameters. (4) Conclusions: six months of treatment with GLP-1 RAs dulaglutide or semaglutide leads to an improvement in the LV GLS in subjects with DM2 with and high/very high risk for ASCVD or with ASCVD. Further studies on larger populations and with a longer follow-up are warranted to confirm these preliminary results.
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Affiliation(s)
- Paolo Basile
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
- Correspondence:
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Sara Volpe
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Alfredo Vozza
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marina Benedetto
- Department of Economics and Finance, University of Bari—Aldo Moro, 70121 Bari, Italy
| | - Maria Cristina Carella
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
| | - Daniela Santoro
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
| | - Francesco Monitillo
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Cinzia Forleo
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
| | - Nunziata Ribecco
- Department of Economics and Finance, University of Bari—Aldo Moro, 70121 Bari, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Marco Matteo Ciccone
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy
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18
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Lisco G, Volpe S, Triggiani D, Triggiani V, Piazzolla G. When serum c-peptide measurement drives adequate diabetes mellitus diagnosis and therapy: a case report. Endocr Metab Immune Disord Drug Targets 2023; 23:1005-1009. [PMID: 36717991 DOI: 10.2174/1871530323666230130151808] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 01/12/2023] [Accepted: 01/18/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND Therapeutic targets in type 2 diabetes mellitus (T2D) are oriented towards nephron- and cardio-protection and the prescription of antihyperglycemic agents with proven renal and cardiovascular benefits are increasing over time. Failure to promptly diagnose insulinopenic diabetes may adversely affect the adequacy of treatment and have harmful consequences, including severe hyperglycemia and diabetic ketoacidosis. CASE REPORT Herein we present the case of a 57-year-old woman referred to our clinic due to poor glycemic control (HbA1c 80 mmol/mol, therapeutic target <53 mmol/mol), class III obesity (BMI 41 kg/m2; normal value <25 kg/m2), and high cardiovascular risk misdiagnosed with T2D several years before. C-peptide measurement (0.3 ng/dL; reference range 1.1 - 4.4 ng/mL) confirmed the diagnosis of an insulinopenic form of diabetes, and islet autoimmunity consequently measured (GADA 2,000 UA/mL, reference range <5 UA/mL; IA2 17.1 UA/mL, reference range <7.5 UA/mL) and defined the diagnosis of an autoimmune form of diabetes. DISCUSSION Deprescribing insulin therapy in T2D patients in favor of other antihyperglycemic medications has become a growing therapeutic opportunity to provide adequate glucose control, promote weight loss, improve insulin sensitivity, and ameliorate cardiovascular and renal outcomes. However, due to immediate problems, a blunted insulin reserve poses a significant restriction on the prescription of non-insulin agents (e.g., diabetic ketoacidosis due to gliflozins). According to our experience, the routine testing of insulin reserve provides detailed information on diabetes pathophysiology with positive implications for the appropriateness of pharmacological prescriptions. CONCLUSION As part of our routine evaluation of diabetic patients, C-peptide measurement is a valuable and inexpensive tool to reclassify diabetes types and provide more appropriate disease management.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Italy
| | - Sara Volpe
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari , Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari, Italy
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Vozza A, Porfido E, Delvino A, Custodero C, Lisco G, Triggiani V, Tortorella C, Piazzolla G. The Impact of COVID-19 Lockdown on Patients with Type 2 Diabetes Mellitus: A Brief Report. Endocr Metab Immune Disord Drug Targets 2023:EMIDDT-EPUB-128817. [PMID: 36644863 DOI: 10.2174/1871530323666230112165948] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/10/2022] [Accepted: 11/28/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND The Italian population's habits changed dramatically during the "COVID-19 lockdown" due to physical distancing and self-isolation. Moreover, medical consultations of patients with chronic diseases, such as type 2 diabetes (T2D), were suspended or postponed, unless urgent or semi-urgent, for several consecutive months. Thus, it is expected that the lockdown could have affected glucometabolic control in T2D. PURPOSE The aim of the study was to assess changes in glucometabolic control in a cohort of T2D patients before (T1) and after (T2) the COVID-19 lockdown (March-May 2020). METHODS The study was approved by the Ethics Committee of the University of Bari, and all patients provided informed written consent to participate. Medical history, complete physical examination, and laboratory assessment were conducted as real-life clinical practice. Changes in clinical and laboratory variables between T1 and T2 were calculated. RESULTS In detail, 13 patients were on metformin as monotherapy, 36 on GLP-1RA, 12 on sodium-glucose transporter 2 inhibitors (SGLT-2i), and 2 on dipeptidyl-peptidase 4 inhibitors (DPP4i). The mean age was 65.3 years (43-83). Study participants were mainly men (73%). The body weight (BW) ranged from 56 to 145 kg, and the waist circumference ranged from 88 to 146 cm. The mean HbA1c was 51.0 mmol/mol. At T2, no statistically significant changes were observed from baseline except for BW [-1.6 (-2.60 to -0.62)] and HbA1c [-2.90 (-4.69; -1.12)]. CONCLUSION We evaluated the effects of the COVID-19 lockdown on glucometabolic control in patients with background well-controlled T2D. We found that the lockdown had no adverse effects on metabolic profile regardless of background clinical characteristics and antihyperglycemic management. Despite limitations due to the nature of this study (sample size, retrospective observation, lack of data on lifestyle changes in our patients' everyday lives), T2D patients managed in our Diabetes Centers faced the lockdown-related restrictions without any detrimental consequence.
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Affiliation(s)
- Alfredo Vozza
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Erasmo Porfido
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Alessandra Delvino
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carlo Custodero
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Cosimo Tortorella
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari "Aldo Moro", School of Medicine, Policlinico, Piazza G. Cesare 11, 70124 Bari, Italy
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Fiore V, Barucca A, Barraco S, Triggiani D, Tragni D, Piazzolla G, Triggiani V, Carbotta G, Lisco G. Dyslipidemia and Cardiovascular Prevention in the Elderly: A Balance between Benefits and Risks of Statin Treatment in a Specific Population. Endocr Metab Immune Disord Drug Targets 2023; 23:1371-1379. [PMID: 37132306 DOI: 10.2174/1871530323666230428092828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Atherosclerotic Cardiovascular Diseases (CVD) are among the most relevant causes of morbidity and mortality worldwide, especially in aged people. Statins are one of the leading pharmacological interventions against atherosclerosis and are widely used to reduce the risk of occurring coronary artery diseases and related outcomes in both primary and secondary prevention. The management of chronic diseases is improved considerably over time, leading to an increase in life expectancy despite heavier comorbidity-related burdens in the elderly. AIMS The paper focused on the role of statins in the management of atherosclerosis and related burdens in elderly patients. RESULTS Statins are essential in reducing the risk of CVD in secondary and primary prevention, particularly in high-risk individuals. Guidelines encourage using specific algorithms with age-specific cutoffs to assess individual cardiovascular risk irrespective of baseline age, as the expansion of life expectancy produces favorable effects of statin treatment in those over 70. DISCUSSION Besides the estimation of baseline CV risk, a specific age-related assessment is also necessary before prescribing statin treatment in aged people focusing on frailty, potential pharmacological interactions due to polypharmacotherapy, cognitive impairment, and background chronic comorbidities, such as diabetes mellitus. Before starting statin therapy, an accurate choice of type and dose of statins is needed as potential adverse events are more prevalent with high-dose than low-to-moderatedose regimens and with lipophile than hydrophile statins (e.g., potential implication on intra-cerebral cholesterol metabolism). CONCLUSION Despite possible adverse events, elderly patients should receive statins, when appropriate, to avoid the first occurrence of recurrent cardiovascular events and related burdens.
