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Calvisi SL, Olarte D, Meloni M, Bianchi S. Sonographic diagnosis of radiographically undetectable bennet fracture. J Ultrasound 2024:10.1007/s40477-024-00901-z. [PMID: 38691324 DOI: 10.1007/s40477-024-00901-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/29/2024] [Indexed: 05/03/2024] Open
Abstract
Intra-articular fractures of the base of the first metacarpal (Bennet fractures) are prone to dislocation and require surgical reduction and fixation to prevent secondary degenerative joint disease and chronic dysfunction. Therefore, a prompt diagnosis is necessary, mostly achieved by conventional roentgenograms. We report the case of a 62-year-old man in whom a Bennet fracture was highly suspected on ultrasound (US) examination realized after a fall. Standard radiographs, obtained after US to confirm the diagnosis, were interpreted as normal. A computed tomography was then performed showing a typical Bennet fracture. This case report demonstrates that a careful assessment of bones must be an integral part of any routine musculo-skeletal US examination, particularly in post-traumatic patients. US can detect bone fractures where radiograph is not discriminating.
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Affiliation(s)
- Stefania Laura Calvisi
- Casa di Cura Beato Palazzolo, Bergamo, Italy.
- CIM SA, Cabinet Imagerie Médicale, Géneva, Switzerland.
| | - Diana Olarte
- CIM SA, Cabinet Imagerie Médicale, Géneva, Switzerland
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Marco Meloni
- Ospedale Moriggia Pelascini, Gravedona e Uniti, Italy
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Meloni M, Giurato L, Monge L, Miranda C, Scatena A, Ragghianti B, Silverii GA, Vermigli C, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Da Ros R, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Monami M, Uccioli L. Effect of a multidisciplinary team approach in patients with diabetic foot ulcers on major adverse limb events (MALEs): systematic review and meta-analysis for the development of the Italian guidelines for the treatment of diabetic foot syndrome. Acta Diabetol 2024; 61:543-553. [PMID: 38461443 DOI: 10.1007/s00592-024-02246-9] [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: 09/22/2023] [Accepted: 01/24/2024] [Indexed: 03/12/2024]
Abstract
The treatment of patients with diabetic foot ulcers (DFUs) is extremely complex, requiring a comprehensive approach that involves a variety of different healthcare professionals. Several studies have shown that a multidisciplinary team (MDT) approach is useful to achieve good clinical outcomes, reducing major and minor amputation and increasing the chance of healing. Despite this, the multidisciplinary approach is not always a recognized treatment strategy. The aim of this meta-analysis was to assess the effects of an MDT approach on major adverse limb events, healing, time-to-heal, all-cause mortality, and other clinical outcomes in patients with active DFUs. The present meta-analysis was performed for the purpose of developing Italian guidelines for the treatment of diabetic foot with the support of the Italian Society of Diabetology (Società Italiana di Diabetologia, SID) and the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD). The study was performed using the Grading of Recommendations Assessment, Development, and Evaluation approach. All randomized clinical trials and observational studies, with a duration of at least 26 weeks, which compared the MDT approach with any other organizational strategy in the management of patients with DFUs were considered. Animal studies were excluded. A search of Medline and Embase databases was performed up until the May 1st, 2023. Patients managed by an MDT were reported to have better outcomes in terms of healing, minor and major amputation, and survival in comparison with those managed using other approaches. No data were found on quality of life, returning-to-walking, and emergency admission. Authors concluded that the MDT may be effective in improving outcomes in patients with DFUs.
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Affiliation(s)
- Marco Meloni
- Department of Systems of Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | - Laura Giurato
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
| | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | | | | | | | - Gerardo Medea
- SIMG- Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione Di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Roberto Da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria Della Misericordia, Ospedale Di Perugia, Perugia, Italy
| | | | | | | | | | - Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | - Luigi Uccioli
- Department of Systems of Medicine, University of Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
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Hazbiu A, Teobaldi I, Sepe M, Federici G, Meloni M, Uccioli L. The Appropriateness of Footwear in Diabetic Patients Observed during a Podiatric Examination: A Prospective Observational Study. J Clin Med 2024; 13:2402. [PMID: 38673674 PMCID: PMC11051551 DOI: 10.3390/jcm13082402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024] Open
Abstract
Background: Adequate compliance with wearing therapeutic footwear (TF) to prevent diabetic foot ulcers is known to be low. The primary aim of this study was to identify population awareness about the ulceration and/or recurrence risk according to footwear choice. The secondary aim was to evaluate the compliance level in footwear choice based on a patient's own risk. Methods: Forty podiatrists participated from 1 September 2017 to 31 August 2018, providing six-section forms which included personal data, risk classification, footwear characteristics and a knowledge questionnaire. Results: This study included 1507 patients. Those with active ulcers were excluded. A total of 43% of patients belonged to risk class 0, 19% to risk class 1, 19% to risk class 2 and 19% to risk class 3. A total of 58% had foot deformities. Conclusions: Nearly half of patients with a high risk of ulceration had knowledge of their own risk but the majority of them did not follow the recommendations. Only a small percentage (36%) of risk class 3 patients wore footwear suitable for their risk class. There was poor consideration of footwear choice among patients. We highlight critical issues in patient education and compliance with wearing footwear appropriate to their risk class.
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Affiliation(s)
- Anisa Hazbiu
- Ambulatorio CIMAU, Via G. Cesare 82, 66054 Vasto, Italy;
| | | | - Mario Sepe
- Centro Podologico Sepe, Via Alcide De Gasperi 4/D, 80036 Palma Campania, Italy;
| | - Giovanni Federici
- Ospedale San Pietro Fatebenefratelli, Via Cassia 600, 00189 Roma, Italy;
| | - Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy;
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy
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Monami M, Scatena A, Miranda C, Monge L, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Ragghianti B, Silverii GA, da Ros R, Meloni M, Giurato L, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Uccioli L, Vermigli C. Correction to: Development of the Italian clinical practice guidelines for the treatment of diabetic foot syndrome: design and methodological aspects. Acta Diabetol 2024:10.1007/s00592-024-02263-8. [PMID: 38565687 DOI: 10.1007/s00592-024-02263-8] [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: 04/04/2024]
Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy.
- University of Florence, Florence, Italy.
| | | | | | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | | | - Gerardo Medea
- SIMG-Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Roberto da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Marco Meloni
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Laura Giurato
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | | | | | | | | | - Luigi Uccioli
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
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Meloni M, Piaggesi A, Uccioli L. From a Spark to a Flame: The Evolution of Diabetic Foot Disease in the Last Two Decades. INT J LOW EXTR WOUND 2024:15347346241238480. [PMID: 38470358 DOI: 10.1177/15347346241238480] [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] [Indexed: 03/13/2024]
Abstract
Despite many improvements have been achieved, diabetic foot disease (DFD) remains a clinical, social, and economic burden. In the last years, DFD showed an evolution of its characteristics with an increase of the ischaemic/neuro-ischaemic foot in comparison to the pure neuropathic foot. Simultaneously, there was and increased incidence of concomitant cardiovascular co-morbidities, which influences the higher fragility of patients with DFS. Peripheral arterial disease (PAD) in subjects with diabetic foot seems to show a more aggressive pattern, being more distal and difficult to treat. Untreatable PAD remains the unmet need for clinicians and the main risk factor of major amputation in patients with diabetic foot ulcers. Authors aimed to describe the evolution of diabetic foot patients in the last two decades, describing also the current and future treatment which may improve outcomes in the next generations.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
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Lazzarini PA, Raspovic KM, Meloni M, van Netten JJ. A new declaration for feet's sake: Halving the global diabetic foot disease burden from 2% to 1% with next generation care. Diabetes Metab Res Rev 2024; 40:e3747. [PMID: 37997627 DOI: 10.1002/dmrr.3747] [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: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/25/2023]
Abstract
The 1989 Saint Vincent Declaration established a goal of halving global diabetes-related amputation rates. A generation later, this goal has been achieved for major but not minor amputations. However, diabetic foot disease (DFD) is not only a leading cause of global amputation but also of hospitalisation, poor quality of life (QoL) and disability burdens. In this paper, we review latest estimates on the global disease burden of DFD and the next generation care of DFD that could reduce this burden. We found DFD causes 2% of the global disease burden. This makes DFD the 13th largest of 350+ leading conditions causing the global disease burden, and much larger than dementia, breast cancer and type 1 diabetes. Neuropathy without ulcers and amputations makes up the largest portion of the global DFD burden yet receives the least DFD focus. Future care focussed on improving safe physical activity in people with DFD could considerably reduce the DFD burden, as this incorporates increasing physical fitness and QoL, while simultaneously decreasing ulceration and other risks. Charcot neuro-osteoarthropathy is more prevalent than previously thought. Most cases respond well to non-removable offloading devices, but surgical intervention may further reduce the considerable burden of these neuropathic fracture dislocations. Ischaemia is becoming more common and complex. Most cases respond well to revascularisation interventions, but novel revascularisation techniques, medical management and autologous cell therapies may hold the key to more cases responding in the future. We conclude that DFD causes a global disease burden larger than most conditions and existing guideline-based care and next generation treatments can reduce this burden. We suggest the World Health Organization and International Diabetes Federation declare a new goal: halving the global DFD burden from 2% to 1% within the next generation.
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Affiliation(s)
- Peter A Lazzarini
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Allied Health Research Collaborative, The Prince Charles Hospital, Brisbane, Queensland, Australia
| | - Katherine M Raspovic
- Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Jaap J van Netten
- Department of Rehabilitation Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Program Rehabilitation, Amsterdam, The Netherlands
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Monami M, Scatena A, Miranda C, Monge L, De Cassai A, Volpe A, Tramonta R, Medea G, Bordieri C, Falcone M, Stefanon L, Bernetti A, Cappella C, Gargiulo M, Lorenzoni V, Scevola G, Stabile E, Ragghianti B, Silverii GA, da Ros R, Meloni M, Giurato L, Murdolo G, Bianchini E, Gaggia F, Gauna C, Romeo F, Apicella M, Mantuano M, Uccioli L, Vermigli C. Development of the Italian clinical practice guidelines for the treatment of diabetic foot syndrome: design and methodological aspects. Acta Diabetol 2023; 60:1449-1469. [PMID: 37491605 DOI: 10.1007/s00592-023-02150-8] [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: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/27/2023]
Abstract
AIMS Diabetic foot syndrome (DFS) and its complications are a growing public health concern. The Italian Society of Diabetology (SID) and the Italian Association of Clinical Diabetologists (AMD), in collaboration with other scientific societies, will develop the first Italian guidelines for the treatment of DFS. METHODS The creation of SID/AMD Guidelines is based on an extended work made by 19 panelists and 12 members of the Evidence Review Team. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide aims, reference population, and target health professionals. Clinical questions have been created using PICO (Patient, Intervention, Comparison, Outcome) conceptual framework. The definition of questions has been performed using a two-step web-based Delphi methodology, a structured technique aimed at obtaining by repeated rounds of questionnaires a consensus opinion from a panel of experts in areas wherein evidence is scarce or conflicting, and opinion is important. RESULTS The mean age of panelists (26.3% women) was 53.7 ± 10.6 years. The panel proposed 34 questions. A consensus was immediately reached for all the proposed questions, 32 were approved and 2 were rejected. CONCLUSIONS The areas covered by clinical questions included diagnosis of ischemia and infection, treatment of ischemic, neuropathic, and infected ulcers, prevention of foot ulceration, organization and education issues, and surgical management. The PICO presented in this paper are designed to provide indications for healthcare professionals in charge of diabetic foot treatment and prevention, primarily based on clinical needs of people with diabetic foot syndrome and considering the existing organization of health care.
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Affiliation(s)
- Matteo Monami
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy.
