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Cattaneo G, Ventin M, Arya S, Kontos F, Michelakos T, Sekigami Y, Cai L, Villani V, Sabbatino F, Chen F, Sadagopan A, Deshpande V, Moore PA, Ting DT, Bardeesy N, Wang X, Ferrone S, Ferrone CR. Interplay between B7-H3 and HLA class I in the clinical course of pancreatic ductal adenocarcinoma. Cancer Lett 2024; 587:216713. [PMID: 38364961 DOI: 10.1016/j.canlet.2024.216713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/16/2024] [Accepted: 02/05/2024] [Indexed: 02/18/2024]
Abstract
Human leukocyte antigen (HLA) class I defects are associated with cancer progression. However, their prognostic significance is controversial and may be modulated by immune checkpoints. Here, we investigated whether the checkpoint B7-H3 modulates the relationship between HLA class I and pancreatic ductal adenocarcinoma (PDAC) prognosis. PDAC tumors were analyzed for the expression of B7-H3, HLA class I, HLA class II molecules, and for the presence of tumor-infiltrating immune cells. We observed defective HLA class I and HLA class II expressions in 75% and 59% of PDAC samples, respectively. HLA class I and B7-H3 expression were positively related at mRNA and protein level, potentially because of shared regulation by RELA, a sub-unit of NF-kB. High B7-H3 expression and low CD8+ T cell density were indicators of poor survival, while HLA class I was not. Defective HLA class I expression was associated with unfavorable survival only in patients with low B7-H3 expression. Favorable survival was observed only when HLA class I expression was high and B7-H3 expression low. Our results provide the rationale for targeting B7-H3 in patients with PDAC tumors displaying high HLA class I levels.
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Affiliation(s)
- Giulia Cattaneo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States. https://twitter.com/GCattaneoPhD
| | - Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shahrzad Arya
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Filippos Kontos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Theodoros Michelakos
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Yurie Sekigami
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Lei Cai
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vincenzo Villani
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Francesco Sabbatino
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - Ananthan Sadagopan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | | | - David T Ting
- MassGeneral Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Nabeel Bardeesy
- MassGeneral Cancer Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Xinhui Wang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Soldano Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Cristina R Ferrone
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States; Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, United States.
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Ventin M, Cattaneo G, Maggs L, Arya S, Wang X, Ferrone CR. Implications of High Tumor Burden on Chimeric Antigen Receptor T-Cell Immunotherapy: A Review. JAMA Oncol 2024; 10:115-121. [PMID: 37943567 DOI: 10.1001/jamaoncol.2023.4504] [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: 11/10/2023]
Abstract
Importance Chimeric antigen receptor (CAR) T-cell therapy has redefined the therapeutic landscape of several hematologic malignant tumors. Despite its clinical efficacy, many patients with cancer experience nonresponse to CAR T-cell treatment, disease relapse within months, or severe adverse events. Furthermore, CAR T-cell therapy has demonstrated minimal to no clinical efficacy in the treatment of solid tumors in clinical trials. Observations A complex interplay between high tumor burden and the systemic and local tumor microenvironment on clinical outcomes of CAR T-cell therapy is emerging from preclinical and clinical data. The hallmarks of advanced cancers-namely, inflammation and immune dysregulation-sustain cancer progression. They negatively affect the production, expansion, antitumor activity, and persistence of CAR T-cell products. Understanding of CAR T-cell therapy, mechanisms underlying its failure, and adverse events under conditions of high tumor burden is critical for realizing the full potential of this novel treatment approach. Conclusions and Relevance This review focuses on linking the efficacy and safety of CAR T-cell therapy with tumor burden. Its limitations relative to high tumor burden, systemic inflammation, and immune dysregulation are discussed. Emerging clinical approaches to overcome these obstacles and more effectively incorporate this therapeutic strategy into the treatment paradigm of patients with solid malignant tumors are also described.