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Affiliation(s)
| | | | - Sonia Barraco
- UOSD Diabetologia, Endocrinologia, ASL RM5, Rome, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, University of Bari, A. Moro, Bari, Italy
| | - Daniele Tragni
- Interdisciplinary Department of Medicine, University of Bari, A. Moro, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari, A. Moro, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari, A. Moro, Bari, Italy
| | | | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, University of Bari, A. Moro, Bari, Italy
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Lisco G, Triggiani D, Giagulli VA, De Pergola G, Guastamacchia E, Piazzolla G, Jirillo E, Triggiani V. Endocrine, Metabolic, and Immune Pathogenesis of Postmenopausal Osteoporosis. Is there a Therapeutic Role in Natural Products? Endocr Metab Immune Disord Drug Targets 2023; 23:1278-1290. [PMID: 37005529 DOI: 10.2174/1871530323666230330121301] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 03/01/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023]
Abstract
BACKGROUND Bone health relies on the equilibrium between resorption and new bone generation. Postmenopausal osteoporosis depends on estrogen deficiency which favorite bone resorption and elevated risk of fractures. Moreover, osteoporosis is characterized by a high release of proinflammatory cytokines suggesting the role of the immune system in the pathogenesis of this complex disease (immunoporosis). AIMS To review the pathophysiology of osteoporosis from an endocrinological and immunological viewpoint and treatments with a specific focus on nutraceuticals. METHODS PubMed/MEDLINE, Scopus, Google Scholar, and institutional web site were searched. Original articles and reviews were screened and selected by September 2022. RESULTS The activation of the Gut Microbiota-Bone Axis contributes to bone health by releasing several metabolites, including short-chain fatty acids (SCFAs), that facilitate bone mineralization directly and indirectly by the induction of T regulatory cells, triggering anti-inflammatory pathways. CONCLUSION Treatments of postmenopausal osteoporosis are based on lifestyle changes, calcium and vitamin D supplementation, and anti-resorptive and anabolic agents, such as bisphosphonates, Denosumab, Teriparatide, Romosozumab. However, phytoestrogens, polyphenols, probiotics, and polyunsaturated fatty acids may improve bone health by several mechanisms, including anti-inflammatory properties. Specific clinical trials are needed to assess the efficacy/effectiveness of the possible anti-osteoporotic activity of natural products as add on to background treatment.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Domenico Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giovanni De Pergola
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Emilio Jirillo
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari Aldo Moro, Bari, Italy
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22
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Crudele L, De Matteis C, Piccinin E, Gadaleta RM, Cariello M, Di Buduo E, Piazzolla G, Suppressa P, Berardi E, Sabbà C, Moschetta A. Low HDL-cholesterol levels predict hepatocellular carcinoma development in individuals with liver fibrosis. JHEP Rep 2022; 5:100627. [PMID: 36561127 PMCID: PMC9763866 DOI: 10.1016/j.jhepr.2022.100627] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 10/05/2022] [Accepted: 11/03/2022] [Indexed: 11/17/2022] Open
Abstract
Background & Aims Dysmetabolic conditions could drive liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), increasing susceptibility to hepatocellular carcinoma (HCC). We therefore aimed to identify novel predictive biomarkers of HCC in patients with and without liver fibrosis. Methods A total of 1,234 patients with putative metabolic conditions and NAFLD were consecutively assessed in our outpatient clinic. Clinical and biochemical data were recorded, and then liver ultrasonography was performed annually for 5 years to detect HCC onset. For the analysis, the population was first divided according to HCC diagnosis; then a further subdivision of those who did not develop HCC was performed based on the presence or absence of liver fibrosis at time 0. Results Sixteen HCC cases were recorded in 5 years. None of our patients had been diagnosed with cirrhosis before HCC was detected. Compared to patients who did not develop HCC, those who did had higher liver transaminases and fibrosis scores at time 0 (p <0.001). In addition, they presented with increased glycated haemoglobin levels and lower 25-OH vitamin D levels (p <0.05). Intriguingly, patients with higher liver fibrosis scores who subsequently developed HCC had lower HDL-cholesterol (HDL-c) levels at time 0 (p <0.001). Furthermore, in the 484 patients presenting with lower HDL-c at baseline, we found that waist circumference, and then vitamin D and glycated haemoglobin levels, were significantly different in those who developed HCC, regardless of liver fibrosis (p <0.05). Conclusions This study identifies HDL-c as a bona fide novel marker to predict HCC in patients with NAFLD. Increased waist circumference and deranged metabolic pathways represent additional predisposing factors among patients with low HDL-c, highlighting the importance of studying cholesterol metabolism and integrating clinical approaches with dietary regimens and a healthy lifestyle to prevent HCC. Impact and implications Visceral adiposity and its associated conditions, such as chronic inflammation and insulin resistance, may play a pivotal role in hepatocellular carcinoma development in patients with non-alcoholic fatty liver disease. We provide new insights on the underlying mechanisms of its pathogenesis, shedding light on the involvement of low levels of "good" HDL-cholesterol. We recommend integrating dietary regimens and advice on healthy lifestyles into the clinical management of non-alcoholic fatty liver disease, with the goal of reducing the incidence of hepatocellular carcinoma.
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Key Words
- ALP, alkaline phosphatase
- ALT, alanine aminotransferase
- APRI score
- APRI, AST-to-platelet ratio index
- AST, aspartate aminotransferase
- CVR, cardiovascular risk
- FA, fatty acid
- FIB-4, fibrosis-4
- GGT, gamma-glutamyltransferase
- HCC, hepatocellular carcinoma
- HDL-c, HDL-cholesterol
- HbA1c, glycated haemoglobin
- LXRs, liver X receptors
- MetS, metabolic syndrome
- Metabolic syndrome
- NAFLD
- NAFLD, non-alcoholic fatty liver disease
- NASH
- NASH, non-alcoholic steatohepatitis
- RCT, reverse cholesterol transport
- TG, triglyceride
- Vitamin D
- WC, waist circumference
- Waist circumference
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Affiliation(s)
- Lucilla Crudele
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo De Matteis
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy,INBB National Institute for Biostructure and Biosystems, Viale delle Medaglie d'Oro 305 - 00136 Roma, Italy
| | - Elena Piccinin
- Department of Basic Medical Science, Neurosciences and Sense organs, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Raffaella Maria Gadaleta
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marica Cariello
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Ersilia Di Buduo
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Piazzolla
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Patrizia Suppressa
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Elsa Berardi
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy,INBB National Institute for Biostructure and Biosystems, Viale delle Medaglie d'Oro 305 - 00136 Roma, Italy,Corresponding author. Address: Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy. Tel: +39 0805593262
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De Nucci S, Castellana F, Zupo R, Lampignano L, Di Chito M, Rinaldi R, Giannuzzi V, Cozzolongo R, Piazzolla G, Giannelli G, Sardone R, De Pergola G. Associations between serum biomarkers and non-alcoholic liver disease: Results of a clinical study of Mediterranean patients with obesity. Front Nutr 2022; 9:1002669. [PMID: 36159489 PMCID: PMC9493452 DOI: 10.3389/fnut.2022.1002669] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
BackgroundTransient elastography is an ultrasound-based method to detect non-alcoholic fatty liver disease (NAFLD). Despite the simultaneously rising prevalence of fatty liver and metabolic disease, further information about metabolic risk indicators of fatty liver is still necessary.MethodsA Southern Italian population sample with obesity (N = 87) was cross-sectionally explored for associations among the presence of NAFLD, assessed by FibroScan, and clinical, biochemical and anthropometric parameters. Inclusion criteria were age >18 years, BMI ≥ 25 kg/m2, no ongoing supplemental or drug therapy, including oral contraceptives or osteoporosis medications; exclusion criteria were pregnancy, endocrinological diseases, cardiovascular diseases, neoplasia, renal or hepatic failure, hereditary thrombocytopenia, hepatitis B (HBV) or hepatitis C virus (HCV) infection, and excess alcohol consumption.ResultsThe study sample featured a female predominance (67%, N = 60), age range 18–64 years, and 40% prevalence of NAFLD, in accordance with the fibroscan-measured controlled attenuation parameter (CAP) threshold value above 302 dB/m. Males were slightly more frequently affected by NAFLD (51.4% vs. 48.6%, p = 0.01). Insulin levels, insulin resistance (quantified by HOMA-IR), diastolic blood pressure, BMI, visceral adipose tissue (VAT), and waist circumference were significantly higher in the NAFLD subset compared to their counterparts (p < 0.01, p < 0.01, p = 0.05, p < 0.01, p < 0.01, p < 0.01, respectively). Uric acid (p < 0.01) also showed a positive trend in the NAFLD group. Other liver steatosis parameters, measured by stiffness (p < 0.01), fatty liver index (FLI) (p < 0.01) and FibroScan-AST (FAST) (p < 0.01), were also significantly greater in the NAFLD group. In three nested linear regression models built to assess associations between CAP values and serum uric acid levels, a single unit increase in uricemia indicated a CAP increase by 14 dB/m, after adjusting for confounders (coefficient: 14.07, 95% CI 0.6–27.54).ConclusionsClinical-metabolic screening for NAFLD cannot ignore uricemia, especially in patients with obesity.
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Affiliation(s)
- Sara De Nucci
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Fabio Castellana
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Roberta Zupo
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Luisa Lampignano
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Martina Di Chito
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Roberta Rinaldi
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Vito Giannuzzi
- Department of Gastroenterology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Raffaele Cozzolongo
- Department of Gastroenterology, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Internal Medicine Unit, University of Bari, Bari, Italy
| | - Gianluigi Giannelli
- Scientific Direction, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Rodolfo Sardone
- Unit of Data Sciences and Technology Innovation for Population Health, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
| | - Giovanni De Pergola
- Unit of Geriatrics and Internal Medicine, National Institute of Gastroenterology “Saverio de Bellis”, Research Hospital, Bari, Italy
- *Correspondence: Giovanni De Pergola
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Piazzolla G, Vozza A, Volpe S, Bergamasco A, Triggiani V, Lisco G, Falconieri M, Tortorella C, Solfrizzi V, Sabbà C. Effectiveness and clinical benefits of new anti-diabetic drugs: A real life experience. Open Med (Wars) 2022; 17:1203-1215. [PMID: 35859794 PMCID: PMC9263895 DOI: 10.1515/med-2022-0504] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 05/11/2022] [Indexed: 12/16/2022] Open
Abstract
We evaluated the clinical impact, in daily clinical practice, of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1RA) therapies in patients with type 2 diabetes. Data from 500 unselected consecutive patients were retrospectively analyzed. Only those with a full assessment at baseline (T0) and after 3 (T3), 6 (T6), and 12 (T12) months of treatment with SGLT2i or GLP1RA were included in the study (n = 167). At baseline, patients had a high mean body weight (BW), abdominal circumference (AC), body mass index (BMI), and HOMA index. Despite normal C-peptide values, 39 patients were being treated with insulin (up to 120 IU/day). During therapy, a progressive improvement in BW, BMI, and AC was observed with both the molecules. Fasting glucose and glycated Hb decrease was already significant at T3 in all patients, while the HOMA index selectively improved with SGLT2i therapy. Renal function parameters remained stable regardless of the drug used. Finally, SGLT2i reduced serum uric acid and improved the lipid profile, while GLP1RA reduced serum levels of liver enzymes. Both the therapeutic regimens allowed a significant reduction or complete suspension of unnecessary insulin therapies. Our real life data confirm the results obtained from randomized clinical trials and should be taken as a warning against inappropriate use of insulin in patients with preserved β-cell function.