- University of Florence, Florence, Italy.
| | | | | | - Luca Monge
- AMD-Italian Association of Clinical Diabetologists, Milan, Italy
| | | | | | | | - Gerardo Medea
- SIMG-Italian Society of General Medicine, Florence, Italy
| | | | - Marco Falcone
- Cisanello Hospital and University of Pisa, Pisa, Italy
| | | | | | - Cristina Cappella
- Associazione di Volontariato Piede Diabetico Umbria ODV, Perugia, Italy
| | - Mauro Gargiulo
- University of Bologna, Policlinico Sant'Orsola-Malpighi, Bologna, Italy
| | | | | | | | - Benedetta Ragghianti
- Azienda Ospedaliero Universitaria Careggi, Largo Brambilla 3, 50141, Florence, Italy
| | | | - Roberto da Ros
- Azienda Sanitaria Universitaria Giuliana Isontina, Monfalcone, Italy
| | - Marco Meloni
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Laura Giurato
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Giuseppe Murdolo
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Eleonora Bianchini
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | - Francesco Gaggia
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
| | | | | | | | | | - Luigi Uccioli
- Endocrinology Unit CTO/SEU Hospitals - Roma 2 Dept of Biomedicine and Prevention - Tor Vergata University, Rome, Italy
| | - Cristiana Vermigli
- Azienda Ospedaliera Santa Maria della Misericordia, Ospedale di Perugia, Perugia, Italy
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Meloni M, Andreadi A, Ruotolo V, Romano M, Bellizzi E, Giurato L, Bellia A, Uccioli L, Lauro D. Hospital Readmission in Patients With Diabetic Foot Ulcers: Prevalence, Causes, and Outcomes. INT J LOW EXTR WOUND 2023:15347346231207747. [PMID: 37849322 DOI: 10.1177/15347346231207747] [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] [Indexed: 10/19/2023]
Abstract
The aim of the current study was to evaluate the rate of readmission in patients affected by diabetes and foot ulcers (DFUs), and causes and outcomes of patients requiring a new hospitalization. The current study is a retrospective observational study including patients who have required hospitalization since January 2019 to September 2022 due to a DFU. Once patients were discharged, they were regularly followed as outpatients. Within 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided into 2 groups, readmitted and not readmitted patients, respectively. Hence, all patients were followed for 6 months more and outcomes of the 2 groups were analyzed and compared. Overall, 310 patients were included. The mean age was 68 ± 12 years, the majority of patients reported type 2 diabetes (>90%), and the mean diabetes duration was approximately 20 years. Sixty-eight (21.9%) patients were readmitted. The main reason for hospital readmission was the presence of critical limb ischemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%), and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5% vs 89.2%, P < .0001) and higher rate of major amputation (10.3% vs 4.5%, P = .2) in comparison to not readmitted patients. Critical limb ischemia resulted in the only independent predictor of hospital readmission. Hospital readmission is a frequent issue among patients with DFUs, and readmitted patients showed a lower chance of wound healing. Critical limb ischemia resulted in the main cause of new hospitalization.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Valeria Ruotolo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Maria Romano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Ermanno Bellizzi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Laura Giurato
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
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9
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Meloni M, Andreadi A, Bellizzi E, Giurato L, Ruotolo V, Romano M, Bellia A, Uccioli L, Lauro D. A multidisciplinary team reduces in-hospital clinical complications and mortality in patients with diabetic foot ulcers. Diabetes Metab Res Rev 2023; 39:e3690. [PMID: 37422897 DOI: 10.1002/dmrr.3690] [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: 03/16/2023] [Revised: 04/26/2023] [Accepted: 05/28/2023] [Indexed: 07/11/2023]
Abstract
AIMS The current study aims to evaluate the effectiveness of a multidisciplinary diabetic foot team (MDFT) in the management of in-patients affected by diabetic foot problems. MATERIALS AND METHODS The study was a retrospective observational study. Consecutive patients with a diabetic foot problem requiring hospitalisation were included. All patients were managed by a MDFT led by diabetologists according to the guidance. The rate of in-hospital complications (IHCs), major amputation, and survival were recorded at the end of patient's hospitalisation. IHC was defined as any new infection different from wound infection, cardiovascular events, acute renal injury, severe anaemia requiring blood transfusion, and any other clinical problem not present at the assessment. RESULTS Overall, 350 patients were included. The mean age was 67.9 ± 12.6 years, 254 (72.6%) were males, 323 (92, 3%) showed Type 2 diabetes with a mean duration of 20.2 ± 9.6 years; 224 (64%) had ischaemic diabetic foot ulcers (DFUs) and 299 (85.4%) had infected DFUs. IHCs were recorded in 30/350 (8.6%) patients. The main reasons for IHCs were anaemia requiring blood transfusion (2.8%), pneumonia (1.7%), acute kidney failure (1.1%). Patients with IHCs showed a higher rate of major amputation (13.3 vs. 3.1%, p = 0.02) and mortality (16.7 vs. 0.6%, p < 0.0001) in comparison to those without. Ischaemic heart disease (IHD) and wound duration at the assessment (>1 month) were independent predictors of IHC, whereas IHCs, heart failure, and dialysis were independent predictors of in-hospital mortality. CONCLUSIONS The multidisciplinary management of diabetic foot problems leads to an IHC rate of 8%. The risk of IHCs is higher in patients with IHD and long wound duration.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Ermanno Bellizzi
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Laura Giurato
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Valeria Ruotolo
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Maria Romano
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
| | - Luigi Uccioli
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico "Tor Vergata", Rome, Italy
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10
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Meloni M, Bellia A, Giurato L, Andreadi A, Uccioli L, Lauro D. Response to the letter of Tariq and colleagues on the paper "below‑the‑ankle arterial disease: a new marker of coronary artery disease in patients with diabetes and foot ulcers". Acta Diabetol 2023; 60:1417-1418. [PMID: 37368026 DOI: 10.1007/s00592-023-02134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Affiliation(s)
- Marco Meloni
- Department of Systems of Medicine, University of Tor Vergata, 00133, Rome, Italy.
| | - Alfonso Bellia
- Department of Systems of Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Laura Giurato
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems of Medicine, University of Tor Vergata, 00133, Rome, Italy
| | - Luigi Uccioli
- Department of Endocrinology and Diabetology, CTO Hospital, 00145, Rome, Italy
| | - Davide Lauro
- Department of Systems of Medicine, University of Tor Vergata, 00133, Rome, Italy
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11
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Meloni M, Giurato L, Andreadi A, Bellizzi E, Bellia A, Lauro D, Uccioli L. Peripheral Blood Mononuclear Cells: A New Frontier in the Management of Patients with Diabetes and No-Option Critical Limb Ischaemia. J Clin Med 2023; 12:6123. [PMID: 37834766 PMCID: PMC10573900 DOI: 10.3390/jcm12196123] [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: 08/24/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/15/2023] Open
Abstract
The current study aimed to evaluate the effectiveness of peripheral blood mononuclear cell (PB-MNC) therapy as adjuvant treatment for patients with diabetic foot ulcers (DFUs) and no-option critical limb ischaemia (NO-CLI). The study is a prospective, noncontrolled, observational study including patients with neuro-ischaemic DFUs and NO-CLI who had unsuccessful revascularization below the ankle (BTA) and persistence of foot ischaemia defined by TcPO2 values less than 30 mmHg. All patients received three cycles of PB-MNC therapy administered through a "below-the-ankle approach" in the affected foot along the wound-related artery according to the angiosome theory. The primary outcome measures were healing, major amputation, and survival after 1 year of follow-up. The secondary outcome measures were the evaluation of tissue perfusion by TcPO2 and foot pain defined by the numerical rating scale (NRS). Fifty-five patients were included. They were aged >70 years old and the majority were male and affected by type 2 diabetes with a long diabetes duration (>20 years); the majority of DFUs were infected and nearly 90% were assessed as gangrene. Overall, 69.1% of patients healed and survived, 3.6% healed and deceased, 10.9% did not heal and deceased, and 16.4% had a major amputation. At baseline and after PB-MNC therapy, the TcPO2 values were 17 ± 11 and 41 ± 12 mmHg, respectively (p < 0.0001), while the pain values (NRS) were 6.8 ± 1.7 vs. 2.8 ± 1.7, respectively (p < 0.0001). Any adverse event was recorded during the PB-MNC therapy. Adjuvant PB-MNC therapy seems to promote good outcomes in patients with NO-CLI and neuro-ischaemic DFUs.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Laura Giurato
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy; (L.G.)
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Ermanno Bellizzi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy (E.B.); (A.B.); (D.L.)
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Luigi Uccioli
- Division of Endocrinology and Diabetes, CTO Andrea Alesini Hospital, 00145 Rome, Italy; (L.G.)
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
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Bellia C, Andreadi A, D’Ippolito I, Scola L, Barraco S, Meloni M, Lauro D, Bellia A. Prevalence and risk of new-onset diabetes mellitus after COVID-19: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2023; 14:1215879. [PMID: 37732118 PMCID: PMC10507325 DOI: 10.3389/fendo.2023.1215879] [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: 05/02/2023] [Accepted: 08/16/2023] [Indexed: 09/22/2023] Open
Abstract
Aims After the acute phase of SARS-CoV-2 infection, the onset of glycemic impairment and diabetes have been reported. Nevertheless, the exact burden of glycemic impairment and diabetes after COVID-19 has not been clearly described. Materials and methods Electronic search was run in Pubmed (MEDLINE), Web of Science, Scopus, and ClinicalTrial.org for reports published from database inception to September 2022. We included observational studies reporting quantitative data on diabetes prevalence or its onset in subjects with a history of SARS-CoV-2 infection from at least 60 days. Risk of bias was assessed by the JBI's critical appraisal checklist. Random effect model was used to calculate pooled data. The review protocol was registered on PROSPERO (CRD42022310722). Results Among 1,630 records screened, 20 studies were included in the analysis. The mean or median age of participants ranged from ~ 35 to 64 years, with a percentage of males ranging from 28% to 80%. Only two studies were considered at low risk of bias. The estimate of diabetes prevalence, calculated on a total of 320,948 participants pooled with 38,731 cases, was 16% (95%CI: 11-22%). The estimate of proportion of incident cases of diabetes was 1.6% (95%CI: 0.8-2.7%). Subgroup analysis showed that previous hospitalization increased the prevalence of diabetes and the proportion of incident cases. Conclusion Diabetes is common in individuals who have experienced SARS-CoV-2 infection, especially if they required hospitalization. This data may be helpful to screen for diabetes and manage its complications in individuals who experienced COVID-19. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022310722, identifier CRD42022310722.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
- Transfusion Medicine Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Ilenia D’Ippolito
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Letizia Scola
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy
- Transfusion Medicine Unit, University Hospital “Paolo Giaccone”, Palermo, Italy
| | - Sonia Barraco
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Marco Meloni
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Division of Endocrinology and Diabetes, Fondazione Policlinico Tor Vergata, Rome, Italy
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Giurato L, Andrea P, Meloni M, Pecchioli C, D'Ambrogi E, Uccioli L. Risk Factors for Ulcer Recurrence in Diabetic Patients Managed by an Integrated Foot Care Protocol. INT J LOW EXTR WOUND 2023:15347346231191583. [PMID: 37654086 DOI: 10.1177/15347346231191583] [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] [Indexed: 09/02/2023]
Abstract
The aim of our study was to identify risk factors for the recurrence of diabetic foot ulcers (DFUs) in a selected population of patients in secondary prevention treated, according to International Guidelines, with an integrated foot care protocol by a referral diabetic foot clinic. A retrospective study was performed with the inclusion of selected outpatients with diabetes at higher risk for ulceration with a history of previous ulcer and/or amputation followed in our diabetic foot clinic between January 2015 and December 2021. According to the presence or absence of recurrence, patients were divided into 2 groups: ulcer recurrence and without ulcer recurrence. One hundred twenty-seven (127) patients were included, 47 patients (37%) developed an ulcer recurrence while 80 patients (63%) did not. The mean age was 71.7 years; 65% were male; 97% were affected by type 2 diabetes with a mean duration of 21.1 years, the mean HbA1c was 63 + 21 mmol/mol. Both groups of patients had foot deformities, such as claw and hammertoes; hallux valgus, and prominent metatarsal heads (MTHs). The presence of deformity was significantly associated with ulceration. The group with ulcer recurrence showed a higher rate of prominence MTHs in comparison to a group without ulcer recurrence. The MTHs resulted as the only independent predictor for recurrence. This study shows that the presence of the prominent MTH is a significant risk factor for ulcer recurrence in a selected population of diabetic foot patients treated in the best way with integrated foot care.
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Affiliation(s)
- Laura Giurato
- Endocrinology and Diabetology Unit, CTO/SE Hospitals, Rome, Italy
- Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy
| | - Panunzi Andrea
- Endocrinology and Diabetology Unit, CTO/SE Hospitals, Rome, Italy
- Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy
| | - Marco Meloni
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Chiara Pecchioli
- Endocrinology and Diabetology Unit, CTO/SE Hospitals, Rome, Italy
| | | | - Luigi Uccioli
- Endocrinology and Diabetology Unit, CTO/SE Hospitals, Rome, Italy
- Department of Biomedicine, Prevention University of Rome Tor Vergata, Rome, Italy
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De Taddeo S, Andreadi A, Minasi A, D’Ippolito I, Borelli B, Meloni M, Romano M, Ruotolo V, Cacciotti L, Rizzo G, Patrizi L, Bellia A, Lauro D. Surgical treatment of post-menopausal ovarian hyperandrogenism improves glucometabolic profile alongside clinical hirsutism. SAGE Open Med Case Rep 2023; 11:2050313X231178404. [PMID: 37325164 PMCID: PMC10265337 DOI: 10.1177/2050313x231178404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/08/2023] [Indexed: 06/17/2023] Open
Abstract
Hyperandrogenism during menopause is often underestimated by clinicians and attributed to the natural aging process. Hyperandrogenism can be associated with some metabolic abnormalities linked together in a vicious circle by insulin resistance. We present the case of an elderly woman affected with type 2 diabetes and obesity who reported the occurrence of clinical hirsutism after physiological menopause at the age of 47 years. At presentation, physical examination and Ferriman-Gallwey score revealed a condition of moderate hirsutism, with markedly increased levels of plasma testosterone and delta-4-androstenedione, obesity (body mass index 31.9), and inadequate glycemic control (glycated hemoglobin 65 mmol/mol). The patient underwent a thorough differential diagnosis by a multidisciplinary team approach, including the various causes of hyperandrogenism during menopause. After choosing surgical option as the appropriate treatment, clinical resolution of hirsutism was observed alongside patient satisfaction and marked improvement of the glucometabolic profile.