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Affiliation(s)
- Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Giulia Cattaneo
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Luke Maggs
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Shahrzad Arya
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Xinhui Wang
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Cristina R Ferrone
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, California
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Giraudo L, Cattaneo G, Gammaitoni L, Iaia I, Donini C, Massa A, Centomo ML, Basiricò M, Vigna E, Pisacane A, Picciotto F, Berrino E, Marchiò C, Merlini A, Paruzzo L, Poletto S, Caravelli D, Biolato AM, Bortolot V, Landoni E, Ventin M, Ferrone CR, Aglietta M, Dotti G, Leuci V, Carnevale-Schianca F, Sangiolo D. CSPG4 CAR-redirected Cytokine Induced Killer lymphocytes (CIK) as effective cellular immunotherapy for HLA class I defective melanoma. J Exp Clin Cancer Res 2023; 42:310. [PMID: 37993874 PMCID: PMC10664597 DOI: 10.1186/s13046-023-02884-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Even acknowledging the game-changing results achieved in the treatment of metastatic melanoma with the use of immune checkpoint inhibitors (ICI), a large proportion of patients (40-60%) still fail to respond or relapse due to the development of resistance. Alterations in the expression of Human Leukocyte Antigen class I (HLA-I) molecules are considered to play a major role in clinical resistance to ICI. Cellular immunotherapy with HLA-independent CAR-redirected lymphocytes is a promising alternative in this challenging setting and dedicated translational models are needed. METHODS In this study, we propose an HLA-independent therapeutic strategy with Cytokine Induced Killer lymphocytes (CIK) genetically engineered with a Chimeric Antigen Receptor (CAR) targeting the tumor antigen CSPG4 as effector mechanism. We investigated the preclinical antitumor activity of CSPG4-CAR.CIK in vitro and in a xenograft murine model focusing on patient-derived melanoma cell lines (Mel) with defective expression of HLA-I molecules. RESULTS We successfully generated CSPG4-CAR.CIK from patients with metastatic melanoma and reported their intense activity in vitro against a panel of CSPG4-expressing patient-derived Mel. The melanoma killing activity was intense, even at very low effector to target ratios, and not influenced by the expression level (high, low, defective) of HLA-I molecules on target cells. Furthermore, CAR.CIK conditioned medium was capable of upregulating the expression of HLA-I molecules on melanoma cells. A comparable immunomodulatory effect was replicated by treatment of Mel cells with exogenous IFN-γ and IFN-α. The antimelanoma activity of CSPG4-CAR.CIK was successfully confirmed in vivo, obtaining a significant tumor growth inhibition of an HLA-defective Mel xenograft in immunodeficient mice. CONCLUSIONS In this study we reported the intense preclinical activity of CSPG4-CAR.CIK against melanoma, including those with low or defective HLA-I expression. Our findings support CSPG4 as a valuable CAR target in melanoma and provide translational rationale for clinical studies exploring CAR-CIK cellular immunotherapies within the challenging setting of patients not responsive or relapsing to immune checkpoint inhibitors.
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Affiliation(s)
- Lidia Giraudo
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Giulia Cattaneo
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
| | - Loretta Gammaitoni
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Ilenia Iaia
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Chiara Donini
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Annamaria Massa
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Maria Laura Centomo
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Marco Basiricò
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Elisa Vigna
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Alberto Pisacane
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Franco Picciotto
- Dermatologic Surgery Section, Department of Surgery, Azienda Ospedaliera Universitaria (AOU) Città Della Salute E Della Scienza, Turin, TO, Italy
| | - Enrico Berrino
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, TO, Italy
| | - Caterina Marchiò
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, TO, Italy
| | - Alessandra Merlini
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Luca Paruzzo
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Stefano Poletto
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Daniela Caravelli
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
| | - Andrea Michela Biolato
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
- Cytoskeleton and Cancer Progression, Department of Oncology, Luxembourg Institute of Health, Luxembourg City, Luxembourg
- Faculty of Science, Technology and Medicine, University of Luxembourg, Esch-Sur-Alzette, Luxembourg
| | - Valentina Bortolot
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Elisa Landoni
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Marco Ventin
- Division of Surgical Oncology, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina R Ferrone
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Massimo Aglietta
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | - Gianpietro Dotti
- Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Valeria Leuci
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy
| | | | - Dario Sangiolo
- Candiolo Cancer Institute, FPO-IRCCS, Strada Provinciale 142 Km 3.95, 10060, Candiolo, TO, Italy.
- Department of Oncology, University of Turin, Regione Gonzole 10, 10043, Orbassano, TO, Italy.
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4
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Arya S, Ventin M, Nebbia M, Fernandez-Del Castillo C, Lionetto G, Qadan M, Lillemoe KD, Deshpande V, Catalano OA, Thiele EA, Ferrone CR. Long-Term Outcomes of Tuberous Sclerosis Complex-Associated Non-functional Pancreatic Neuroendocrine Tumors: Should We Be More Conservative? Ann Surg Oncol 2023; 30:7748-7755. [PMID: 37648887 PMCID: PMC10562497 DOI: 10.1245/s10434-023-14157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Hereditary syndromes such as tuberous sclerosis complex (TSC) account for 10% of pancreatic neuroendocrine tumors (PNETs). Surgical intervention is the current standard of care for sporadic PNETs (spPNETs) that are >2 cm in size. We compared the long-term outcomes of resected TSC-PNETs with patients with spPNETs. METHODS We conducted a retrospective review of perioperative data and outcomes of TSC-PNETs compared with spPNETs. Inclusion criteria involved selecting patients whose tumors were no larger than 5.1 cm, the maximum size observed in the TSC-PNET group. RESULTS Of the 347 patients resected for PNETs, 14 were TSC-PNETs and 241 were non-functional spPNETs. The median age for the whole cohort was 56 years (interquartile range [IQR] 21.0) and 47% were female. The median follow-up was 103.8 months (95% confidence interval [CI] 89.2-118.6). Specifically, 14 patients with TSC-PNETs and 194 patients with spPNETs were included. Compared with spPNETs, patients with TSC-PNETs were operated on at a younger age (24.0 vs. 57.5 years; p < 0.001), were more frequently multifocal (28.5% vs. 0.0%; p < 0.001), were more likely to undergo minimally invasive operations (78.6% vs. 24.3%; p < 0.001), and had more R1 resections (28.6% vs. 5.7%; p = 0.006). Local and distant tumor recurrence was only observed in the spPNET group. The 5-year mortality rates for the spPNET and TSC-PNET groups were 6.2% and 0.0%, respectively. No PNET-related deaths were observed among TSC-PNETs. CONCLUSION None of the TSC-PNET patients recurred after a median follow-up of 78.0 months. The risk-benefit of aggressive pancreatic operations in TSC-PNET patients is still unclear and our findings suggest a conservative approach should be considered.