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Affiliation(s)
- Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari, Piazza G. Cesare 11 , 70124 Bari , Italy
| | - Alfredo Vozza
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Sara Volpe
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Alessandro Bergamasco
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Michela Falconieri
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Cosimo Tortorella
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Vincenzo Solfrizzi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro,” School of Medicine , Bari , 70124 Bari , Italy
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Volpe S, Lisco G, Racaniello D, Fanelli M, Colaianni V, Vozza A, Triggiani V, Sabbà C, Tortorella C, De Pergola G, Piazzolla G. Once-Weekly Semaglutide Induces an Early Improvement in Body Composition in Patients with Type 2 Diabetes: A 26-Week Prospective Real-Life Study. Nutrients 2022; 14:nu14122414. [PMID: 35745144 PMCID: PMC9227575 DOI: 10.3390/nu14122414] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Body weight (BW) loss is an essential therapeutic goal in type 2 diabetes (T2D). Glucagon-like peptide-1 receptor agonists are effective in reducing BW, but their effect on body composition has not yet been fully explored. The study aim was to assess the impact of Semaglutide on body composition in patients with T2D. Methods: Forty patients with T2D were treated with subcutaneous Semaglutide and evaluated at the baseline (T0) and after three (T3) and six (T6) months. Body composition was assessed by a phase-sensitive bioimpedance analyzer. Visceral adipose tissue (VAT) thickness was also measured with an ultrasonographic method (US-VAT). Anthropometric variables, muscular strength, and laboratory tests were analyzed and compared. Results: A significant decrease in VAT, the fat mass index (FMI), and BW loss was observed at all observation times. US-VAT, the skeletal mass index (SMI), the fat-free mass index (FFMI), waist circumferences, and glycated hemoglobin had lessened after three months and remained stable at T6. No variations in muscle strength, the muscle quality index, and body water were found. Discussion: In a real-life setting, Semaglutide provided significant weight loss mainly due to a reduction in the FMI and VAT, with non-clinically relevant changes in the SMI, the FFMI, and muscle strength. Most importantly, the results were obtained after three months of treatment and persisted thereafter.
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Affiliation(s)
- Sara Volpe
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Giuseppe Lisco
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Davide Racaniello
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Margherita Fanelli
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Valentina Colaianni
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Alfredo Vozza
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Cosimo Tortorella
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
| | - Giovanni De Pergola
- Unit of Internal Medicine and Geriatrics, National Institute of Gastroenterology, “Saverio de Bellis” Research Hospital, Castellana Grotte, Via Turi 27, 70013 Bari, Italy;
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, School of Medicine, University of Bari “Aldo Moro”, Piazza Giulio Cesare 11, 70124 Bari, Italy; (S.V.); (G.L.); (D.R.); (M.F.); (V.C.); (A.V.); (V.T.); (C.S.); (C.T.)
- Correspondence:
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Lisco G, De Tullio A, Disoteo O, De Geronimo V, Piazzolla G, De Pergola G, Giagulli VA, Jirillo E, Guastamacchia E, Sabbà C, Triggiani V. Basal insulin intensification with GLP-1RA and dual GIP and GLP-1RA in patients with uncontrolled type 2 diabetes mellitus: A rapid review of randomized controlled trials and meta-analysis. Front Endocrinol (Lausanne) 2022; 13:920541. [PMID: 36157450 PMCID: PMC9494570 DOI: 10.3389/fendo.2022.920541] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Tirzepatide, a dual agonist of Glucose-Dependent Insulinotropic Polypeptide (GIP) and Glucagon-Like Peptide 1 (GLP-1) receptors, improved glucose control and reduced body weight in different therapeutic approaches. Herein, we overviewed the role of GIP and GLP-1 in the pathophysiology of type 2 diabetes and systematically reviewed the efficacy and safety of injectable incretin-based therapy added to basal insulin in light of the results of the SURPASS-5 trial. We identified eleven randomized clinical trials. GLP-1 receptor agonists (GLP-1RAs) or Tirzepatide added to basal insulin than rigorously titrated basal insulin significantly ameliorates glucose control (Δ HbA1c = -1%, 95% CI -1.25; -0.74, I2 94%; Δ FPG = -14.6 mg/dL, 95% CI -21.6-; -7.6, I2 90%; chance to achieve HbA1c <7% = RR 2.62, 95% CI 2.10; 3.26, I2 89%), reduces body weight (Δ = -3.95 kg, 95% CI -5.1, -2.79, I2 96%) without increasing the risk of hypoglycemia (RR = 1.01, 95% CI 0.86; 1.18, I2 7.7%). Tirzepatide provides an impressive weight loss exceeding that observed with GLP-1RAs. Injectable incretin-based therapy plus basal insulin remains a potent and safe therapeutic approach in uncontrolled type 2 diabetes patients previously treated with basal insulin alone. Tirzepatide is expected to ameliorate the management of "diabesity" in this usually difficult-to-treat cluster of patients.
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Affiliation(s)
- Giuseppe Lisco
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Anna De Tullio
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Olga Disoteo
- Diabetology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Giovanni De Pergola
- National Institute of Gastroenterology, Saverio de Bellis, Research Hospital, Bari, Italy
| | - Vito Angelo Giagulli
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Emilio Jirillo
- Department of Basic Medical Sciences, Neuroscience and Sensory Organs, School of Medicine, University of Bari, Bari, Italy
| | - Edoardo Guastamacchia
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
| | - Vincenzo Triggiani
- Interdisciplinary Department of Medicine, Section of Internal Medicine, Geriatrics, Endocrinology and Rare Diseases, University of Bari “Aldo Moro”, School of Medicine, Policlinico, Bari, Italy
- *Correspondence: Vincenzo Triggiani,
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Härdfeldt J, Cariello M, Simonelli S, Ossoli A, Scialpi N, Piglionica M, Pasculli E, Noia A, Berardi E, Suppressa P, Piazzolla G, Sabbà C, Calabresi L, Moschetta A. Abdominal obesity negatively influences key metrics of reverse cholesterol transport. Biochim Biophys Acta Mol Cell Biol Lipids 2021; 1867:159087. [PMID: 34813947 DOI: 10.1016/j.bbalip.2021.159087] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 12/26/2022]
Abstract
Cardiometabolic risk factors increase the risk of atherosclerotic cardiovascular disease (ASCVD), but whether these metabolic anomalies affect the anti-atherogenic function of reverse cholesterol transport (RCT) is not yet clearly known. The present study aimed to delineate if the function and maturation of high density lipoprotein (HDL) particles cross-sectionally associate with surrogate markers of ASCVD in a population comprising of different degree of cardiometabolic risk. We enrolled 131 subjects and characterized cardiometabolic risk based on the IDF criteria's for metabolic syndrome (MS). In this population, cholesterol efflux capacity (CEC), Lecithin-cholesterol acyltransferase (LCAT) and ApoA-1 glycation was associated with waist circumference, abdominal visceral fat (VFA) and abdominal subcutaneous fat. In multivariate analyses, VFA was identified as a critical contributor for low CEC and LCAT. When stratified into groups based on the presence of cardiometabolic risk factors, we found a prominent reduction in CEC and LCAT as a function of the progressive increase of cardiometabolic risk from 0-2, 0-3 to 0-4/5, whereas an increase in Pre-β-HDL and ApoA-1 glycation was observed between the lowest and highest risk groups. These findings confirm the connection between MS and its predisposing conditions to an impairment of atheroprotective efflux-promoting function of HDLs. Furthermore, we have identified the bona fide pathogenically contribution of abdominal obesity to profound alterations of key metrics of RCT.
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Affiliation(s)
- Jennifer Härdfeldt
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136 Rome, Italy; Metabolism Unit, Department of Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, S-141 86 Stockholm, Sweden
| | - Marica Cariello
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Sara Simonelli
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, via Balzaretti 9, 20133 Milano, Italy
| | - Alice Ossoli
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, via Balzaretti 9, 20133 Milano, Italy
| | - Natasha Scialpi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Marilidia Piglionica
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136 Rome, Italy
| | - Emanuela Pasculli
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Alessia Noia
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Elsa Berardi
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Patrizia Suppressa
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Giuseppina Piazzolla
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy
| | - Laura Calabresi
- Center E. Grossi Paoletti, Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, via Balzaretti 9, 20133 Milano, Italy
| | - Antonio Moschetta
- Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy; INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136 Rome, Italy; National Cancer Research Center, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy.