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Affiliation(s)
- Sofia De Taddeo
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Aikaterini Andreadi
- Section of Endocrinology and Metabolic Diseases, Department of Systems Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome, Roma, Italy
| | - Alessandro Minasi
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Ilenia D’Ippolito
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Barbara Borelli
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Marco Meloni
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Maria Romano
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Valeria Ruotolo
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Laura Cacciotti
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Giuseppe Rizzo
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Lodovico Patrizi
- Section of Gynecology and Obstetrics, Department of Surgical Sciences, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
| | - Alfonso Bellia
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
- Section of Endocrinology and Metabolic Diseases, Department of Systems Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome, Roma, Italy
| | - Davide Lauro
- Division of Endocrinology and Diabetology, Fondazione PTV Policlinico Tor Vergata, Roma, Italy
- Section of Endocrinology and Metabolic Diseases, Department of Systems Medicine, Faculty of Medicine and Surgery, Tor Vergata University of Rome, Roma, Italy
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15
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Rossana C, Meloni M, Giurato L, Lazaro-Martinez JL, Aikaterini A, Valeria R, Bellia A, Lauro D, Uccioli L. Microbiological and Clinical Characteristics of Infected Diabetic Foot Ulcers Managed in a Tertiary Level Diabetic Foot Service. INT J LOW EXTR WOUND 2023:15347346231178642. [PMID: 37264617 DOI: 10.1177/15347346231178642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The study aimed to evaluate the clinical and microbiological characteristics of diabetic foot infections (DFIs) in patients referring to a specialized diabetic foot service (DFS). The study is a retrospective observational study conducted in a single center, including patients who were referred for a new DFI. All patients were managed through a limb salvage protocol according to international guidelines. The following items were recorded: type of bacteria, presence of single or polymicrobial infection, and the antibiotic resistance. Overall, 268 patients were included. The mean age was 68.9 ± 10.9 years, 75% were male, and 97.2% had type 2 diabetes with a mean diabetes duration of 16 ± 9 years. One hundred thirty-nine (51.9%) DFU were ischemic, 120 (44.7%) patients had osteomyelitis, 107 (39.9%) had gangrene, 37 (13.9%) had phlegmon/abscess/cellulitis and 4 (1.5%) had necrotizing fasciitis. Among 370 bacteria isolated, gram positive were found in 207 (55.9%) cases, and gram negative in 163 (44.1%) cases. The higher rates of isolates were Staphylococcus aureus (32.9%), Pseudomonas aeruginosa (10.8%), and Enterococcus faecalis (8.9%). Polymicrobial infection was reported in 33.6% of cases and antibiotic resistance was recorded in 16.5% of isolates. Among them, 10.3% were methicillin-resistant S. aureus (MRSA). Antibiotic resistance was detected in 40.9% of cases in association with gangrene and osteomyelitis. The current study shows as polymicrobial infections and antibiotic resistance is frequently reported in DFIs, and antibiotic resistance was more associated with gangrene and osteomyelitis. Among bacteria reporting antimicrobial resistance, the highest rate was found for MRSA.
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Affiliation(s)
| | - Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Laura Giurato
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Andreadi Aikaterini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Ruotolo Valeria
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
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Andreadi A, Muscoli S, Tajmir R, Meloni M, Muscoli C, Ilari S, Mollace V, Della Morte D, Bellia A, Di Daniele N, Tesauro M, Lauro D. Recent Pharmacological Options in Type 2 Diabetes and Synergic Mechanism in Cardiovascular Disease. Int J Mol Sci 2023; 24:ijms24021646. [PMID: 36675160 PMCID: PMC9862607 DOI: 10.3390/ijms24021646] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 01/18/2023] Open
Abstract
Diabetes Mellitus is a multifactorial disease with a critical impact worldwide. During prediabetes, the presence of various inflammatory cytokines and oxidative stress will lead to the pathogenesis of type 2 diabetes. Furthermore, insulin resistance and chronic hyperglycemia will lead to micro- and macrovascular complications (cardiovascular disease, heart failure, hypertension, chronic kidney disease, and atherosclerosis). The development through the years of pharmacological options allowed us to reduce the persistence of chronic hyperglycemia and reduce diabetic complications. This review aims to highlight the specific mechanisms with which the new treatments for type 2 diabetes reduce oxidative stress and insulin resistance and improve cardiovascular outcomes.
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Affiliation(s)
- Aikaterini Andreadi
- Department of Systems Medicine, Section of Endocrinology and Metabolic Diseases, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
- Correspondence: (A.A.); (D.L.)
| | - Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Rojin Tajmir
- Department of Systems Medicine, Section of Endocrinology and Metabolic Diseases, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, Section of Endocrinology and Metabolic Diseases, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Carolina Muscoli
- Department of Health Science, University of Magna Graecia, 88100 Catanzaro, Italy
| | - Sara Ilari
- Department of Health Science, University of Magna Graecia, 88100 Catanzaro, Italy
| | - Vincenzo Mollace
- Department of Health Science, University of Magna Graecia, 88100 Catanzaro, Italy
| | - David Della Morte
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Internal Medicine—Hypertension, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
- Department of Neurology, Evelyn F. McKnight Brain Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Alfonso Bellia
- Department of Systems Medicine, Section of Endocrinology and Metabolic Diseases, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Internal Medicine—Hypertension, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Manfredi Tesauro
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Internal Medicine—Hypertension, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, Section of Endocrinology and Metabolic Diseases, University of Rome Tor Vergata, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Fondazione Policlinico Tor Vergata, 00133 Rome, Italy
- Correspondence: (A.A.); (D.L.)
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Urso F, Brambilla L, Carriero F, Meloni M. 389 Reconstructed Human Epidermis Colonized with C.acnes: Pro-inflammatory and Oxidative Stress Response. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Meloni M, Bellia A, Giurato L, Lauro D, Uccioli L. Below-the-ankle arterial disease: a new marker of coronary artery disease in patients with diabetes and foot ulcers. Acta Diabetol 2022; 59:1331-1338. [PMID: 35864261 DOI: 10.1007/s00592-022-01932-w] [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: 04/30/2022] [Accepted: 06/29/2022] [Indexed: 11/01/2022]
Abstract
AIM The aim of the current study is to evaluate the association between below-the-ankle (BTA) arterial disease and coronary artery disease (CAD) in patients with diabetic foot ulcers (DFUs). METHODS The study group was composed of patients with an active neuro-ischaemic DFUs managed in a tertiary care diabetic foot clinic. All patients received a pre-set limb salvage protocol including lower limb revascularization. By a retrospective analysis of individual angiograms, patients were divided in two groups: below-the-ankle (BTA) and above-the-ankle (ATA) arterial disease groups. The rate of CAD at baseline assessment and the new events of acute myocardial ischaemia (AMI) during 1-year of follow-up were evaluated and compared between the two groups. RESULTS Two hundreds seventy-two (272) patients were included, 120 (44.1%) showed BTA arterial disease while 152 (55.9%) ATA arterial disease. The mean age was 68.9 ± 9.6 years, 198 (72.8%) were male, 246 (90.4%) had type 2 diabetes, the mean diabetes duration was 20.7 ± 11.6 years, the mean HbA1c was 7.8 ± 4.2% (62 ± 22 mmmol/mol). The whole population reported CAD in 172 cases (63.4%), and the rate in the BTA group was significantly higher than in ATA group, respectively, 90 (75.4%) vs 82 (54.1%), p < 0.0001. During the follow-up, BTA group had 5% of new cases of AMI in comparison to 1.3% in ATA group (p < 0.001). At the multivariate analysis BTA resulted an independent marker of CAD [OR 1.9 CI 9 5% (1.3-4.5) p = 0.0001]. CONCLUSION The current study shows a significant association between BTA arterial disease and CAD. A close cardiovascular screen should be required in patients with DFUs.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy.
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Laura Giurato
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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Panunzi A, Madotto F, Sangalli E, Riccio F, Sganzaroli AB, Galenda P, Bertulessi A, Barmina MF, Ludovico O, Fortunato O, Setacci F, Airoldi F, Tavano D, Giurato L, Meloni M, Uccioli L, Bruno A, Spinetti G, Caravaggi CMF. Results of a prospective observational study of autologous peripheral blood mononuclear cell therapy for no-option critical limb-threatening ischemia and severe diabetic foot ulcers. Cardiovasc Diabetol 2022; 21:196. [PMID: 36171587 PMCID: PMC9516816 DOI: 10.1186/s12933-022-01629-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 09/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background Cell therapy with autologous peripheral blood mononuclear cells (PB-MNCs) may help restore limb perfusion in patients with diabetes mellitus and critical limb-threatening ischemia (CLTI) deemed not eligible for revascularization procedures and consequently at risk for major amputation (no-option). Fundamental is to establish its clinical value and to identify candidates with a greater benefit over time. Assessing the frequency of PB circulating angiogenic cells and extracellular vesicles (EVs) may help in guiding candidate selection. Methods We conducted a prospective, non-controlled, observational study on no-option CLTI diabetic patients that underwent intramuscular PB-MNCs therapy, which consisted of more cell treatments repeated a maximum of three times. The primary endpoint was amputation rate at 1 year following the first treatment with PB-MNCs. We evaluated ulcer healing, walking capability, and mortality during the follow-up period. We assessed angiogenic cells and EVs at baseline and after each cell treatment, according to primary outcome and tissue perfusion at the last treatment [measured as transcutaneous oxygen pressure (TcPO2)]. Results 50 patients were consecutively enrolled and the primary endpoint was 16%. TcPO2 increased after PB-MNCs therapy (17.2 ± 11.6 vs 39.1 ± 21.8 mmHg, p < .0001), and ulcers healed with back-to-walk were observed in 60% of the study population (88% of survivors) during follow-up (median 1.5 years). Patients with a high level of TcPO2 (≥ 40 mmHg) after the last treatment showed a high frequency of small EVs at enrollment. Conclusions In no-option CLTI diabetic patients, PB-MNCs therapy led to an improvement in tissue perfusion, a high rate of healing, and back-to-walk. Coupling circulating cellular markers of angiogenesis could help in the identification of patients with a better clinical benefit over time. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01629-y.
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Affiliation(s)
| | - Fabiana Madotto
- Value-based Healthcare Unit, IRCCS MultiMedica, Milan, Italy
| | - Elena Sangalli
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | - Federica Riccio
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy
| | | | | | | | | | - Ornella Ludovico
- Diabetic Foot Dpt, IRCCS MultiMedica, Milan, Italy.,Unit of Endocrinology, IRCCS Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | | | | | - Flavio Airoldi
- Interventional Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Davide Tavano
- Interventional Cardiology Unit, IRCCS MultiMedica, Milan, Italy
| | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Rome, Italy
| | - Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Antonino Bruno
- Laboratory of Immunology and General Pathology, Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.,Laboratory of Innate Immunity, Unit of Molecular Pathology, Biochemistry and Immunology, IRCCS MultiMedica, Milan, Italy
| | - Gaia Spinetti
- Laboratory of Cardiovascular Pathophysiology-Regenerative Medicine, IRCCS MultiMedica, Milan, Italy.
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Moral-Sanz J, Lewis SA, MacMillan S, Meloni M, McClafferty H, Viollet B, Foretz M, Del-Pozo J, Mark Evans A. AMPK deficiency in smooth muscles causes persistent pulmonary hypertension of the new-born and premature death. Nat Commun 2022; 13:5034. [PMID: 36028487 PMCID: PMC9418192 DOI: 10.1038/s41467-022-32568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 08/05/2022] [Indexed: 11/10/2022] Open
Abstract
AMPK has been reported to facilitate hypoxic pulmonary vasoconstriction but, paradoxically, its deficiency precipitates pulmonary hypertension. Here we show that AMPK-α1/α2 deficiency in smooth muscles promotes persistent pulmonary hypertension of the new-born. Accordingly, dual AMPK-α1/α2 deletion in smooth muscles causes premature death of mice after birth, associated with increased muscularisation and remodeling throughout the pulmonary arterial tree, reduced alveolar numbers and alveolar membrane thickening, but with no oedema. Spectral Doppler ultrasound indicates pulmonary hypertension and attenuated hypoxic pulmonary vasoconstriction. Age-dependent right ventricular pressure elevation, dilation and reduced cardiac output was also evident. KV1.5 potassium currents of pulmonary arterial myocytes were markedly smaller under normoxia, which is known to facilitate pulmonary hypertension. Mitochondrial fragmentation and reactive oxygen species accumulation was also evident. Importantly, there was no evidence of systemic vasculopathy or hypertension in these mice. Moreover, hypoxic pulmonary vasoconstriction was attenuated by AMPK-α1 or AMPK-α2 deletion without triggering pulmonary hypertension.
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Affiliation(s)
- Javier Moral-Sanz
- Centre for Discovery Brain Sciences and Cardiovascular Science, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Sophronia A Lewis
- Centre for Discovery Brain Sciences and Cardiovascular Science, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Sandy MacMillan
- Centre for Discovery Brain Sciences and Cardiovascular Science, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Marco Meloni
- Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, EH16 4TJ, UK
| | - Heather McClafferty
- Centre for Discovery Brain Sciences and Cardiovascular Science, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK
| | - Benoit Viollet
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
| | - Marc Foretz
- Université Paris Cité, CNRS, INSERM, Institut Cochin, F-75014, Paris, France
| | - Jorge Del-Pozo
- R(D)SVS, University of Edinburgh Easter Bush Campus, EH25 9RG, Roslin, Edinburgh, UK
| | - A Mark Evans
- Centre for Discovery Brain Sciences and Cardiovascular Science, College of Medicine and Veterinary Medicine, Hugh Robson Building, University of Edinburgh, Edinburgh, EH8 9XD, UK.