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De Matteis C, Cariello M, Graziano G, Battaglia S, Suppressa P, Piazzolla G, Sabbà C, Moschetta A. AST to Platelet Ratio Index (APRI) is an easy-to-use predictor score for cardiovascular risk in metabolic subjects. Sci Rep 2021; 11:14834. [PMID: 34290320 PMCID: PMC8295377 DOI: 10.1038/s41598-021-94277-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 03/16/2021] [Accepted: 07/05/2021] [Indexed: 02/06/2023] Open
Abstract
Visceral obesity is characterized by a low-grade inflammatory systemic state that contributes to the genesis of non-alcoholic fatty liver disease (NAFLD), frequently associated with liver fibrosis. Non-invasive serum markers have recently emerged as reliable, easy-to-use scores to predict liver fibrosis. NAFLD is often linked to metabolic and cardiovascular risk. Thus, in this cross-sectional study, we investigated in a population of 1225 subjects if AST to Platelet Ratio Index (APRI), one of the non-invasive liver fibrosis serum markers, can predict cardiovascular risk (CVR). APRI has been previously validated as an efficient score to predict liver fibrosis in viral hepatitis patients with a cut-off of 0.5 for fibrosis and 1.5 for cirrhosis. Our study showed that APRI significantly correlates with CVR and determines, when elevated, a significant increase in CVR for both genders, especially females. This spike in CVR, observed when APRI is elevated, is relatively high in patients in the age of 51–65 years, but it is significantly higher in younger and premenopausal women, approaching risk values usually typical of men at the same age. Taken together, our data highlighted the role of APRI as a reliable predictor easy-to-use score for CVR in metabolic patients.
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Affiliation(s)
- Carlo De Matteis
- INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136, Rome, Italy
| | - Marica Cariello
- INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136, Rome, Italy
| | - Giusi Graziano
- INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136, Rome, Italy
| | - Stefano Battaglia
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.,Depatment of Tissues and Organs Transplantation and Cellular Therapies, "Aldo Moro" University of Bari, Bari, Italy
| | - Patrizia Suppressa
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Giuseppina Piazzolla
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Carlo Sabbà
- Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy
| | - Antonio Moschetta
- INBB, National Institute for Biostructures and Biosystems, Viale delle Medaglie d'Oro 305, 00136, Rome, Italy. .,Clinica Medica "Cesare Frugoni", Department of Interdisciplinary Medicine, Aldo Moro University of Bari, Piazza Giulio Cesare 11, 70124, Bari, Italy.
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Angelini G, Albanese M, Ursi R, Lisi F, Bellino MC, Amato L, Gioia MI, Parisi G, Brunetti ND, Piazzolla G, Ciccone MM, Iacoviello M. Eligibility of outpatients with chronic heart failure for sodium-glucose co-transporter-2 inhibitors. ESC Heart Fail 2021; 8:2951-2958. [PMID: 33991178 PMCID: PMC8318395 DOI: 10.1002/ehf2.13380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/04/2021] [Accepted: 04/09/2021] [Indexed: 01/10/2023] Open
Abstract
Aims Sodium–glucose co‐transporter‐2 inhibitors (SGLT2i) have been shown to have a relevant role in the prevention of hospitalizations for heart failure and improvement in the life expectancy of patients with diabetes and outpatients with chronic heart failure (CHF) with reduced left ventricular ejection fraction, independently from the presence of type 2 diabetes mellitus (T2DM). The aim of our study was to evaluate in a real‐world population the number of outpatients with CHF who meet the enrolment criteria of the main randomized controlled trials (RCT) published in the last 5 years and consequently identify the percentage of patients who could potential benefit from SGLT2i therapy. Methods and results We retrospectively evaluated all consecutive outpatients referred for CHF. The diagnosis of T2DM was according to the latest European Society of Cardiology Guidelines. Clinical characteristics considered for the enrolment in the RCTs were recorded. We enrolled 515 patients, 384 (75%) of whom had a left ventricular ejection fraction (LVEF) ≤ 40%, 82 (16%) had pre‐diabetes, and 187 (36%) had diabetes. Most of the patients with LVEF ≤ 40% met the criteria for the DAPA‐HF trial (65%), and this percentage was even higher if the serum level of N‐terminal pro‐brain natriuretic peptide was not considered. A high percentage of patients with diabetes and LVEF > 40% met the criteria for the DECLARE (39%), CANVAS (47%), and EMPA‐REG (30%) trials. Patients meeting the enrolment criteria of RCTs evaluating SGLT2i were also characterized by a high risk of heart failure events during follow‐up. Conclusions In spite of a low number of patients actually treated with SGLT2i, we observed that a high prevalence of patients with CHF met the clinical characteristics of RCTs that have demonstrated a beneficial effect of SGLT2i.
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Affiliation(s)
- Gianmarco Angelini
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Miriam Albanese
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Raffaella Ursi
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Francesco Lisi
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | | | - Luca Amato
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | | | - Giuseppe Parisi
- Cardiology Department, Local Health Service of Bari, Bari, Italy
| | - Natale Daniele Brunetti
- Department of Medical and Surgical Science, University of Foggia, Viale Luigi Pinto 1, Foggia, 71122, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, Internal Medicine Unit, University of Bari, Bari, 70124, Italy
| | - Marco Matteo Ciccone
- School of Cardiology, University of Bari, Piazza Giulio Cesare 11, Bari, 70124, Italy
| | - Massimo Iacoviello
- Department of Medical and Surgical Science, University of Foggia, Viale Luigi Pinto 1, Foggia, 71122, Italy
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Volpe S, Tortorella C, Solfrizzi V, Piazzolla G. When Inappropriate Use of Insulin is Dangerous: The Utility of C-Peptide Assay in the Era of Cardioprotective Antidiabetic Drugs. Diabetes Metab Syndr Obes 2021; 14:3517-3521. [PMID: 34385826 PMCID: PMC8352573 DOI: 10.2147/dmso.s321340] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 06/26/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION New antidiabetic drugs have simplified treatment regimens in patients with type-2 diabetes (T2D). More importantly, they have proven to reduce cardiovascular risk by lowering insulin-resistance, blood pressure and body weight, in addition to avoiding inappropriate insulin therapy, responsible for hypoglycemic episodes and weight gain. In this context, accurate assessment of the metabolic status of T2D patients becomes essential. The C-peptide assay is a simple but often overlooked test that can provide a fundamental contribution to the correct disease classification and optimal therapeutic management of diabetic patients. CLINICAL CASE We report the case of a 72-year-old patient, treated with insulin for 26 years after a diagnosis of type-1 diabetes (T1D), resulting in inadequate glycemia control and a severe evolution of cardiovascular complications. After an accurate evaluation of the clinical history, phenotype and laboratory data, including the determination of C-peptide serum levels, a diagnosis was made of T2D not T1D. Considering the patient's very high cardiovascular risk and dysmetabolic profile, insulin therapy was discontinued and more appropriate therapy with dulaglutide and metformin was instituted. These overall therapeutic modifications yielded remarkable clinical advantages in terms of the glycometabolic profile, weight reduction, abdominal circumference and body mass index decrease, as well as a better quality of life, with complete resolution of the dangerous hypoglycemic episodes. CONCLUSION In the era of new cardioprotective antidiabetic drugs, we believe the importance of the C-peptide assay should be re-evaluated in order to avoid misdiagnosis and to improve the therapeutic approach to T2D.
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Affiliation(s)
- Sara Volpe
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, Italy
| | - Cosimo Tortorella
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, Italy
| | - Vincenzo Solfrizzi
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, Italy
| | - Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Bari, 70124, Italy
- Correspondence: Giuseppina Piazzolla Interdisciplinary Department of Medicine, University of Bari “Aldo Moro” Medical School, Policlinico, Piazza G. Cesare 11, Bari, 70124, ItalyFax +39 080 5478126 Email
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Solfrizzi V, Scafato E, Custodero C, Loparco F, Ciavarella A, Panza F, Seripa D, Imbimbo BP, Lozupone M, Napoli N, Piazzolla G, Galluzzo L, Gandin C, Baldereschi M, Di Carlo A, Inzitari D, Pilotto A, Sabbà C. Liver fibrosis score, physical frailty, and the risk of dementia in older adults: The Italian Longitudinal Study on Aging. Alzheimers Dement (N Y) 2020; 6:e12065. [PMID: 32864415 PMCID: PMC7443742 DOI: 10.1002/trc2.12065] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/14/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Liver fibrosis increases progressively with aging and has been associated with poorer cognitive performance in middle-aged and older adults. We investigated the relationships between a non-invasive score for advanced liver fibrosis (non-alcoholic fatty liver disease [NAFLD] fibrosis score [NFS]) and dementia risk. We also assessed physical frailty, a common geriatric condition which is associated to dementia. We tested the joint effects of physical frailty and fibrosis on dementia incidence. METHODS A total of 1061 older adults (65 to 84 years), from the Italian Longitudinal Study on Aging, were prospectively evaluated for the risk of dementia in a period between 1992 and 2001. Liver fibrosis was defined according to the NFS. Physical frailty was assessed according to the Fried's criteria. Cox proportional hazards models were used to estimate the short- and long-term risk of overall dementia, associated to the NFS, testing the effect modifier of physical frailty status. RESULTS Older adults with only high NFS (F3-F4) did not exhibit a significant increased risk of overall dementia. Over 8 years of follow-up, frail older adults with high NFS had an increased risk of overall dementia (hazard ratio [HR]: 4.23; 95% confidence interval [CI]: 1.22 to 14.70, P = .023). Finally, physically frail older adults with low albumin serum levels (albumin < 4.3 g/dL) and with advanced liver fibrosis (F3-F4 NFS) compared to those with lower liver fibrosis score (F0-F2 NFS) were more likely to have a higher risk of overall dementia in a long term-period (HR: 16.42; 95% CI: 1.44 to 187.67, P = .024). DISCUSSION Advanced liver fibrosis (F3-F4 NFS) could be a long-term predictor for overall dementia in people with physical frailty. These findings should encourage a typical geriatric, multidisciplinary assessment which accounts also for the possible co-presence of frail condition in older adults with chronic liver disease and liver fibrosis.
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Affiliation(s)
- Vincenzo Solfrizzi
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Emanuele Scafato
- Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS)Istituto Superiore di Sanità (ISS)RomaItaly
- Department of Cardiovascular, Dysmetabolic and Ageing‐Associated DiseasesIstituto Superiore di Sanità (ISS)RomaItaly
| | - Carlo Custodero
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Francesca Loparco
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Alessandro Ciavarella
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Francesco Panza
- Geriatric UnitFondazione IRCCS “Casa Sollievo della Sofferenza”FoggiaItaly
- National Institute of Gastroenterology “Saverio de Bellis”Research HospitalBariItaly
| | - Davide Seripa
- Geriatric UnitFondazione IRCCS “Casa Sollievo della Sofferenza”FoggiaItaly
- Hematology and Stem Cell Transplant UnitVito Fazzi HospitalLecceItaly
| | | | - Madia Lozupone
- Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense OrgansUniversity of Bari Aldo MoroBariItaly
| | - Nicola Napoli
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Giuseppina Piazzolla
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
| | - Lucia Galluzzo
- Department of Cardiovascular, Dysmetabolic and Ageing‐Associated DiseasesIstituto Superiore di Sanità (ISS)RomaItaly
| | - Claudia Gandin
- Population Health and Health Determinants Unit, National Centre for Epidemiology, Surveillance and Health Promotion (CNESPS)Istituto Superiore di Sanità (ISS)RomaItaly
| | - Marzia Baldereschi
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
| | - Antonio Di Carlo
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
| | - Domenico Inzitari
- Institute of NeuroscienceItalian National Research Council (CNR)FirenzeItaly
- Department of NEUROFARBA, Neuroscience SectionUniversity of FlorenceFirenzeItaly
| | - Alberto Pilotto
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
- Geriatrics Unit, Department of Geriatric CareOrthogeriatrics and RehabilitationGenovaItaly
| | - Carlo Sabbà
- Clinica Medica “Frugoni” and Geriatric Medicine‐Memory UnitUniversity of Bari Aldo MoroBariItaly
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Piazzolla G, Candigliota M, Fanelli M, Castrovilli A, Berardi E, Antonica G, Battaglia S, Solfrizzi V, Sabbà C, Tortorella C. Hyperhomocysteinemia is an independent risk factor of atherosclerosis in patients with metabolic syndrome. Diabetol Metab Syndr 2019; 11:87. [PMID: 31673296 PMCID: PMC6815401 DOI: 10.1186/s13098-019-0484-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 10/15/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) is a clinical condition potentially promoting the development of atherosclerotic disease. To date, the clinical impact of elevated serum homocysteine (Hcy) levels in MetS is still under discussion. The aim of this cross sectional study was to evaluate the relationship between MetS and hyperhomocysteinemia and the potential role of Hcy in the pathogenesis of atherosclerotic complications of MetS. METHODS We recruited 300 outpatients with MetS. All patients underwent a medical history collection, physical examination, blood sampling and carotid ultrasound echo-color Doppler. According to Hcy levels, MetS patients were divided into two groups: "normal" (< 10.7 μmol/l; n = 140, group 1) and "high" Hcy (≥ 10.7 μmol/l; n = 160, group 2). Comparisons between groups were made by Student's t-test or Chi-square test. The effects of potential covariates on group differences were evaluated by general linear models. The relationships between continuous variables were assessed by simple or multiple correlation and by linear regression. Multiple regression models were built to evaluate the effects of Hcy, together with other potential risk factors, on carotid atherosclerosis. RESULTS Patients with high Hcy were predominantly male and slightly older than group 1 patients. Smokers and non-smokers exhibited similar Hcy levels, nor was a statistical relationship between pack-years and Hcy observed. Group 2 showed lower levels of folic acid, vitamin D, high density lipoprotein (HDL)-cholesterol and glomerular filtration rate (e-GFR) than group 1, but higher levels of C-peptide, uric acid and triglycerides. In all patients, Hcy was positively correlated with C-peptide and uric acid and negatively with folic acid and e-GFR. Intima-media thickness (IMT) and carotid stenosis degree were significantly higher in patients with high Hcy and a positive relationship between Hcy and both IMT and carotid stenosis was detected in all patients. Finally, Hcy atherogenic effects were independent of other well-known atherosclerosis risk factors. CONCLUSIONS Our results highlight a link between MetS and hyperhomocysteinemia and a direct effect of Hcy on atherogenic process during MetS. Early correction of folic acid levels may contribute to prevent cardiovascular complications in MetS patients.
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Affiliation(s)
- Giuseppina Piazzolla
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Mafalda Candigliota
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Margherita Fanelli
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Anna Castrovilli
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Elsa Berardi
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Gianfranco Antonica
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Stefano Battaglia
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Vincenzo Solfrizzi
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Carlo Sabbà
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
| | - Cosimo Tortorella
- Interdisciplinary Department of Medicine, University of Bari School of Medicine, Piazza G. Cesare 11, 70124 Bari, Italy
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Carabellese F, Felthous AR, La Tegola D, Piazzolla G, Distaso S, Logroscino G, Leo A, Ventriglio A, Catanesi R. Qualitative analysis of the capacity to consent to treatment in patients with a chronic neurodegenerative disease: Alzheimer's disease / Analisi qualitativa sulla capacità a prestare consenso al trattamento in pazienti con malattie cronico degenerative neuropsicoorganiche: Demenza di Alzheimer. Int J Soc Psychiatry 2018; 64:26-36. [PMID: 29183264 DOI: 10.1177/0020764017739642] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Informed consent is an essential element in doctor-patient relationship. In particular, obtaining valid informed consent from patients with neurocognitive diseases is a critical issue at present. For this reason, we decided to conduct research on elderly patients with Alzheimer's disease ( Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to assess their capacity to make treatment decisions. METHODS The experimental group comprised 70 Alzheimer patients who were admitted to the Neurodegenerative Disease Unit of the University of Bari. The control group consisted of 83 elderly patients without neurocognitive disorders who were hospitalized in the Geriatric Unit at the same university. After providing written consent to participate in the research, each subject underwent the following assessments: (a) assessment of comprehension sheet, (b) Neuropsychiatric Inventory (NPI) and Global Functioning Evaluation (GFE), (c) neurological evaluation, (d) neuropsychological assessment with a full battery of tests, (d) The MacArthur Treatment Competence Study (MacArthur Competence Assessment Tool for Treatment (MacCAT-T); understanding, appreciating, reasoning and expressing a choice) and (e) a semi-structured interview administered by the patient's caregiver. RESULTS/CONCLUSION The present survey was designed to analyze possible qualitative and quantitative correlations between cognitive functioning and capacity to consent in relation to different degrees of severity of the neurodegenerative disorder. A large portion of the patients in our experimental sample did not appear to have the capacity to provide a valid consent. The authors present initial results of this study and discuss their possible implications.
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Affiliation(s)
- Felice Carabellese
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | - Alan R Felthous
- 2 Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Donatella La Tegola
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | | | - Salvatore Distaso
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
| | - Giancarlo Logroscino
- 4 Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Leo
- 4 Neurodegenerative Disease Unit, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, Bari, Italy
| | - Antonio Ventriglio
- 5 Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Roberto Catanesi
- 1 Section of Criminology and Forensic Psychiatry, University of Bari, Bari, Italy
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Lancioni GE, O'Reilly MF, Singh NN, Oliva D, Piazzolla G, Groeneweg J. Assessing Influence of Stimulation on Mood and Aberrant Behavior of Persons with Multiple Disabilities during Brief Treadmill Sessions. Percept Mot Skills 2016; 99:931-6. [PMID: 15648490 DOI: 10.2466/pms.99.3.931-936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed the influence of favorite stimuli on indices of happiness, e.g., smiling or excited vocalizations, and aberrant behavior, e.g., cantilena-like vocalizations or hand waving, of two young adults with multiple disabilities during 5-min. treadmill sessions. Several favorite stimuli, e.g., music and vibratory events, were available for the participants. The stimuli were presented in a rotation fashion during the sessions. To control for the effects of the stimuli, treadmill sessions without stimuli were also conducted. Analysis showed that the treadmill sessions with stimuli led to higher indices of happiness and lower aberrant behavior for both participants, compared to the treadmill sessions without stimuli.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Bari, Italy.