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21
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Muscoli S, Barillà F, Tajmir R, Meloni M, Della Morte D, Bellia A, Di Daniele N, Lauro D, Andreadi A. The New Role of SGLT2 Inhibitors in the Management of Heart Failure: Current Evidence and Future Perspective. Pharmaceutics 2022; 14:pharmaceutics14081730. [PMID: 36015359 PMCID: PMC9416279 DOI: 10.3390/pharmaceutics14081730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/24/2022] Open
Abstract
The sodium-glucose transporter 2 inhibitors (SGLT2i) are a relatively new class of medication used in the management of type 2 diabetes. Recent clinical trials and research have demonstrated this class’s effectiveness in treating heart failure, since they reduce the risk of cardiovascular events, hospitalization, and mortality. The mechanism by which they do so is unclear; however, SGLT2i inhibit the tubular reabsorption of glucose, lowering the interstitial volume. This mechanism leads to a reduction in blood pressure and an improvement of endothelial function. As a result, improvements in hospitalization and mortality rate have been shown. In this review, we focus on the primary outcome of the clinical trials designed to investigate the effect of SGLT2i in heart failure, regardless of patients’ diabetic status. Furthermore, we compare the various SGLT2i regarding their risk reduction to investigate their potential as a treatment option for patients with reduced ejection fraction and preserved ejection fraction.
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Affiliation(s)
- Saverio Muscoli
- Division of Cardiology, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Francesco Barillà
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Rojin Tajmir
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - David Della Morte
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Internal Medicine—Hypertension, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Internal Medicine—Hypertension, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
- Division of Endocrinology and Diabetology, Department of Medical Sciences, Fondazione Policlinico “Tor Vergata”, 00133 Rome, Italy
- Correspondence:
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22
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Bonnevaux H, Courta J, Passe-Coutrin W, Bauchet AL, Roobrouck A, Amara C, Beys E, Balzano M, Moulard M, Meloni M, Dullaers M, Chiron M, Virone-Oddos A. Abstract 2909: CD123-CODV-TCE bispecific T-cell engager for acute myeloid leukemia (AML): Activity on primary AML and safety in non-human primates. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-2909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Acute myeloid leukemia (AML) is characterized by accumulation of abnormal blast cells in the bone marrow and blood. Although treatments like chemotherapy, allogeneic stem cell transplantation and new biotherapies improve the survival of patients, relapse is common and may be due to residual leukemic stem cells (LSCs). Since LSCs express high levels of CD123 (interleukin-3 receptor), CD123 represents an attractive target for relapsed/refractory (R/R) AML patients. Here, the expression of CD123 on leukemic cells and LSCs from fresh AML patient samples was confirmed, with a similar receptor density ranging from 350 to 12,500 and from 1,200 to 29,000 sites per cell, respectively. Also, the cytotoxic activity of the bispecific T-cell engager (TCE) CD123-CODV-TCE (that binds to CD3 on T cells and CD123 on blast cells) against primary blast cells isolated from the blood of 30 AML patients was evaluated. CD123-CODV-TCE induced high killing of AML blast cells with both high and low CD123 antigen density (from 298 to 18,719 sites per cell). The Effector: Target (E:T) ratio was highly variable among all patients, ranging from less than 1 to more than 100 blast cells for one T cell, and did not impact the activity of CD123-CODV-TCE. Since cytokine release syndrome is associated with TCE therapies, the release of proinflammatory cytokines was monitored in parallel to cytotoxicity. CD123-CODV-TCE induced the release of all tested cytokines (IL-6, IFNγ, TNFα and IL-8) without clear correlation with blast killing efficacy level. Since a similar CD123 expression pattern in human and cynomolgus monkey tissues was found, and CD123-CODV-TCE binds to human and cynomolgus CD3ε and CD123, non-human primates were used for the evaluation of pharmacodynamic effects and safety. A repeat-dose monkey study was performed using a progressive, weekly (X4) intra-monkey dose escalation scheme. The depletion of CD123 positive cells in blood was evidenced from the lowest dose tested (0.1 μg/kg) to the highest (5 µg/kg) with no adverse effects observed at 0.1 µg/kg. The main adverse effect consisted of a marked increase of the level of cytokines at 5 hours following compound administration at 1 μg/kg and above. Importantly, following the dose-escalation scheme 0.1/1/3/3 µg/kg, only limited cytokine release after the 4th administration was observed, suggesting that mitigation of cytokine release can be obtained by progressive intra-monkey dose escalation. Taken together, these results indicate that CD123-CODV-TCE leads to potent and specific leukemic cancer cell killing independently of CD123 receptor density and E:T ratio, and that studies monitoring cytokine release in monkeys can be useful for future clinical development of TCEs in the setting of R/R AML.
Citation Format: Helene Bonnevaux, Jacqueline Courta, Wilfried Passe-Coutrin, Anne-Laure Bauchet, Annelies Roobrouck, Celine Amara, Eric Beys, Marielle Balzano, Maxime Moulard, Marco Meloni, Melissa Dullaers, Marielle Chiron, Angela Virone-Oddos. CD123-CODV-TCE bispecific T-cell engager for acute myeloid leukemia (AML): Activity on primary AML and safety in non-human primates [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2909.
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Meloni M, Perrin P, Slinger E, Maracle C, Fournier A, Acuff N, Mooney J, Igarashi RY, Virone-Oddos A, Chiron M. Abstract 4209: CD38KO K-NK cells prevent NK cell fratricide effect and improve isatuximab-mediated cytotoxicity against multiple myeloma cells. Cancer Res 2022. [DOI: 10.1158/1538-7445.am2022-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Multiple myeloma (MM) is a plasma cell malignancy characterized by clonal accumulation of malignant plasma cells in the bone marrow. CD38 is highly expressed on MM cells, and antibodies targeting CD38 (such as Isatuximab and Daratumumab) induce MM cell killing though several mechanisms, particularly by NK cell-mediated antibody dependent cellular cytotoxicity (ADCC). However, NK cells also express CD38 and treatment with anti-CD38 antibodies results in a rapid decrease of NK cells presumably due to fratricide, which may potentially limit NK cell mediated ADCC and reduce the efficacy of anti-CD38 antibody treatment. NK cells lacking CD38 in combination with Daratumumab have been shown to be resistant to NK cell fratricide and have improved ADCC. Here, we investigated the effect of knocking out CD38 in K-NK cells (CD38KO K-NK) in combination with Isatuximab. Peripheral blood NK cells were isolated from healthy donors and expanded using Kiadis PM21 particle technology (Oyer et al, Cytotherapy 2016) to produce highly activated K-NK cells. To produce CD38KO K-NK cells, CRISPR gene editing was applied during NK cell expansion by electroporating with Cas9/RNP complexes targeting CD38, and successful deletion of CD38 was confirmed by flow cytometry analysis. Analysis of key NK cell receptors by flow cytometry evidenced very similar receptor profiles between WT and CD38KO K-NK cells, suggesting that CD38 deletion does not affect the potent activation state of the K-NK cells. Importantly, CD38KO K-NK cells were found to be resistant to Isatuximab-induced fratricide. The cytotoxic activity of CD38KO K-NK cells in combination with Isatuximab against LP-1 and H929 MM cell lines was also measured. Calcein release assay and Incucyte based analysis revealed that cytotoxicity of CD38KO K-NK cells is enhanced in presence of Isatuximab, and that CD38KO K-NK cells are more cytotoxic than WT when combined with Isatuximab. Furthermore, the effect of Isatuximab/CD38KO K-NK cells combination also in association with SAR444245 (also termed THOR-707; Ptacin et al, Nat Commun 2021), an engineered non-α binding IL-2 that promotes NK cell activation and proliferation, was tested. Cytotoxicity of WT or CD38KO NK cells is enhanced in the presence of SAR444245. Indeed, addition of SAR444245 was found to further enhance the cytotoxic activity of CD38KO K-NK cells against LP-1 MM cells when combined with Isatuximab, resulting in an overall superior and sustained cytotoxicity. These data suggest that deletion of CD38 mitigates NK cell fratricide and improves Isatuximab-mediated ADCC against MM cells, and provide evidence for the therapeutic potential of the triple combination CD38KO NK cells, Isatuximab and SAR444245 in the setting of MM.
Citation Format: Marco Meloni, Pauline Perrin, Erik Slinger, Chrissta Maracle, Alain Fournier, Nicole Acuff, Jill Mooney, Robert Y. Igarashi, Angela Virone-Oddos, Marielle Chiron. CD38KO K-NK cells prevent NK cell fratricide effect and improve isatuximab-mediated cytotoxicity against multiple myeloma cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 4209.
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Abstract
Epidemiologic studies have documented an association between diabetes and increased risk of cognitive decline in the elderly. Based on animal model studies, several mechanisms have been proposed to explain such an association, including central insulin signaling, neurodegeneration, brain amyloidosis, and neuroinflammation. Nevertheless, the exact mechanisms in humans remain poorly defined. It is reasonable, however, that many pathways may be involved in these patients leading to cognitive impairment. A major aim of clinicians is identifying early onset of neurologic signs and symptoms in elderly diabetics to improve quality of life of those with cognitive impairment and reduce costs associated with long-term complications. Several biomarkers have been proposed to identify diabetics at higher risk of developing dementia and diagnose early stage dementia. Although biomarkers of brain amyloidosis, neurodegeneration and synaptic plasticity are commonly used to diagnose dementia, especially Alzheimer disease, their role in diabetes remains unclear. The aim of this review is to explore the molecular mechanisms linking diabetes with cognitive decline and present the most important findings on the clinical use of biomarkers for diagnosing and predicting early cognitive decline in diabetics.
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Affiliation(s)
- Chiara Bellia
- Department of Biomedicine, Neurosciences, and Advanced Diagnostics, University of Palermo, Palermo, Italy.
| | - Mauro Lombardo
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - David Della-Morte
- Department of Human Sciences and Quality of Life Promotion, San Raffaele Open University, Rome, Italy; Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy; Department of Neurology and Evelyn F. McKnight Brain Institute, Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
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25
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Panunzi A, Giurato L, Meloni M, Uccioli L. Bioactive Glass in a Multi Drug Resistance Osteomyelitis in Diabetic Foot: Case Report. INT J LOW EXTR WOUND 2022:15347346221102643. [PMID: 35585695 DOI: 10.1177/15347346221102643] [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] [Indexed: 11/15/2022]
Abstract
Diabetic foot osteomyelitis (DFO) is a clinical problem with high risk of amputation. The treatment of DFO is still an unsolved challenge. Surgical therapy, antibiotic therapy or conservative treatment are still debated for the timing and the consequences. Long antibiotic therapies expose the selection of multidrug-resistant bacteria. Nowadays the use of new bone substitutes aims to support the load of the bone segments and to ensure the eradication of the infectious process after surgical treatment. A case report of digital osteomyelitis due to a multidrug resistant bacteria was treated with a conservative treatment and use of bioglass (Bonalive) that has the ability to inhibit bacterial growth. A long follow-up shows the resolution of infectious process, no ulcer recurrence and persistent recovery of its ability to walk. Our results agree with literature data and suggest that bioglass may be considered a useful option to manage DFO and achieve healing with a very conservative approach.
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Affiliation(s)
- Andrea Panunzi
- 60259Department of Systems Medicine, 9318University of Rome "Tor Vergata", Rome, Italy
| | - Laura Giurato
- 60259Department of Systems Medicine, 9318University of Rome "Tor Vergata", Rome, Italy
| | - Marco Meloni
- 60259Department of Systems Medicine, 9318University of Rome "Tor Vergata", Rome, Italy
| | - Luigi Uccioli
- 60259Department of Systems Medicine, 9318University of Rome "Tor Vergata", Rome, Italy
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Avolio E, Katare R, Thomas AC, Caporali A, Schwenke D, Carrabba M, Meloni M, Caputo M, Madeddu P. Cardiac pericyte reprogramming by MEK inhibition promotes arteriologenesis and angiogenesis of the ischemic heart. J Clin Invest 2022; 132:e152308. [PMID: 35349488 PMCID: PMC9106362 DOI: 10.1172/jci152308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 03/23/2022] [Indexed: 11/17/2022] Open
Abstract
Pericytes (PCs) are abundant yet remain the most enigmatic and ill-defined cell population in the heart. Here, we investigated whether PCs can be reprogrammed to aid neovascularization. Primary PCs from human and mouse hearts acquired cytoskeletal proteins typical of vascular smooth muscle cells (VSMCs) upon exclusion of EGF/bFGF, which signal through ERK1/2, or upon exposure to the MEK inhibitor PD0325901. Differentiated PCs became more proangiogenic, more responsive to vasoactive agents, and insensitive to chemoattractants. RNA sequencing revealed transcripts marking the PD0325901-induced transition into proangiogenic, stationary VSMC-like cells, including the unique expression of 2 angiogenesis-related markers, aquaporin 1 (AQP1) and cellular retinoic acid-binding protein 2 (CRABP2), which were further verified at the protein level. This enabled us to trace PCs during in vivo studies. In mice, implantation of Matrigel plugs containing human PCs plus PD0325901 promoted the formation of αSMA+ neovessels compared with PC only. Two-week oral administration of PD0325901 to mice increased the heart arteriolar density, total vascular area, arteriole coverage by PDGFRβ+AQP1+CRABP2+ PCs, and myocardial perfusion. Short-duration PD0325901 treatment of mice after myocardial infarction enhanced the peri-infarct vascularization, reduced the scar, and improved systolic function. In conclusion, myocardial PCs have intrinsic plasticity that can be pharmacologically modulated to promote reparative vascularization of the ischemic heart.