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Aboul-Ata AAE, Vitti A, Nuzzaci M, El-Attar AK, Piazzolla G, Tortorella C, Harandi AM, Olson O, Wright SA, Piazzolla P. Plant-based vaccines: novel and low-cost possible route for Mediterranean innovative vaccination strategies. Adv Virus Res 2014; 89:1-37. [PMID: 24751193 DOI: 10.1016/b978-0-12-800172-1.00001-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
A plant bioreactor has enormous capability as a system that supports many biological activities, that is, production of plant bodies, virus-like particles (VLPs), and vaccines. Foreign gene expression is an efficient mechanism for getting protein vaccines against different human viral and nonviral diseases. Plants make it easy to deal with safe, inexpensive, and provide trouble-free storage. The broad spectrum of safe gene promoters is being used to avoid risk assessments. Engineered virus-based vectors have no side effect. The process can be manipulated as follows: (a) retrieve and select gene encoding, use an antigenic protein from GenBank and/or from a viral-genome sequence, (b) design and construct hybrid-virus vectors (viral vector with a gene of interest) eventually flanked by plant-specific genetic regulatory elements for constitutive expression for obtaining chimeric virus, (c) gene transformation and/or transfection, for transient expression, into a plant-host model, that is, tobacco, to get protocols processed positively, and then moving into edible host plants, (d) confirmation of protein expression by bioassay, PCR-associated tests (RT-PCR), Northern and Western blotting analysis, and serological assay (ELISA), (e) expression for adjuvant recombinant protein seeking better antigenicity, (f) extraction and purification of expressed protein for identification and dosing, (g) antigenicity capability evaluated using parental or oral delivery in animal models (mice and/or rabbit immunization), and (h) growing of construct-treated edible crops in protective green houses. Some successful cases of heterologous gene-expressed protein, as edible vaccine, are being discussed, that is, hepatitis C virus (HCV). R9 mimotope, also named hypervariable region 1 (HVR1), was derived from the HVR1 of HCV. It was used as a potential neutralizing epitope of HCV. The mimotope was expressed using cucumber mosaic virus coat protein (CP), alfalfa mosaic virus CP P3/RNA3, and tobacco mosaic virus (TMV) CP-tobacco mild green mosaic virus (TMGMV) CP as expression vectors into tobacco plants. Expressed recombinant protein has not only been confirmed as a therapeutic but also as a diagnostic tool. Herpes simplex virus 2 (HSV-2), HSV-2 gD, and HSV-2 VP16 subunits were transfected into tobacco plants, using TMV CP-TMGMV CP expression vectors.
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Affiliation(s)
- Aboul-Ata E Aboul-Ata
- Molecular Biology Laboratory II, Plant Virus and Phytoplasma Research Department, Plant Pathology Research Institute, ARC, Giza, Egypt.
| | - Antonella Vitti
- School of Agricultural, Forestry, Food and Environmental Sciences, University of Basilicata, Potenza, Italy
| | - Maria Nuzzaci
- School of Agricultural, Forestry, Food and Environmental Sciences, University of Basilicata, Potenza, Italy
| | - Ahmad K El-Attar
- Molecular Biology Laboratory II, Plant Virus and Phytoplasma Research Department, Plant Pathology Research Institute, ARC, Giza, Egypt
| | - Giuseppina Piazzolla
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Allergology and Immunology, University of Bari, Bari, Italy
| | - Cosimo Tortorella
- Department of Emergency and Organ Transplantation, Section of Internal Medicine, Allergology and Immunology, University of Bari, Bari, Italy
| | - Ali M Harandi
- Department of Microbiology and Immunology, Institute of Biomedicine, University of Gothenburg, Gothenburg, Sweden
| | - Olof Olson
- Department of Pure and Applied Biochemistry, Lund University, Lund, Sweden
| | - Sandra A Wright
- Department of Electronics, Mathematics and Natural Sciences, University of Gävle, Gävle, Sweden
| | - Pasquale Piazzolla
- School of Agricultural, Forestry, Food and Environmental Sciences, University of Basilicata, Potenza, Italy
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Tortorella C, Piazzolla G, Matteo M, Pinto V, Tinelli R, Sabbà C, Fanelli M, Cicinelli E. Interleukin-6, interleukin-1β, and tumor necrosis factor α in menstrual effluents as biomarkers of chronic endometritis. Fertil Steril 2014; 101:242-7. [DOI: 10.1016/j.fertnstert.2013.09.041] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Revised: 09/09/2013] [Accepted: 09/29/2013] [Indexed: 01/12/2023]
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Piazzolla G, Nuzzaci M, Vitti A, Napoli N, Schiavone M, Piazzolla P, Antonaci S, Tortorella C. Apoptotic effects of a chimeric plant virus carrying a mimotope of the hepatitis C virus hypervariable region 1: role of caspases and endoplasmic reticulum-stress. J Clin Immunol 2012; 32:866-76. [PMID: 22392048 PMCID: PMC3389245 DOI: 10.1007/s10875-012-9676-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 02/20/2012] [Indexed: 12/03/2022]
Abstract
The role of apoptosis in the persistence of hepatitis C virus (HCV) infection is controversial. Moreover, conflicting data on the modulation of this process by HCV proteins have been provided. We evaluated the susceptibility of peripheral lymphocytes from patients with chronic hepatitis C to apoptosis both spontaneous and after incubation with a chimeric Cucumber mosaic virus (CMV) carrying 180 copies of the synthetic R9 mimotope obtained from more than 200 hypervariable region-1 sequences of HCV. Resting T lymphocytes were found to be sensitized to apoptosis as a result of chronic HCV infection. The plant virus-derived vector R9-CMV displayed a strong pro-apoptotic effect associated with activation of both caspase-8 and −9, indicating the involvement of both extrinsic and intrinsic apoptotic pathways. A parallel R9-CMV-mediated activation of endoplasmic reticulum-stress was suggested by the significant induction of BiP/GRP78, GADD153 and caspase-12. These data contribute to define the complex HCV/host interaction, and open new prospects for developing a plant-derived antigen-presenting system to strengthen host defences against persistent pathogens.
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Affiliation(s)
- G Piazzolla
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari, 70124, Bari, Italy.
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Vitti A, Piazzolla G, Condelli V, Nuzzaci M, Lanorte MT, Boscia D, De Stradis A, Antonaci S, Piazzolla P, Tortorella C. Cucumber mosaic virus as the expression system for a potential vaccine against Alzheimer's disease. J Virol Methods 2010; 169:332-40. [PMID: 20691733 DOI: 10.1016/j.jviromet.2010.07.039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 07/28/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
Abstract
A primary therapeutic goal in Alzheimer's disease (AD) is to reduce the quantity of amyloid β protein (Aβ) present in the brain. To develop an effective, safe system for vaccination against Alzheimer's disease, the plant virus Cucumber mosaic virus (CMV) was engineered genetically to express Aβ-derived fragments that stimulate mainly humoral immune responses. Six chimeric constructs, bearing the Aβ1-15 or the Aβ4-15 sequence in positions 248, 392 or 529 of the CMV coat protein (CP) gene, were created. Viral products proved to be able to replicate in their natural host. However, only chimeric Aβ1-15-CMVs were detected by Aβ1-42 antiserum in Western blot analysis. Experimental evidence of Immunoelectron microscopy revealed a complete decoration of Aβ1-15-CMV(248) and Aβ1-15-CMV(392) following incubation with either anti-Aβ1-15 or anti-Aβ1-42 polyclonal antibodies. These two chimeric CMVs appear to be endowed with features making them possible candidates for vaccination against Alzheimer's disease.
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Affiliation(s)
- A Vitti
- Department of Biology, Plant Protection and Agrobiotechnology, University of Basilicata, Viale dell'Ateneo Lucano, 10, 85100 Potenza, Italy
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Tortorella C, Loria MP, Piazzolla G, Schulze-Koops H, Lipsky PE, Jirillo E, Antonaci S. Age-related impairment of T cell proliferative responses related to the decline of CD28+ T cell subsets. Arch Gerontol Geriatr 2009; 26:55-70. [PMID: 18653126 DOI: 10.1016/s0167-4943(97)00033-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/1997] [Revised: 08/05/1997] [Accepted: 08/08/1997] [Indexed: 10/16/2022]
Abstract
The impairment of phytohaemagglutinin-triggered lymphocyte proliferation represents a prominent immunologic abnormality in elderly individuals. To assess whether the reduced function is related to a CD28/B7 signalling deficiency, purified T lymphocytes and antigen presenting cells (APCs) were analyzed for their phenotypic profile and/or functional capacities. T cell responses to immobilized OKT3 monoclonal antibodies (mAb) or a combination of anti-CD2 mAb and phorbol esters were unaffected in old subjects when compared to the younger counterpart. In contrast, CD28 costimulation in the presence of OKT3 or anti-CD2 mAb, gave rise to significantly diminished T cell proliferative responses. These findings correlated with a marked decline of CD28(+) T cell frequency, which mainly involved the CD4(-)CD45RO(-) cell subset. The defect in CD28 expression could not be reversed by T cell stimulation, as a comparable increase in CD28 levels occurred in both 'aged' and 'young' T cells after in vitro activation. Moreover, the elderly group did not exhibit a reduction of interleukin (IL)-2 synthesis, as assessed at 24 h of culture, regardless of the stimulant used. Finally, B7.2 (CD86) expression by 'aged' CD14(+) APCs was unaffected in both resting and interferon-gamma activated cells. These results suggest that an intrinsic defect in CD28 expression might in part account for the age-related decline of T cell proliferative responses.