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Affiliation(s)
- Elisa Avolio
- Bristol Medical School, Translational Health Sciences, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Rajesh Katare
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Anita C. Thomas
- Bristol Medical School, Translational Health Sciences, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Andrea Caporali
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Daryl Schwenke
- Department of Physiology, HeartOtago, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Michele Carrabba
- Bristol Medical School, Translational Health Sciences, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Marco Meloni
- University/BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Massimo Caputo
- Bristol Medical School, Translational Health Sciences, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
| | - Paolo Madeddu
- Bristol Medical School, Translational Health Sciences, and Bristol Heart Institute, University of Bristol, Bristol, United Kingdom
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Meloni M, Giurato L, Panunzi A, Bellia A, Bohbot S, Lauro D, Uccioli L. Effectiveness of Sucrose Octasulfate Dressing in the Treatment of Neuro-Ischaemic Diabetic Foot Heel Ulcers: A Retrospective Single arm Study. INT J LOW EXTR WOUND 2022:15347346221087499. [PMID: 35287510 DOI: 10.1177/15347346221087499] [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] [Indexed: 11/17/2022]
Abstract
The study aimed to evaluate the effectiveness of the use of sucrose octasulfate impregnated dressing (TLC-NOSF [Technology Lipido-Colloid-Nano-OligoSaccharide Factor]) in the management of persons with neuro-ischaemic heel diabetic foot ulcers (DFUs). Consecutive patients who referred for an active non-infected neuro-ischaemic heel DFU belonging to grade IC (superficial) or IIC (deep to tendons, muscle or capsule) according to Texas University Classification were included. All patients were managed by a pre-set limb salvage protocol in the respect of International guidelines and the TLC-NOSF dressing was used as primary and specific dressing. Patients were evaluated any 2 to 4 weeks until wound healing or different outcomes. Primary outcome was the rate of complete wound healing after 24 weeks of follow-up. The secondary outcomes assessed the healing time, the rate of wound regression, the re-ulceration in the case of complete healing and the safety. Thirty patients were included. The mean age was 67 ± 11 years, 17 (56.7%) were male, all of them were affected by type 2 diabetes with a mean duration of 18 ± 7 years. Twenty patients (66.7%) showed deep ulcers (grade 2 of Texas University Classification); the mean TcPO2 at the inclusion was 42 ± 7 mm Hg. Twenty-two patients (73.3%) healed by Week 24. The mean time of healing was 84 ± 32 days, 2 (6.7%) patients had ulcer relapse after healing, 28 (93.3%) had wound regression >50%, 2 (6.7%) had mild infection, 1 (3.3%) reported major amputation. No serious adverse events related to TLC-NOSF dressing or local reactions were reported. This current study showed the potential benefit of sucrose octasulfate for treating neuro-ischaemic heel DFUs in addition to the standard of care.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
| | - Laura Giurato
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
| | - Andrea Panunzi
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
| | | | - Davide Lauro
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, 9318University of Rome Tor Vergata, Rome, Italy
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Bellia A, Meloni M, Andreadi A, Uccioli L, Lauro D. Geographic and Ethnic Inequalities in Diabetes-Related Amputations. Front Clin Diabetes Healthc 2022; 3:855168. [PMID: 36992760 PMCID: PMC10012100 DOI: 10.3389/fcdhc.2022.855168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022]
Abstract
Individuals with diabetes mellitus are at increasing risk for major lower-extremity amputations (LEAs). Poor quality of life and remarkable disabilities are associated with LEAs, determining a high economic burden for the healthcare systems. Reducing LEAs is therefore a primary marker of quality of care of the diabetic foot. At global level, between-countries comparisons of LEAs rates are basically hampered by differences in criteria used for data collection and analysis among studies. Significant variability in amputation rates exists between geographic areas, and also within specific regions of a country. Overall 5-year mortality rate after major amputations is reported to vary substantially across countries, from 50 to 80%. The odds of LEAs are substantially higher for Black, Native American and Hispanic ethnicities compared with White groups, with similar figures observed in the economically disadvantaged areas compared to more developed ones. Such discrepancies may reflect differences in diabetes prevalence as well as in financial resources, health-care system organization and management strategies of patients with diabetic foot ulcers. Looking at the experience of countries with lower rates of hospitalization and LEAs worldwide, a number of initiatives should be introduced to overcome these barriers. These include education and prevention programs for the early detection of diabetic foot at primary care levels, and the multidisciplinary team approach with established expertise in the treatment of the more advanced stage of disease. Such a coordinated system of support for both patients and physicians is highly required to reduce inequalities in the odd of diabetes-related amputations worldwide.
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Affiliation(s)
- Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
- *Correspondence: Alfonso Bellia,
| | - Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Aikaterini Andreadi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- Unit of Endocrinology and Diabetes, University Hospital Policlinico Tor Vergata, Rome, Italy
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Alépée N, Grandidier M, Teluob S, Amaral F, Caviola E, De Servi B, Martin S, Meloni M, Nardelli L, Pasdelou C, Tagliati V, Viricel A, Adriaens E, Michaut V. Validation of the SkinEthic HCE time-to-toxicity test method for eye hazard classification of chemicals according to UN GHS. Toxicol In Vitro 2022; 80:105319. [DOI: 10.1016/j.tiv.2022.105319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/21/2021] [Accepted: 01/19/2022] [Indexed: 10/19/2022]
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Andreadi A, Bellia A, Di Daniele N, Meloni M, Lauro R, Della-Morte D, Lauro D. The molecular link between oxidative stress, insulin resistance, and type 2 diabetes: A target for new therapies against cardiovascular diseases. Curr Opin Pharmacol 2021; 62:85-96. [PMID: 34959126 DOI: 10.1016/j.coph.2021.11.010] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 02/07/2023]
Abstract
Type 2 Diabetes Mellitus (T2D) is a chronic disease with a pandemic incidence whose pathogenesis has not yet been clarified. Raising evidence highlighted the role of oxidative stress in inducing insulin resistance, pancreatic beta-cell dysfunction, and leading to cardiovascular disease (CVD). Therefore, understanding the link between oxidative stress, T2D and CVD may help to further understand the pathological processes beyond this association, to personalize the algorithm of the cure, and to find new therapeutic targets. Here, we discussed the role of oxidative stress and the decrease of antioxidant defenses in the pathogenesis of T2D. Furthermore, some aspects of hypoglycemic therapies and their potential role as antioxidant agents were examined, which might be pivotal in preventing CVD in T2D patients.
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Affiliation(s)
- Aikaterini Andreadi
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Renato Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - David Della-Morte
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy; San Raffaele Rome Open University, Rome, Italy; Department of Neurology, Evelyn F. McKnight Brain Institute, Miller School, Miami, USA
| | - Davide Lauro
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy; University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy.
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Boschetti G, Sgarabotto D, Meloni M, Bruseghin M, Whisstock C, Marin M, Ninkovic S, Pinfi M, Brocco E. Antimicrobial Resistance Patterns in Diabetic Foot Infections, an Epidemiological Study in Northeastern Italy. Antibiotics (Basel) 2021; 10:antibiotics10101241. [PMID: 34680820 PMCID: PMC8532857 DOI: 10.3390/antibiotics10101241] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/21/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
This study is a retrospective epidemiological assessment of bacterial species isolated from a cohort of out-patients with diabetic foot infections referred to our “Diabetic Foot Unit” over one year, with particular attention to index pathogens, as identified by the EARS Network. Staphylococcus aureus and Pseudomonas aeruginosa accounted for 33.5% and 11.9% of cases, respectively. MRSA was isolated in 27.1% of patients, with 14.06% showing additional resistance to three antimicrobial classes. Pseudomonas aeruginosa presented extensive resistance to fluoroquinolones (57.3%), which was associated with resistance to piperacillin in 17.6% or to carbapenems in 23.5% of cases. Other pathogens, such as methicillin resistantStaphylococcus epidermidis, Escherichia coli and Morganella morganii ESBL and Enterococcus faecium VRE, were also found.
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Affiliation(s)
- Giovanni Boschetti
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
- Correspondence: or ; Tel.: +39-(34)-90595578
| | | | - Marco Meloni
- U.O. Medicina del Piede Diabetico, Università di Tor Vergata, 00133 Rome, Italy;
| | - Marino Bruseghin
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
| | - Christine Whisstock
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
| | - Mariagrazia Marin
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
| | - Sasa Ninkovic
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
| | - Michela Pinfi
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
| | - Enrico Brocco
- U.O. Piede Diabetico, Policlinico Abano Terme, 35031 Padova, Italy; (M.B.); (C.W.); (M.M.); (S.N.); (M.P.); (E.B.)
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Bouillet B, Ahluwalia R, Iacopi E, Garcia-Klepzig JL, Lüdemann C, Manu C, Meloni M, Saenz De Buruaga VR, Vouillarmet J, Petit JM, Van Acker K, Lázaro-Martínez JL. Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays. J Wound Care 2021; 30:804-808. [PMID: 34644141 DOI: 10.12968/jowc.2021.30.10.804] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. METHOD In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. RESULTS Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). CONCLUSION The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
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Affiliation(s)
- Benjamin Bouillet
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
| | | | - Elisabetta Iacopi
- University of Pisa, Ospedale di Cisanello, via Paradisa 2, 56126 Pisa, Italy
| | | | - Claas Lüdemann
- Franziskus Krankenhaus Berlin, Budapester Strasse, 15-19, 10787 Berlin, Germany
| | - Chris Manu
- King's College Hospital, Denmark Hill, London, UK
| | - Marco Meloni
- University of Roma Tor Vergata, Viale Oxford 81, 00133 Roma, Italy
| | | | - Julien Vouillarmet
- CHU Lyon Sud, Pavillon Médical, 165 chemin du Grand Revoyet 69495 Pierre Bénite, France
| | - Jean-Michel Petit
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Dijon, France.,Unité INSERM, LNC-UMR 1231, Université de Bourgogne, Dijon, France
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Bouillet B, Meloni M, Ahluwalia R. Improving referral of patients with diabetic foot ulcer to specialised diabetes foot care units. J Wound Care 2021; 30:782-784. [PMID: 34644130 DOI: 10.12968/jowc.2021.30.10.782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Benjamin Bouillet
- Department of Endocrinology, Diabetes and Metabolic Disorders, Dijon University Hospital, France; INSERM Unit, LNC-UMR 1231, University of Burgundy, Dijon, France
| | | | - Raju Ahluwalia
- Department of Orthopaedics and King's Diabetes Foot Clinic, King's College Hospital, Denmark Hill, London, UK
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Meloni M, Lazaro-Martínez JL, Ahluwalia R, Bouillet B, Izzo V, Di Venanzio M, Iacopi E, Manu C, Garcia-Klepzig JL, Sánchez-Ríos JP, Lüedemann C, De Buruaga VRS, Vouillarmet J, Guillaumat J, Aleandri AR, Giurato L, Edmonds M, Piaggesi A, Van Acker K, Uccioli L. Effectiveness of fast-track pathway for diabetic foot ulcerations. Acta Diabetol 2021; 58:1351-1358. [PMID: 33942178 PMCID: PMC8413149 DOI: 10.1007/s00592-021-01721-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 04/12/2021] [Indexed: 01/22/2023]
Abstract
AIM To investigate the effectiveness of fast-track pathway (FTP) in the management of diabetic foot ulceration (DFU) after 2 years of implementation. METHODS The study group was composed of patients who referred to a specialized DF centre due to DFUs. Those were divided in two groups: early referral (ER) and late referral (LR) patients. According to FTP, ER were considered patients who referred after 2 weeks in the case of uncomplicated non-healing ulcers (superficial, not infected, not ischemic), within 4 days in the case of complicated ulcers (ischemic, deep, mild infection) and within 24 h in the case of severely complicated ulcers (abscess, wet gangrene, fever). Healing, healing time, minor and major amputation, hospitalization, and survival were evaluated. The follow-up was 6 months. RESULTS Two hundred patients were recruited. The mean age was 70 ± 13 years, 62.5% were male, 91% were affected by type 2 diabetes with a mean duration of 18 ± 11 years. Within the group, 79.5% had ER while 20.5% had LR. ER patients showed increased rates of healing (89.9 vs. 41.5%, p = 0.001), reduced healing time (10 vs. 16 weeks, p = 0.0002), lower rates of minor (17.6 vs. 75.6%, p < 0.0001) and major amputation (0.6 vs. 36.6%, p < 0.0001), hospitalization (47.1 vs. 82.9%, p = 0.001), and mortality (4.4 vs. 19.5%, p = 0.02) in comparison to LR. At multivariate analysis, ER was an independent predictor of healing, while LR was an independent predictor for minor and major amputation and hospitalization. CONCLUSION After the FTP implementation, less cases of LR were reported in comparison to ER. ER was an independent predictor of positive outcomes such as healing, healing time, limb salvage, hospitalization, and survival.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy.
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic Department, King ́s College Hospital, London, UK
| | | | - Valentina Izzo
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | | | - Elisabetta Iacopi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | - Chris Manu
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | | | | | | | | | | | | | | | - Laura Giurato
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
| | - Micheal Edmonds
- Diabetic Foot Clinic, King's College Hospital, Denmark Hill, London, UK
| | - Alberto Piaggesi
- Diabetic Foot Section, University of Pisa, Ospedale Di Cisanello, Pisa, Italy
| | | | - Luigi Uccioli
- Diabetic Foot Unit, University of Rome Tor Vergata, Viale Oxford 81, 00133, Rome, Italy
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Meloni M, Izzo V, Giurato L, Da Ros V, Morosetti D, Ferrannini M, Brocco E, Gandini R, Uccioli L. Peripheral arterial disease in patients with renal-diabetic foot ulcers. J Wound Care 2021; 30:660-664. [PMID: 34382847 DOI: 10.12968/jowc.2021.30.8.660] [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] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe the angiographic characteristics of peripheral arterial disease (PAD) in persons with diabetic foot ulcers (DFUs) on dialysis treatment. METHOD The study is a retrospective analysis of patients with DFUs and PAD who had been referred to our diabetic foot clinic. All patients had been managed by a pre-set limb salvage protocol including revascularisation of the affected limb. Arterial lesions (stenosis between 50-99% and occlusions) were retrospectively evaluated through angiogram analysis. According to the presence or not of dialysis, patients were divided into two patient groups: renal-diabetic foot (RDF) and diabetic foot (DF). Distribution of PAD and immediate revascularisation outcome (technical revascularisation outcome) for RDF and DF were separately reported and compared. RESULTS The sample included 239 patients: mean age was 71.8 years; 72.4% were male; 87.4% had type 2 diabetes; mean diabetes duration was 21.4 years; and the mean HbA1c was 63±22mmol/mol. The RDF group compared with the DF group reported higher numbers of vessels affected (n=5±1.6 versus 3.9±1.5, respectively, p<0.0001), greater involvement of the superficial femoral artery (90.2% versus 75.8%, respectively, p=0.003), the tibial-peroneal trunk (53.7% versus 25.5%, respectively, p=0.01), the anterior tibial artery (93.9% versus 80.9%, respectively, p=0.03) and below-the-ankle (BTA) arteries (70.7% versus 35.7%, respectively, p=0.0001). The RDF group showed a higher rate of revascularisation failure in comparison to DF patients (43.9% versus 15.3%, respectively, p<0.0001). BTA arterial disease (odds ratio 9.5; 95% Confidence Interval: 3.5-25.4; p=0.0001) resulted as the only independent predictor of revascularisation failure. CONCLUSION In this study, RDF patients showed a widespread distribution of arterial lesions with a higher involvement of foot arteries in comparison with DF patients. BTA arterial disease was found to be an independent predictor of revascularisation failure.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Italy
| | - Valentina Izzo
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Italy
| | - Laura Giurato
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Italy
| | - Valerio Da Ros
- Department of Interventional Radiology, University of Rome 'Tor Vergata', Italy
| | - Daniele Morosetti
- Department of Interventional Radiology, University of Rome 'Tor Vergata', Italy
| | - Michele Ferrannini
- Division of Hypertension and Nephrology, Department of Systems Medicine, University of Rome 'Tor Vergata', Italy
| | - Enrico Brocco
- Diabetic Foot Unit, Foot and Ankle Clinic, Abano Terme Polyclinic, Italy
| | - Roberto Gandini
- Department of Interventional Radiology, University of Rome 'Tor Vergata', Italy
| | - Luigi Uccioli
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome 'Tor Vergata', Italy
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Ortillon J, Le Bail JC, Villard E, Léger B, Poirier B, Girardot C, Beeske S, Ledein L, Blanchard V, Brieu P, Naimi S, Janiak P, Guillot E, Meloni M. High Glucose Activates YAP Signaling to Promote Vascular Inflammation. Front Physiol 2021; 12:665994. [PMID: 34149446 PMCID: PMC8213390 DOI: 10.3389/fphys.2021.665994] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/11/2021] [Indexed: 12/17/2022] Open
Abstract
Background and Aims The YAP/TAZ signaling is known to regulate endothelial activation and vascular inflammation in response to shear stress. Moreover, YAP/TAZ signaling plays a role in the progression of cancers and renal damage associated with diabetes. However, whether YAP/TAZ signaling is also implicated in diabetes-associated vascular complications is not known. Methods The effect of high glucose on YAP/TAZ signaling was firstly evaluated in vitro on endothelial cells cultured under static conditions or subjected to shear stress (either laminar or oscillatory flow). The impact of diabetes on YAP/TAZ signaling was additionally assessed in vivo in db/db mice. Results In vitro, we found that YAP was dephosphorylated/activated by high glucose in endothelial cells, thus leading to increased endothelial inflammation and monocyte attachment. Moreover, YAP was further activated when high glucose was combined to laminar flow conditions. YAP was also activated by oscillatory flow conditions but, in contrast, high glucose did not exert any additional effect. Interestingly, inhibition of YAP reduced endothelial inflammation and monocyte attachment. Finally, we found that YAP is also activated in the vascular wall of diabetic mice, where inflammatory markers are also increased. Conclusion With the current study we demonstrated that YAP signaling is activated by high glucose in endothelial cells in vitro and in the vasculature of diabetic mice, and we pinpointed YAP as a regulator of high glucose-mediated endothelial inflammation and monocyte attachment. YAP inhibition may represent a potential therapeutic opportunity to improve diabetes-associated vascular complications.
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Affiliation(s)
- Jeremy Ortillon
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | | | - Elise Villard
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Bertrand Léger
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Bruno Poirier
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | | | - Sandra Beeske
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Laetitia Ledein
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Véronique Blanchard
- Molecular Histopathology and Bio-Imaging Translational Sciences, Sanofi R&D, Chilly-Mazarin, France
| | - Patrice Brieu
- Molecular Histopathology and Bio-Imaging Translational Sciences, Sanofi R&D, Chilly-Mazarin, France
| | - Souâd Naimi
- Molecular Histopathology and Bio-Imaging Translational Sciences, Sanofi R&D, Chilly-Mazarin, France
| | - Philip Janiak
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Etienne Guillot
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
| | - Marco Meloni
- Cardiovascular Research Unit, Sanofi R&D, Chilly-Mazarin, France
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Morosetti D, Chiocchi M, Argirò R, Salimei F, Nezzo M, Vidali S, Gasparrini F, Meloni M, Uccioli L, Gandini R. Endovascular treatment of calcific lesions of the common femoral artery using atherectomy device associated with scoring balloon angioplasty in diabetic patients with high "major amputation" risk. Vascular 2021; 30:463-473. [PMID: 34056973 DOI: 10.1177/17085381211019244] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate the outcomes of patients with calcific lesions in the common femoral artery undergoing endovascular procedures with atherectomy device and scoring balloon angioplasty combined with treatment of steno-occlusive disease of the remaining arterial districts of the lower limb. METHODS Between January 2015 and December 2018, 11 diabetic patients at high risk for "major amputation", with calcific lesions of the common femoral artery and ischemic ulcers requiring endovascular treatment were retrospectively evaluated. Technical success was defined as revascularization of the common femoral artery with a residual stenosis lower than 30%. Primary endpoints were an immediate increase of perilesional transcutaneous oxygen pressure (TCPO2) > 40 mmHg, ulcerative lesions improvement up to healing or skin flaps re-epithelialization after minor amputation, limb rescue with rejected major amputation, and resolution of rest pain if present. RESULTS The success rate of the revascularization procedures was 100%. No patient underwent surgical conversion. One case of peri-operative bleeding at the brachial access site was observed. There were no cases of arterial dissection or undesired distal embolization. The average baseline value of perilesional TCPO2 was 21.8 ± 9.2 mmHg. The mean TCPO2 value was 57.4 ± 7.2 mmHg three days after the procedure (P < 0.05), and 51.2 ± 9.8 mmHg 15 days after (P < 0.05). Minor amputations were performed in five patients with advanced ulcerative lesions. No major amputations were performed in the follow-up period. At 14 months follow-up, one patient developed new occlusion of the CFA for extension from the external iliac artery and underwent a new endovascular procedure. We observed an overall primary patency rate of 91% and a primary assisted patency rate of 100% in our 18-month follow-up. CONCLUSIONS Endovascular approach for severely calcified atherosclerotic lesions of the common femoral artery seems to represent a valid therapeutic option associated with promising results in terms of clinical outcome and low complication rates.
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Affiliation(s)
- Daniele Morosetti
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marcello Chiocchi
- UOC Diagnostica per Immagini, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Renato Argirò
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Fabio Salimei
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marco Nezzo
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Sofia Vidali
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Fulvio Gasparrini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Marco Meloni
- Diabetic foot Unit, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Luigi Uccioli
- Diabetic foot Unit, University Hospital Policlinico Tor Vergata, Roma, Italy
| | - Roberto Gandini
- UOSD Radiologia Interventistica, University Hospital Policlinico Tor Vergata, Roma, Italy
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Barabino S, Benitez-Del-Castillo JM, Fuchsluger T, Labetoulle M, Malachkova N, Meloni M, Utheim TP, Rolando M. Dry eye disease treatment: the role of tear substitutes, their future, and an updated classification. Eur Rev Med Pharmacol Sci 2021; 24:8642-8652. [PMID: 32964952 DOI: 10.26355/eurrev_202009_22801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The aim of this review is to summarize the results of a consensus meeting held by a group of experts in dry eye disease (DED) to discuss the importance of tear substitutes in the treatment of DED. The meeting focused especially on the main characteristics of lacrimal substitutes, the development of in vitro models to investigate DED pathophysiology and treatment, the importance of conducting rigorous clinical trials, the requirements of the upcoming European Legislation on medical devices, the advances in the formulation of safer preservatives, the peculiarities of treatment in younger subjects, and the importance of an updated terminology for lacrimal substitutes. MATERIALS AND METHODS A literature search was conducted using MEDLINE, with different combinations of pertinent keywords, depending on the subject under discussion, such as "dry eye disease"; "tear substitutes"; "in vitro models"; "ocular surface"; "clinical trials"; "European Regulation"; "preservatives" "younger patients". Also, each author included in the discussion selected articles from their personal library. Using a consensus-based method called nominal group technique to reach a conclusion and proposal for a new classification of eye drops used to improve the tear film and ocular surface epithelia, the experts also conducted a round table meeting. RESULTS The new terms proposed by the authors are "wetting agents", "multiple-action tear substitutes" or "ocular surface modulators". The new classification is needed to distinguish eye drops used to improve the tear film and ocular surface epithelia, in line with the new definition of DED, which recognizes the loss of ocular homeostasis, and the creation of a vicious circle of chronic inflammation and ocular damage as fundamental aspects of DED pathophysiology. CONCLUSIONS Although tear substitutes have been historically used to provide eye lubrication to the ocular surface, recent advances in the pathophysiology of dry eye disease (DED) clarified that treatment should not just focus on tear film quality or quantity, but address the loss of homeostasis of the ocular surface, blocking the vicious circle of chronic inflammation and ocular damage. Given the scant comparative evidence on tear substitutes currently on the market, further studies should focus on developing new agents, considering the advantages provided by in vitro models, importance of conducting rigorous clinical trials, availability of less harmful preservatives and obligations related to the new European legislation on medical devices. Based on the discussion of these topics, a group of experts held a consensus meeting to identify new and more appropriate terms for different tear substitutes. The proposed terms are wetting agents, multiple-action tear substitutes and ocular surface modulators. Regardless of the agent used, it is important to note that tear substitutes represent one of many options for DED treatment, which should not overlook the psychological aspects of the disease and the peculiarities of younger subjects, who seem to have a higher risk for DED, possibly related to digital devices excessive use.
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Affiliation(s)
- S Barabino
- Ocular Surface and Dry Eye Center, Ospedale L. Sacco, University of Milan, Milan, Italy.
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Giménez DR, Taverna A, Meloni M, Correa N, Sylvester F, Tatián M. A new record of Ascidiella scabra (Müller, 1776) (Ascidiacea, Phlebobranchia) in the southwestern Atlantic. CheckList 2021. [DOI: 10.15560/17.3.723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Non-indigenous ascidians are transported across oceans in vessel-hull fouling communities, and regional traffic plays a role in their secondary spread. We found the ascidian Ascidiella scabra (Müller, 1776) in the hull-fouling community of an oceanographic vessel confined to waters of the southwestern Atlantic and Southern Oceans. The previously known distribution of this species was restricted to its native area (Mediterranean Sea and northeastern Atlantic); its presence in the southwestern Atlantic may have been masked in the past by the occurrence of its congener Ascidiella aspersa (Müller, 1776).
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Nguembu S, Meloni M, Endalle G, Dokponou H, Dada OE, Kanmounye US. P88 Paroxysmal sympathetic storm and the role of beta-blockers in traumatic brain injury: a scoping review protocol. BJS Open 2021. [PMCID: PMC8030136 DOI: 10.1093/bjsopen/zrab032.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Most cases of paroxysmal sympathetic hyperactivity (PSH) result from traumatic brain injury (TBI). Little is known about its pathophysiology and treatment, and several neuroprotective drugs are used including beta-blockers. The aim of our study is to collate existing evidence of the role of beta-blockers in the treatment of PSH. Method We will search MEDLINE, Web of Science, EMBASE, Cochrane, and Google Scholar. The search terms used will cover the following terms: “paroxysmal sympathetic hyperactivity”, “traumatic brain injury” and “beta-blockers.”: No language or geographical restrictions will be applied. Two independent co-authors will screen the titles and abstracts of each article following predefined inclusion and exclusion criteria. If there is a conflict the two reviewers will find a consensus and if they cannot a third co-author will decide. Using a pre-designed and pre-piloted data extraction form, data from each included citation will be collected (authors identification, study type, TBI severity, type of beta-blockers used, dosage of the drug, clinical signs of PSH, Glasgow Coma Scale, Glasgow Outcome Scale, mortality, morbidity and length of stay). Simple descriptive data analyses will be performed and the results will be presented both in a narrative and tabular form. Results The effectiveness of beta-blockers in post-TBI PHS will be evaluated through clinical signs of PHS(increased heart rate, respiratory rate, temperature, blood pressure, and sweating), Glasgow Coma Scale, and Glasgow Outcome Scale. mortality, morbidity and length of stay. Conclusion At the end of this scoping review we will design a systematic review with metaanalysis if there are a reasonable number of studies otherwise we will design a randomized controlled trial.