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Affiliation(s)
- C Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Policlinico, 70124 Bari, Italy.
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Tortorella C, Simone O, Piazzolla G, Stella I, Antonaci S. Age-related impairment of GM-CSF-induced signalling in neutrophils: role of SHP-1 and SOCS proteins. Ageing Res Rev 2007; 6:81-93. [PMID: 17142110 DOI: 10.1016/j.arr.2006.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 10/20/2006] [Accepted: 10/28/2006] [Indexed: 11/23/2022]
Abstract
Functional activities of mature human neutrophils are strongly influenced by the pro-inflammatory cytokine granulocyte macrophage-colony stimulating factor (GM-CSF). Accordingly, a defective response to GM-CSF might have dramatic consequences for neutrophil functions and the host defence against infections. Such an event is most likely to occur in senescence. A number of studies have, in fact, reported an impairment of the GM-CSF capacity to prime and/or to activate respiratory burst, as well as to delay apoptotic events, in neutrophils from elderly individuals. In the last 2 decades many efforts have been made to explore at molecular levels the mechanism underlying these defects. Recent studies let us depict a scenario in which an increased activity of inhibitory molecules, such as Src homology domain-containing protein tyrosine phosphatase-1 (SHP-1) and suppressors of cytokine signalling (SOCS), is responsible for the age-related failure of GM-CSF to stimulate neutrophil functions via inhibition of Lyn-, phosphoinositide 3-kinase (PI3-K)/extracellular signal-regulated kinase (ERK)- and signal transducers and activators of transcription (STAT)-dependent pathways. The control of SHP-1 and/or SOCS activity might therefore be an important therapeutic target for the restoration of normal immune responses during senescence.
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Affiliation(s)
- Cosimo Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Policlinico, 70124 Bari, Italy.
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Tortorella C, Simone O, Piazzolla G, Stella I, Cappiello V, Antonaci S. Role of phosphoinositide 3-kinase and extracellular signal-regulated kinase pathways in granulocyte macrophage-colony-stimulating factor failure to delay fas-induced neutrophil apoptosis in elderly humans. J Gerontol A Biol Sci Med Sci 2007; 61:1111-8. [PMID: 17167151 DOI: 10.1093/gerona/61.11.1111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Fas-stimulated neutrophils from elderly individuals show impaired granulocyte macrophage-colony-stimulating factor (GM-CSF)-induced apoptosis cell rescue. Herein, this defect was found to be associated with a significant reduction in GM-CSF-mediated Akt and extracellular signal-regulated kinase 1/2 (ERK1/2) phosphorylation. Using Akt and ERK1/2 inhibitors, we demonstrated that both kinases were critical for GM-CSF antiapoptotic effects. Whereas Akt inhibition also affected GM-CSF-dependent ERK1/2 phosphorylation, ERK1/2 inhibition did not affect GM-CSF-induced Akt phosphorylation, suggesting that phosphoinositide 3-kinase (PI3-K)/Akt and ERK1/2 are activated in series and that PI3-K is located upstream of ERK1/2 along the GM-CSF-dependent signaling pathway. No age-associated changes in GM-CSF receptor expression were observed. Interestingly, both suppressors of cytokine signaling (SOCS)1 and SOCS3 proteins were significantly higher in unstimulated neutrophils from elderly individuals and, unlike in young individuals, did not further increase following GM-CSF cell triggering. These results indicate that defective PI3-K/Akt/ERK1/2 activation, likely dependent on elevated SOCS1 and SOCS3 levels, may affect the GM-CSF capacity to delay neutrophil apoptosis in elderly persons.
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Affiliation(s)
- Cosimo Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, Policlinico, 70124 Bari, Italy.
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Nuzzaci M, Piazzolla G, Vitti A, Lapelosa M, Tortorella C, Stella I, Natilla A, Antonaci S, Piazzolla P. Cucumber mosaic virus as a presentation system for a double hepatitis C virus-derived epitope. Arch Virol 2007; 152:915-28. [PMID: 17238010 DOI: 10.1007/s00705-006-0916-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Accepted: 11/30/2006] [Indexed: 11/26/2022]
Abstract
Chimeric plant viruses are emerging as promising vectors for use in innovative vaccination strategies. In this context, cucumber mosaic virus (CMV) has proven to be a suitable carrier of the hepatitis C virus (HCV)-derived R9 mimotope. In the present work, a new chimeric CMV, expressing on its surface the HCV-derived R10 mimotope, was produced but lost the insert after the first passage on tobacco. A comparative analysis between R10- and R9-CMV properties indicated that R9-CMV stability was related to structural features typical of the foreign insert. Thus, in order to combine high virus viability with strong immuno-stimulating activity, we doubled R9 copies on each of the 180 coat protein (CP) subunits of CMV. One of the chimeras produced by this approach (2R9-CMV) was shown to systemically infect the host, stably maintaining both inserts. Notably, it was strongly recognized by sera of HCV-infected patients and, as compared with R9-CMV, displayed an enhanced ability to stimulate lymphocyte IFN-gamma production. The high immunogen levels achievable in plants or fruits infected with 2R9-CMV suggest that this chimeric form of CMV may be useful in the development of oral vaccines against HCV.
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Affiliation(s)
- M Nuzzaci
- Department of Biology, Plant Protection and Agrobiotechnology, University of Basilicata, Potenza, Italy
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43
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Lancioni GE, O'Reilly MF, Singh NN, Oliva D, Piazzolla G, Gatto L, Smaldone A. Multiple microswitches for persons with multiple disabilities: a basic procedure to examine the persons' choice behavior. Percept Mot Skills 2006; 102:13-6. [PMID: 16671591 DOI: 10.2466/pms.102.1.13-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined a basic choice-analysis procedure to clarify choice between two responses and related stimuli by five persons with multiple disabilities ages 17.1 to 50.2 yr. The procedure was based on reversing the links between responses and stimuli to assess whether the stimuli accounted for differences in response levels. When this was not the case, the procedure added extra stimuli for the less preferred response to judge whether such an increase would compensate for the apparent disadvantage of that response, e.g., its higher physical cost. Analysis showed that the choice of three of the five participants seemed motivated by the stimuli following the responses. The choice of the other two persons seemed related to a preference for one of the responses which was partially or largely modified when extra stimuli were added.
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Affiliation(s)
- G E Lancioni
- Department of Psychology, University of Bari, Via Quintino Sella 268, 70100 Bari, Italy.
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Tortorella C, Stella I, Piazzolla G, Cappiello V, Simone O, Pisconti A, Antonaci S. Impaired interleukin-12-dependent T-cell functions during aging: role of signal transducer and activator of transcription 4 (STAT4) and suppressor of cytokine signaling 3 (SOCS3). J Gerontol A Biol Sci Med Sci 2006; 61:125-35. [PMID: 16510856 DOI: 10.1093/gerona/61.2.125] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Interleukin (IL)-12 is the major inducer of T helper cell (Th) 1-type responses. Despite a higher IL-12 production, phytohemagglutinin (PHA)-stimulated peripheral blood mononuclear cells (PBMC), as well as CD4(+) or CD8(+) T cells from elderly donors released interferon (IFN)-gamma amounts similar to those observed in young controls, and underwent only a slight increase in IFN-gamma production after IL-12 costimulation. These findings were not due to an age-related reduction in IL-12 receptor expression. Interestingly, no difference in PHA-triggered signal transducer and activator of transcription 4 (STAT4) phosphorylation between young and elderly donors was found, and a significant IL-12-induced STAT4 activation occurred only in PHA-preactivated cells from the younger group. The age-related defect in IL-12 signaling was STAT4-restricted as it did not involve the p38 mitogen-activated protein kinase (MAPK) pathway. Finally, suppressor of cytokine signaling 3 (SOCS3) expression was significantly higher in unstimulated cells from elderly individuals, and it did not diminish after cell stimulation. These results indicate that a defective STAT4 activation, likely dependent on elevated SOCS3 levels, is involved in the impaired IL-12-dependent T-cell functions with aging.
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Affiliation(s)
- Cosimo Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari Medical School, Policlinico, 70124 Bari, Italy.
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Piazzolla G, Nuzzaci M, Tortorella C, Panella E, Natilla A, Boscia D, De Stradis A, Piazzolla P, Antonaci S. Immunogenic Properties of a Chimeric Plant Virus Expressing a Hepatitis C Virus (HCV)-Derived Epitope: New Prospects for an HCV Vaccine. J Clin Immunol 2005; 25:142-52. [PMID: 15821891 DOI: 10.1007/s10875-005-2820-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2004] [Indexed: 01/09/2023]
Abstract
A vaccine against Hepatitis C virus (HCV) is urgently needed due to the unsatisfactory clinical response to current therapies. We evaluated the immunological properties of a chimeric Cucumber mosaic virus (CMV), a plant virus engineered to express on its surface a synthetic peptide derived from many HVR1 sequences of the HCV envelope protein E2 (R9 mimotope). Evidence was obtained that the chimeric R9-CMV elicits a specific humoral response in rabbits. Furthermore, in patients with chronic HCV infection, purified preparations of R9-CMV down-modulated the lymphocyte surface density of CD3 and CD8, and induced a significant release of interferon (IFN)-gamma, interleukin (IL)-12 p70 and IL-15 by lymphomonocyte cultures. Finally, an R9 mimotope-specific CD8 T-cell response, as assessed by intracellular IFN-gamma production, was achieved in the majority of the patients studied. Our results open up new prospects for the development of effective vaccines against HCV infection. Moreover, the wide edible host range of CMV makes the production of an edible vaccine conceivable.