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Affiliation(s)
- Stéphane Nguembu
- Research department of association of future African neurosurgeons
| | - Marco Meloni
- Research department of association of future African neurosurgeons
| | | | - Hugues Dokponou
- Research department of association of future African neurosurgeons
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Meloni M, Acquati S, Licciardello C, Ludovico O, Sepe M, Vermigli C, Da Ros R. Barriers to diabetic foot management in Italy: A multicentre survey in diabetic foot centres of the Diabetic Foot Study Group of the Italian Society of Diabetes (SID) and Association of Medical Diabetologists (AMD). Nutr Metab Cardiovasc Dis 2021; 31:776-781. [PMID: 33549455 DOI: 10.1016/j.numecd.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 10/12/2020] [Accepted: 10/13/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Diabetic foot (DF) disease is a current health and social burden. The authors aimed to identify the barriers to the DF management across Italy. METHODS AND RESULTS A questionnaire was submitted to Italian centres dedicated to DF care. The questionnaire was composed of 12 questions focused on the barriers to the DF management including timing of referral, hospital management, and community follow-up. Each centre could answer by choosing a score from 1 to 5 for every item with the following numerical variables: 1 = never; 2 = rarely; 3 = sometimes; 4 = often; 5 = always. Accordingly, for each item a national and regional score was reported and a comparison between regions was carried out. National and regional scores were estimated using the total score for each item as a numerator and the number of national centres included as a denominator. Among 102 centres, 99 were included and 3 were excluded due to missing data. The 99 centres belonged to 16 regions with the following distribution: Calabria 4, Campania 5, Emilia-Romagna 14, Friuli-Venezia-Giulia 4, Lazio 12, Liguria 4, Lombardy 10, Marche 1, Molise 1, Piedmont 5, Apulia 5, Sardinia 5, Sicily 4, Tuscany 11, Veneto 9, Umbria 5. The items with the highest score were late referral (3.3) and urgent surgery (3.2). The regions with the highest score were Molise (3.9) and Calabria (3.5). CONCLUSION The main issues across Italy were late referral and the requirement for urgent surgery for acute DF. In the regional scenario, the southern central areas showed more barriers than northern regions.
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Affiliation(s)
- Marco Meloni
- Diabetic Foot Unit, Department of Systems Medicine, University of Rome Tor Vergata, Italy.
| | - Silvia Acquati
- Unit of Endocrinology, Pierantoni-Morgagni Hospital, Forlì AUSL Romagna, Italy
| | - Carmelo Licciardello
- UFC Malattie disendocrine e dismetaboliche, Centro Catanese di Medicina e Chirurgia, Catania, Italy
| | - Ornella Ludovico
- Unit of Endocrinology, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | | | - Cristiana Vermigli
- Unit of Endocrinology, Diabetic Foot Centre, University Hospital Santa Maria della Misericordia, Perugia, Italy
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Meloni M, Bouillet B, Ahluwalia R, Lüdemann C, Sánchez‐Ríos JP, Iacopi E, Lazaro‐Martinez JL. Fast-track pathway for diabetic foot ulceration during COVID-19 crisis: A document from International Diabetic Foot Care Group and D-Foot International. Diabetes Metab Res Rev 2021; 37:e3396. [PMID: 32804425 PMCID: PMC7460948 DOI: 10.1002/dmrr.3396] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/07/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Marco Meloni
- Diabetic Foot CenterUniversity of Tor VergataRomeItaly
| | | | - Raju Ahluwalia
- Department of Trauma and Ortophaedic DepartmentKing's College HospitalLondonUK
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Spiroski AM, Sanders R, Meloni M, McCracken IR, Thomson A, Brittan M, Gray GA, Baker AH. The Influence of the LINC00961/SPAAR Locus Loss on Murine Development, Myocardial Dynamics, and Cardiac Response to Myocardial Infarction. Int J Mol Sci 2021; 22:ijms22020969. [PMID: 33478078 PMCID: PMC7835744 DOI: 10.3390/ijms22020969] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/07/2021] [Accepted: 01/14/2021] [Indexed: 01/14/2023] Open
Abstract
Long non-coding RNAs (lncRNAs) have structural and functional roles in development and disease. We have previously shown that the LINC00961/SPAAR (small regulatory polypeptide of amino acid response) locus regulates endothelial cell function, and that both the lncRNA and micropeptide counter-regulate angiogenesis. To assess human cardiac cell SPAAR expression, we mined a publicly available scRNSeq dataset and confirmed LINC00961 locus expression and hypoxic response in a murine endothelial cell line. We investigated post-natal growth and development, basal cardiac function, the cardiac functional response, and tissue-specific response to myocardial infarction. To investigate the influence of the LINC00961/SPAAR locus on longitudinal growth, cardiac function, and response to myocardial infarction, we used a novel CRISPR/Cas9 locus knockout mouse line. Data mining suggested that SPAAR is predominantly expressed in human cardiac endothelial cells and fibroblasts, while murine LINC00961 expression is hypoxia-responsive in mouse endothelial cells. LINC00961–/– mice displayed a sex-specific delay in longitudinal growth and development, smaller left ventricular systolic and diastolic areas and volumes, and greater risk area following myocardial infarction compared with wildtype littermates. These data suggest the LINC00961/SPAAR locus contributes to cardiac endothelial cell and fibroblast function and hypoxic response, growth and development, and basal cardiovascular function in adulthood.
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Affiliation(s)
- Ana-Mishel Spiroski
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Rachel Sanders
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Marco Meloni
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Ian R. McCracken
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Adrian Thomson
- Edinburgh Preclinical Imaging, Edinburgh Preclinical Imaging, BHF Centre for Cardiovascular Science, University of Edinburgh, Edinburgh EH16 4TJ, UK;
| | - Mairi Brittan
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Gillian A. Gray
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
| | - Andrew H. Baker
- Centre for Cardiovascular Science, Queens Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, UK; (A.-M.S.); (R.S.); (M.M.); (I.R.M.); (M.B.); (G.A.G.)
- Correspondence: ; Tel.: +44-0131-24-26728
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Meloni M, Izzo V, Da Ros V, Morosetti D, Stefanini M, Brocco E, Giurato L, Gandini R, Uccioli L. Characteristics and Outcome for Persons with Diabetic Foot Ulcer and No-Option Critical Limb Ischemia. J Clin Med 2020; 9:E3745. [PMID: 33233329 PMCID: PMC7700155 DOI: 10.3390/jcm9113745] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/14/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022] Open
Abstract
The study aimed to evaluate clinical and vascular characteristics, as well as outcomes, for diabetic persons with foot ulceration and no-option critical limb ischemia (CLI). The study group included a sample of patients admitted to our diabetic foot unit because of a new diabetic foot ulcer and CLI. All subjects were managed using a limb salvage protocol which includes lower-limb revascularization. According to whether or not the revascularization procedure was a success, patients were respectively divided into two groups: successfully treated CLI patients (ST-CLI) and no-option CLI patients (NO-CLI). Failed revascularization was considered in the case of technical recanalization failure of occluded vessels (inability to overcome the obstruction) and/or absence of arterial flow to the foot. Limb salvage, major amputation, and death after 1 year of follow-up were evaluated and compared between the two groups. Overall, 239 patients were included, 74.9% belonging to ST-CLI and 25.1% to NO-CLI. NO-CLI patients reported more cases of ischemic heart disease (80 vs. 62.1, p = 0.008), heart failure (63.3 vs. 32.4%, p < 0.0001), and end-stage renal disease (ESRD) (60 vs. 25.7%) than ST-CLI patients. In addition, more vessels were affected in the NO-CLI group (5.2 ± 1.6 vs. 4 ± 1.5, p < 0.0001), and there was more involvement of tibio-peroneal trunk (50 vs. 30.2%, p = 0.006), anterior tibial (93.3 vs. 82.7, p = 0.03), posterior tibial (93.3 vs. 73.7%, p = 0.0005), peroneal (70 vs. 48%, p = 0.002), and below-the-ankle arteries (73.3 vs. 39.1%, p < 0.0001) than ST-CLI. The 1 year outcomes for the whole population were 69.9% limb salvage, 10.9% major amputation, and 19.2% death. The outcomes for NO-CLI and ST-CLI were, respectively, as follows: limb salvage (13.8 vs. 73.4%, p < 0.0001), amputation (30 vs. 4.5%, p = 0.0001), and mortality (50 vs. 8.9%, p < 0.0001). NO-CLI patients showed a more severe pattern of peripheral arterial disease (PAD) with distal arterial lesions and worse outcomes than ST-CLI.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.I.); (L.G.); (L.U.)
| | - Valentina Izzo
- Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.I.); (L.G.); (L.U.)
| | - Valerio Da Ros
- Department of Biomedicine and Prevention, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.D.R.); (D.M.)
| | - Daniele Morosetti
- Department of Biomedicine and Prevention, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.D.R.); (D.M.)
| | - Matteo Stefanini
- Department of Radiology, Policlinico Casilino, Via Casilina 1049, 00169 Rome, Italy;
| | - Enrico Brocco
- Department of Foot and Ankle, Polyclinic Abano Terme, 35031 Abano Terme, Italy;
| | - Laura Giurato
- Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.I.); (L.G.); (L.U.)
| | - Roberto Gandini
- Department of Interventional Radiology, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy;
| | - Luigi Uccioli
- Department of Systems Medicine, University of Tor Vergata, Viale Oxford 81, 00133 Rome, Italy; (V.I.); (L.G.); (L.U.)
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Avolio E, Thomas A, Caporali A, Meloni M, Caputo M, Madeddu P. A short term treatment with a Mek1/2 inhibitor promotes myocardial arteriogenesis and perfusion in vivo: focus on cardiac mural cells. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Arteriogenesis is crucial for heart recovery after ischaemia, but cellular and molecular mechanisms able to foster this phenomenon are still poorly characterised.
Purpose
To discover novel pro-arteriogenic approaches by exploiting cardiac mural cells endowed with arteriogenic capacity: pericytes (PCs) and vascular smooth muscle cells (VSMCs).
Methods and results
We derived human and murine CD31neg CD34pos cardiac PCs (cPCs) from myocardial samples of adult subjects and confirmed the pericyte phenotype and function in vitro. We discovered that the withdrawal of EGF and bFGF from the culture media induces the differentiation of cPCs into contractile VSMCs. Molecular investigations of pathways associated with the two factors showed that the Mek1/2-Erk1/2 signalling exerts an inhibitory transcriptional control on contractile VSMC genes. Screening of compounds able to interfere with this pathway revealed that PD0325901 – a potent Mek1/2 inhibitor (MeKi) tested in clinical trials for the treatment of cancer – activates the VSMC phenotype in cPCs. We observed a similar effect on coronary artery VSMCs. Next, we interrogated the effect of PD0325901 on cardiac arteriogenesis in vivo. Adult C57BL6/J mice were given the MeKi 10 mg/kg/day or vehicle (DMSO), orally for 14 days (n=11/group). At the endpoint, echocardiographic evaluation of left ventricle (LV) function and dimensions (n=6/group) showed no difference in comparison with the respective baseline in both groups. Effective inhibition of Mek1/2 in the heart of PD-treated mice was confirmed by the reduced immunostaining for the phosphorylated form of Erk1/2. The MeKi cardiotoxicity was ruled out by assessment of cardiomyocytes and vascular cells apoptosis (Tunel) and plasmatic levels of cTn-I. Histological analyses of the hearts (n=5/group) showed an increase in small arterioles (diameter <20μm) density in the LV of PD-mice compared with the DMSO group (16.4 vs 11.7 art/mm2). No change was observed for the capillary density. The drug promoted the maturation of VSMCs within both small and large (>20μm) arterioles, as shown by the higher ratio between the areas of the vascular wall occupied by the mature contractile marker SM myosin heavy chain and the synthetic/early contractile marker alpha-SM actin (αSMA). The PD treatment reduced the fraction of small arterioles covered with a CD34pos layer (53% vs 70% of total arterioles), along with a lower ratio between the areas occupied by adventitial CD34pos cells and αSMApos VSMCs, suggesting a contribution of cPCs to the arteriolar remodelling. Last, the drug improved the LV myocardial perfusion in the PD- vs the DMSO-group (6.8 vs 5.3 ml/min/g of LV tissue, n=6/group).
Conclusions
We show that a short treatment with a Mek1/2 inhibitor stimulates myocardial arteriogenesis and perfusion without either inducing cardiotoxicity or deteriorating heart function. This may be a novel, intriguing approach to promote therapeutic arteriogenesis.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): British Heart Foundation Centre for Vascular Regeneration II
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Affiliation(s)
- E Avolio
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - A Thomas
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - A Caporali
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M Meloni
- University of Edinburgh, Centre for Cardiovascular Science, Edinburgh, United Kingdom
| | - M Caputo
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
| | - P Madeddu
- University of Bristol, Bristol Medical School, Bristol, United Kingdom
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Spencer HL, Sanders R, Boulberdaa M, Meloni M, Cochrane A, Spiroski AM, Mountford J, Emanueli C, Caporali A, Brittan M, Rodor J, Baker AH. The LINC00961 transcript and its encoded micropeptide, small regulatory polypeptide of amino acid response, regulate endothelial cell function. Cardiovasc Res 2020; 116:1981-1994. [PMID: 31990292 PMCID: PMC8216332 DOI: 10.1093/cvr/cvaa008] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 09/10/2019] [Accepted: 02/11/2020] [Indexed: 12/18/2022] Open
Abstract
AIMS Long non-coding RNAs (lncRNAs) play functional roles in physiology and disease, yet understanding of their contribution to endothelial cell (EC) function is incomplete. We identified lncRNAs regulated during EC differentiation and investigated the role of LINC00961 and its encoded micropeptide, small regulatory polypeptide of amino acid response (SPAAR), in EC function. METHODS AND RESULTS Deep sequencing of human embryonic stem cell differentiation to ECs was combined with Encyclopedia of DNA Elements (ENCODE) RNA-seq data from vascular cells, identifying 278 endothelial enriched genes, including 6 lncRNAs. Expression of LINC00961, first annotated as an lncRNA but reassigned as a protein-coding gene for the SPAAR micropeptide, was increased during the differentiation and was EC enriched. LINC00961 transcript depletion significantly reduced EC adhesion, tube formation, migration, proliferation, and barrier integrity in primary ECs. Overexpression of the SPAAR open reading frame increased tubule formation; however, overexpression of the full-length transcript did not, despite production of SPAAR. Furthermore, overexpression of an ATG mutant of the full-length transcript reduced network formation, suggesting a bona fide non-coding RNA function of the transcript with opposing effects to SPAAR. As the LINC00961 locus is conserved in mouse, we generated an LINC00961 locus knockout (KO) mouse that underwent hind limb ischaemia (HLI) to investigate the angiogenic role of this locus in vivo. In agreement with in vitro data, KO animals had a reduced capillary density in the ischaemic adductor muscle after 7 days. Finally, to characterize LINC00961 and SPAAR independent functions in ECs, we performed pull-downs of both molecules and identified protein-binding partners. LINC00961 RNA binds the G-actin sequestering protein thymosin beta-4x (Tβ4) and Tβ4 depletion phenocopied the overexpression of the ATG mutant. SPAAR binding partners included the actin-binding protein, SYNE1. CONCLUSION The LINC00961 locus regulates EC function in vitro and in vivo. The gene produces two molecules with opposing effects on angiogenesis: SPAAR and LINC00961.