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Affiliation(s)
- G Piazzolla
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari, Policlinico, 70124 Bari, Italy.
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46
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Tortorella C, Stella I, Piazzolla G, Simone O, Cappiello V, Antonaci S. Role of defective ERK phosphorylation in the impaired GM-CSF-induced oxidative response of neutrophils in elderly humans. Mech Ageing Dev 2004; 125:539-46. [PMID: 15336911 DOI: 10.1016/j.mad.2004.06.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 06/07/2004] [Indexed: 11/18/2022]
Abstract
GM-CSF-induced oxidative responses are defective in neutrophils of elderly humans. In the present study we evaluated whether this phenomenon might be related to alterations in cytokine-dependent MAPK signalling. Neutrophils obtained from elderly humans and stimulated with GM-CSF showed a significant reduction in phosphorylated ERK1/2 levels and an even higher decrease in ERK1/2 activation with respect to baseline. No changes in GM-CSF-induced p38 MAPK phosphorylation were observed. Cell pretreatment with the MEK inhibitor PD98059 determined a marked suppression of GM-CSF-induced O2- release. Interestingly, under the above experimental condition, there was no longer any difference in O2- production observed between elderly and young subjects. Furthermore, despite the fact that the p38 MAPK pathway was activated less strongly by GM-CSF, the p38 MAPK inhibitor SB203580 reduced GM-CSF-induced O2- production in the neutrophils of the elderly to levels similar to those obtained with PD98059. TNF-alpha-triggered O2- production was not altered by ageing and in fact, a similar ERK1/2 or p38 MAPK activation was found in TNF-alpha-stimulated neutrophils from elderly and young individuals. In accordance with the different potency of TNF-alpha in activating ERK1/2 and p38 MAPK, the TNF-alpha-induced oxidative responses were more sensitive to the inhibitory effects of SB203580 than to those of PD98059 in young as well as elderly subjects. These results suggest that, along the GM-CSF-dependent ERK signalling pathway, a step proximal to MEK1/2 but distal to the connection with the p38 MAPK module likely becomes defective as a feature of age. The consequent decline in ERK1/2 activation could potentially account for the GM-CSF-dependent impairment of the neutrophil respiratory burst that occurs with ageing.
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Affiliation(s)
- Cosimo Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari Medical School, Policlinico, Bari 70124, Italy.
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Natilla A, Piazzolla G, Nuzzaci M, Saldarelli P, Tortorella C, Antonaci S, Piazzolla P. Cucumber mosaic virus as carrier of a hepatitis C virus-derived epitope. Arch Virol 2004; 149:137-54. [PMID: 14689280 DOI: 10.1007/s00705-003-0190-x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2003] [Revised: 01/01/2003] [Accepted: 07/02/2003] [Indexed: 11/30/2022]
Abstract
Cucumber mosaic virus (CMV) is a three component isodiametric plant virus which is common worldwide and has an extremely wide host range. A pseudorecombinant was made, derived from the RNA3 component of the CMV-S strain, carrying the coat protein (CP) gene, and the RNA1,2 components of the CMV-D strain. This system developed mild mosaic and vein clearing in Xanthi tobacco three weeks after inoculation. The CP gene was then engineered in three different positions, to encode a Hepatitis C virus (HCV) epitope. The selected peptide was the so-called R9 mimotope, a synthetic surrogate derived from a consensus profile of many hypervariable region 1 (HVR1) sequences of the putative HCV envelope protein E2. Serum samples from 60 patients with chronic hepatitis C displayed a significant immunoreactivity to crude plant extracts infected with the chimeric CMV. These results suggest that further investigation should be made into a possible vaccine function for the CMV-HCV mimotope system.
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Affiliation(s)
- A Natilla
- Dipartimento di Biologia, Difesa e Biotecnologie Agro-Forestali, Università Degli Studi della Basilicata, Potenza, Italy
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Tortorella C, Pisconti A, Piazzolla G, Antonaci S. APC-dependent impairment of T cell proliferation in aging: role of CD28- and IL-12/IL-15-mediated signaling. Mech Ageing Dev 2002; 123:1389-402. [PMID: 12297341 DOI: 10.1016/s0047-6374(02)00079-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The age-related impairment of phytohaemagglutinin (PHA)-triggered peripheral blood mononuclear cell (PBMC) proliferation was paralleled by an expansion of CD28 (-) T lymphocytes with a poor capacity to undergo lectin-induced blastogenesis. However, both CD28 (-) and CD28 (+) T cells isolated from aged individuals exhibited a significant reduction of proliferative response to PHA in comparison with young controls, this implies that the CD28-mediated signaling is not the only defective pathway in the elderly. Thus, PBMC or T cell subsets plus monocytes from aged donors were stimulated with PHA and assayed for the production of, or the response to cytokines known to regulate T cell functions. Results can be so summarized: (i). interleukin (IL)-2 as well as IL-10 release was unaffected by age; (ii). in both groups of subjects, IL-15 concentrations were similar to those spontaneously released by PBMC; (iii). surprisingly, IL-12 p70 and IL-12 p40 production by PBMC was markedly increased in the aged group; (iv) in spite of this finding and of the experimental outcome that IFN-gamma synthesis was almost completely dependent on IL-12. PBMC from old individuals did not release higher amounts of IFN-gamma in comparison with young controls; (v). moreover, only a slight increase in IFN-gamma production was observed in PBMC cultures from the aged group as a result of IL-12 and/or IL-15 costimulation; (vi) at the same time, even though IL-12 as well as IL-15 were necessary for an efficient T cell proliferation, the addition of exceeding doses of cytokines proved to be ineffective in enhancing the proliferative outcome of PBMC or of both CD28 (+) and CD28 (-) T cells in the aged group. Taken together, the data outline the role of CD28 and IL-12/IL-15 signaling impairment in T cell proliferative deficiency during senescence.
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Affiliation(s)
- Cosimo Tortorella
- Department of Internal Medicine, Immunology and Infectious Diseases, Section of Internal Medicine, University of Bari Medical School, Clinica Medica II, Policlinico, 70124, Bari, Italy.
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49
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Lancioni GE, O'Reilly MF, Singh NN, Oliva D, Piazzolla G, Pirani P, Groeneweg J. Evaluating the use of multiple microswitches and responses for children with multiple disabilities. J Intellect Disabil Res 2002; 46:346-351. [PMID: 12000586 DOI: 10.1046/j.1365-2788.2002.00411.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND The present study assessed the feasibility of (1) establishing multiple microswitches and responses (some of which had not been used before) with two children with multiple disabilities, and (2) maintaining such microswitches and responses in the children's daily contexts. METHODS The microswitches were introduced individually and then combined. During the last part of treatment and the follow-up, each child had three microswitches. RESULTS The data show that both children learned to use all three available microswitches. Moreover, they retained fairly high levels of responding with the microswitches in their daily contexts during follow-up periods of 4 and 6 months. CONCLUSIONS The personal and practical implications of these findings are discussed.
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Affiliation(s)
- G E Lancioni
- University of Leiden, Wassenaarseweg 52, 2333 AK Leiden, the Netherlands.
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50
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Antonaci S, Piazzolla G, Napoli N, Vella FS, Fiore G, Schiraldi O. Relationship between T lymphocyte responsiveness and T-helper1/T-helper2 type cytokine release in chronic hepatitis C: a critical reappraisal. Microbios 2002; 106:203-12. [PMID: 11522131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Recruitment of virus-specific T lymphocyte subpopulations to liver sites in chronic hepatitis C virus (HCV) infection implies a key role for the immune response in host-virus interaction. In spite of a multispecific and polyclonal cytotoxic function exerted by CD8+ lymphocytes, CD4-mediated activity is weak. This allows the infection to persist which in turn is responsible for the development of chronic hepatitis C (CH-C). Such a finding outlines the occurrence of a possible relationship between cytokine (CK) production by CD4 subsets, i.e. T helper (Th)1 or Th2 cells, and the clinical outcome. A prevalence of Th1-derived CK occurs in infected liver, while increased amounts of Th2-related CK are usually found in peripheral blood. Moreover, peripheral blood mononuclear cell (PBMC) cultures from CH-C subjects exhibit an impaired interferon (IFN)-gamma production and an increase of interleukin (IL)-12 p70 release after stimulation. The latter pattern seems to be due to the enhanced release of IL-12 p40 homodimers, which antagonize IL-12 p70 bioactivity and favour IL-10-induced effects. These results suggest that further extensive studies on the imbalance of the CK network at a molecular level are required to improve the therapeutical approach in CH-C subjects.
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Affiliation(s)
- S Antonaci
- Department of Internal Medicine, Immunology and Infectious Diseases, University of Bari Medical School, Policlinico, Italy
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