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Affiliation(s)
- Helen L Spencer
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Rachel Sanders
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Mounia Boulberdaa
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Marco Meloni
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Amy Cochrane
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Ana-Mishel Spiroski
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Joanne Mountford
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, 126 University Pl, Glasgow G12 8TA, UK
| | - Costanza Emanueli
- National Heart and Lung Institute, Vascular Sciences and Cardiac Function,
Imperial Centre for Translational and Experimental Medicine, Imperial College
London, London W12 0NN, UK
| | - Andrea Caporali
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Mairi Brittan
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Julie Rodor
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
| | - Andrew H Baker
- University/BHF Centre for Cardiovascular Science, Queens Medical Research
Institute, University of Edinburgh, 47 Little France Crescent, Edinburgh
EH16 4TJ, UK
- Institute of Cardiovascular and Medical Sciences, University of
Glasgow, 126 University Pl, Glasgow G12 8TA, UK
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O'Neill KM, Campbell DC, Edgar KS, Gill EK, Moez A, McLoughlin KJ, O'Neill CL, Dellett M, Hargey CJ, Abudalo RA, O'Hare M, Doyle P, Toh T, Khoo J, Wong J, McCrudden CM, Meloni M, Brunssen C, Morawietz H, Yoder MC, McDonald DM, Watson CJ, Stitt AW, Margariti A, Medina RJ, Grieve DJ. NOX4 is a major regulator of cord blood-derived endothelial colony-forming cells which promotes post-ischaemic revascularization. Cardiovasc Res 2020; 116:393-405. [PMID: 30937452 DOI: 10.1093/cvr/cvz090] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 02/19/2019] [Accepted: 03/29/2019] [Indexed: 02/06/2023] Open
Abstract
AIMS Cord blood-derived endothelial colony-forming cells (CB-ECFCs) are a defined progenitor population with established roles in vascular homeostasis and angiogenesis, which possess low immunogenicity and high potential for allogeneic therapy and are highly sensitive to regulation by reactive oxygen species (ROS). The aim of this study was to define the precise role of the major ROS-producing enzyme, NOX4 NADPH oxidase, in CB-ECFC vasoreparative function. METHODS AND RESULTS In vitro CB-ECFC migration (scratch-wound assay) and tubulogenesis (tube length, branch number) was enhanced by phorbol 12-myristate 13-acetate (PMA)-induced superoxide in a NOX-dependent manner. CB-ECFCs highly-expressed NOX4, which was further induced by PMA, whilst NOX4 siRNA and plasmid overexpression reduced and potentiated in vitro function, respectively. Increased ROS generation in NOX4-overexpressing CB-ECFCs (DCF fluorescence, flow cytometry) was specifically reduced by superoxide dismutase, highlighting induction of ROS-specific signalling. Laser Doppler imaging of mouse ischaemic hindlimbs at 7 days indicated that NOX4-knockdown CB-ECFCs inhibited blood flow recovery, which was enhanced by NOX4-overexpressing CB-ECFCs. Tissue analysis at 14 days revealed consistent alterations in vascular density (lectin expression) and eNOS protein despite clearance of injected CB-ECFCs, suggesting NOX4-mediated modulation of host tissue. Indeed, proteome array analysis indicated that NOX4-knockdown CB-ECFCs largely suppressed tissue angiogenesis, whilst NOX4-overexpressing CB-ECFCs up-regulated a number of pro-angiogenic factors specifically-linked with eNOS signalling, in parallel with equivalent modulation of NOX-dependent ROS generation, suggesting that CB-ECFC NOX4 signalling may promote host vascular repair. CONCLUSION Taken together, these findings indicate a key role for NOX4 in CB-ECFCs, thereby highlighting its potential as a target for enhancing their reparative function through therapeutic priming to support creation of a pro-reparative microenvironment and effective post-ischaemic revascularization.
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Affiliation(s)
- Karla M O'Neill
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - David C Campbell
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Kevin S Edgar
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Eleanor K Gill
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Arya Moez
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Kiran J McLoughlin
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Christina L O'Neill
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Margaret Dellett
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Ciarán J Hargey
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Rawan A Abudalo
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Michael O'Hare
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Philip Doyle
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Tinrui Toh
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Joshua Khoo
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - June Wong
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Cian M McCrudden
- School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, UK
| | | | - Coy Brunssen
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, Medical Faculty and University Clinics Carl Gustav Carus, Technische Universität Dresden, D-01307 Dresden, Germany
| | - Henning Morawietz
- Division of Vascular Endothelium and Microcirculation, Department of Medicine III, Medical Faculty and University Clinics Carl Gustav Carus, Technische Universität Dresden, D-01307 Dresden, Germany
| | - Mervin C Yoder
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Denise M McDonald
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Chris J Watson
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Alan W Stitt
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Andriana Margariti
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - Reinhold J Medina
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
| | - David J Grieve
- Centre for Experimental Medicine, Wellcome-Wolfson Institute, Queen's University Belfast, 97 Lisburn Road, Belfast BT9 7AE, UK
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48
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Montanaro M, Meloni M, Anemona L, Giurato L, Scimeca M, Izzo V, Servadei F, Smirnov A, Candi E, Mauriello A, Uccioli L. Macrophage Activation and M2 Polarization in Wound Bed of Diabetic Patients Treated by Dermal/Epidermal Substitute Nevelia. INT J LOW EXTR WOUND 2020; 21:377-383. [PMID: 32815405 DOI: 10.1177/1534734620945559] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Clinical evidences have shown good results using dermal/epidermal substitutes (DESs) to treat diabetic foot ulcers. Recent studies suggest that, in addition to their scaffold action, DESs may favor wound healing by influencing wound bed inflammatory cells. This study aims to investigate whether DES may influence the inflammatory infiltrate and macrophages polarization toward a reparative phenotype. Fifteen diabetic patients with chronic foot ulcers have been randomly enrolled: 5 treated only by standard of care, served as control group (CG), and 10 treated with DES composed of type 1 bovin collagen (Nevelia, SYMATESE) considered as test group (TG). A biopsy was taken at baseline (T0) and after 30 days (T1). From bioptic paraffin specimen histological, immunohistochemical, and immunofluorescence analysis was performed. Immunohistochemistry reactions evaluated the number of M1 macrophage (CD38+) and M2 macrophage (CD163+). TG patients displayed general macrophage activation and their greater polarization toward M2 subpopulation 30 days after DES implant, compared with CG. From T0 to T1 there was a significant decrease of CD38+ (230 ± 42 and 135 ± 48 mm2, respectively; P < .001) and significant increase of CD163+ (102 ± 21 positive cells/mm2 and 366 ± 42 positive cells/mm2, respectively; P < .001). Confocal microscopy confirmed an increase of M2 cells as expressed by the reduced CD68+/CD163+ ratio. After 6 months of observation 6 patients (60%) of the TG completely healed, while only 1 patient (20%) healed in the CG (P < .01). The tested DES makes possible to treat diabetic foot ulcers inducing tissue reparative processes through macrophage activation and M2 reparative polarization.
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Affiliation(s)
| | | | | | | | | | | | | | - Artem Smirnov
- University of Rome "Tor Vergata," Rome, Italy.,Ludwig Institute for Cancer Research, University of Oxford, Oxford, UK
| | - Eleonora Candi
- University of Rome "Tor Vergata," Rome, Italy.,IDI-IRCCS, Rome, Italy
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49
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Castellan RF, Vitiello M, Vidmar M, Johnstone S, Iacobazzi D, Mellis D, Cathcart B, Thomson A, Ruhrberg C, Caputo M, Newby DE, Gray GA, Baker AH, Caporali A, Meloni M. miR-96 and miR-183 differentially regulate neonatal and adult postinfarct neovascularization. JCI Insight 2020; 5:134888. [PMID: 32544097 PMCID: PMC7453899 DOI: 10.1172/jci.insight.134888] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 11/08/2019] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
Following myocardial infarction (MI), the adult heart has minimal regenerative potential. Conversely, the neonatal heart can undergo extensive regeneration, and neovascularization capacity was hypothesized to contribute to this difference. Here, we demonstrate the higher angiogenic potential of neonatal compared with adult mouse cardiac endothelial cells (MCECs) in vitro and use this difference to identify candidate microRNAs (miRs) regulating cardiac angiogenesis after MI. miR expression profiling revealed miR-96 and miR-183 upregulation in adult compared with neonatal MCECs. Their overexpression decreased the angiogenic potential of neonatal MCECs in vitro and prevented scar resolution and neovascularization in neonatal mice after MI. Inversely, their inhibition improved the angiogenic potential of adult MCECs, and miR-96/miR-183–KO mice had increased peri-infarct neovascularization. In silico analyses identified anillin (ANLN) as a direct target of miR-96 and miR-183. In agreement, Anln expression declined following their overexpression and increased after their inhibition in vitro. Moreover, ANLN expression inversely correlated with miR-96 expression and age in cardiac ECs of cardiovascular patients. In vivo, ANLN+ vessels were enriched in the peri-infarct area of miR-96/miR-183–KO mice. These findings identify miR-96 and miR-183 as regulators of neovascularization following MI and miR-regulated genes, such as anillin, as potential therapeutic targets for cardiovascular disease. MiR-96 and miR-183 act as molecular switches to regulate endothelial cells angiogenic potential and differentially regulate neovascularization following myocardial infarction in neonatal and adult mice.
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Affiliation(s)
- Raphael Fp Castellan
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom.,UCL Institute of Ophthalmology, London, United Kingdom
| | - Milena Vitiello
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Martina Vidmar
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Steven Johnstone
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, United Kingdom
| | - Dominga Iacobazzi
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - David Mellis
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Benjamin Cathcart
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adrian Thomson
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Massimo Caputo
- Bristol Heart Institute, School of Clinical Sciences, University of Bristol, Bristol, United Kingdom
| | - David E Newby
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Gillian A Gray
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrew H Baker
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrea Caporali
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Marco Meloni
- British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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50
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Toor IS, Rückerl D, Mair I, Ainsworth R, Meloni M, Spiroski AM, Benezech C, Felton JM, Thomson A, Caporali A, Keeble T, Tang KH, Rossi AG, Newby DE, Allen JE, Gray GA. Eosinophil Deficiency Promotes Aberrant Repair and Adverse Remodeling Following Acute Myocardial Infarction. JACC Basic Transl Sci 2020; 5:665-681. [PMID: 32760855 PMCID: PMC7393409 DOI: 10.1016/j.jacbts.2020.05.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [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: 08/28/2019] [Revised: 05/12/2020] [Accepted: 05/12/2020] [Indexed: 01/24/2023]
Abstract
In ST-segment elevation myocardial infarction of both patients and mice, there was a decline in blood eosinophil count, with activated eosinophils recruited to the infarct zone. Eosinophil deficiency resulted in attenuated anti-inflammatory macrophage polarization, enhanced myocardial inflammation, increased scar size, and deterioration of myocardial structure and function. Adverse cardiac remodeling in the setting of eosinophil deficiency was prevented by interleukin-4 therapy.
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Affiliation(s)
- Iqbal S. Toor
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Dominik Rückerl
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Iris Mair
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Rob Ainsworth
- Division of Pathology, Deanery of Molecular, Genetic and Population Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Marco Meloni
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Ana-Mishel Spiroski
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Cecile Benezech
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Jennifer M. Felton
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Adrian Thomson
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Andrea Caporali
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Thomas Keeble
- Essex Cardiothoracic Centre, Basildon and Thurrock Hospitals NHS Foundation Trust, Essex, United Kingdom
- School of Medicine, Anglia Ruskin University, Cambridge, United Kingdom
| | - Kare H. Tang
- Essex Cardiothoracic Centre, Basildon and Thurrock Hospitals NHS Foundation Trust, Essex, United Kingdom
| | - Adriano G. Rossi
- MRC Centre for Inflammation Research, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - David E. Newby
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
| | - Judith E. Allen
- Faculty of Biology, Medicine and Health, School of Biological Sciences, University of Manchester, Manchester, United Kingdom
| | - Gillian A. Gray
- British Heart Foundation/University Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, United Kingdom
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