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Affiliation(s)
- Shahrzad Arya
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Martina Nebbia
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Gabriella Lionetto
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Motaz Qadan
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vikram Deshpande
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Onofrio A Catalano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Elizabeth A Thiele
- Herscot Center for Tuberous Sclerosis Complex, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina R Ferrone
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Wang Y, Drum DL, Sun R, Zhang Y, Chen F, Sun F, Dal E, Yu L, Jia J, Arya S, Jia L, Fan S, Isakoff SJ, Kehlmann AM, Dotti G, Liu F, Zheng H, Ferrone CR, Taghian AG, DeLeo AB, Ventin M, Cattaneo G, Li Y, Jounaidi Y, Huang P, Maccalli C, Zhang H, Wang C, Yang J, Boland GM, Sadreyev RI, Wong L, Ferrone S, Wang X. Stressed target cancer cells drive nongenetic reprogramming of CAR T cells and solid tumor microenvironment. Nat Commun 2023; 14:5727. [PMID: 37714830 PMCID: PMC10504259 DOI: 10.1038/s41467-023-41282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 08/29/2023] [Indexed: 09/17/2023] Open
Abstract
The poor efficacy of chimeric antigen receptor T-cell therapy (CAR T) for solid tumors is due to insufficient CAR T cell tumor infiltration, in vivo expansion, persistence, and effector function, as well as exhaustion, intrinsic target antigen heterogeneity or antigen loss of target cancer cells, and immunosuppressive tumor microenvironment (TME). Here we describe a broadly applicable nongenetic approach that simultaneously addresses the multiple challenges of CAR T as a therapy for solid tumors. The approach reprograms CAR T cells by exposing them to stressed target cancer cells which have been exposed to the cell stress inducer disulfiram (DSF) and copper (Cu)(DSF/Cu) plus ionizing irradiation (IR). The reprogrammed CAR T cells acquire early memory-like characteristics, potent cytotoxicity, enhanced in vivo expansion, persistence, and decreased exhaustion. Tumors stressed by DSF/Cu and IR also reprogram and reverse the immunosuppressive TME in humanized mice. The reprogrammed CAR T cells, derived from peripheral blood mononuclear cells of healthy donors or metastatic female breast cancer patients, induce robust, sustained memory and curative anti-solid tumor responses in multiple xenograft mouse models, establishing proof of concept for empowering CAR T by stressing tumor as a promising therapy for solid tumors.
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Affiliation(s)
- Yufeng Wang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of General Surgery, Tongji Hospital, School of Medicine, Tongji University, Shanghai, China
| | - David L Drum
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruochuan Sun
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Gastrointestinal Surgery and General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yida Zhang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Feng Chen
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Fengfei Sun
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Emre Dal
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ling Yu
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jingyu Jia
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Shahrzad Arya
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lin Jia
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Song Fan
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Steven J Isakoff
- Termeer Center for Targeted Therapies, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Allison M Kehlmann
- Termeer Center for Targeted Therapies, Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Gianpietro Dotti
- Lineberger Comprehensive Cancer Center and Department of Microbiology and Immunology, University of North Carolina, Chapel Hill, NC, USA
| | - Fubao Liu
- Department of Hepatobiliary & Pancreatic Surgery and Liver Transplantation, Anhui Medical University, Hefei, Anhui, China
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina R Ferrone
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alphonse G Taghian
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Albert B DeLeo
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marco Ventin
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Giulia Cattaneo
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yongxiang Li
- Department of Gastrointestinal Surgery and General Surgery, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Youssef Jounaidi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peigen Huang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Hanyu Zhang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cheng Wang
- Vincent Center for Reproductive Biology, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jibing Yang
- Center for Comparative Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Genevieve M Boland
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ruslan I Sadreyev
- Department of Molecular Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - LaiPing Wong
- Department of Molecular Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Soldano Ferrone
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Orthopaedics, Massachusetts General Hospital, Boston, MA, USA
| | - Xinhui Wang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Cherchi V, Vetrugno L, Terrosu G, Deana C, Ventin M, Zanini V, Barbariol F, Pravisani R, Bove T, Risaliti A, Lorenzin D, Baccarani U. Association between artificial nutrition in brain dead donors and early allograft function in liver transplant recipients: an observational study. Clin Transplant 2023; 37:e15034. [PMID: 37212369 DOI: 10.1111/ctr.15034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 04/23/2023] [Accepted: 05/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND The role of nutrition in donor after brain deaths (DBDs) has yet to be adequately discussed. The primary aim of this study was to investigate whether the nutritional intake in the 48 h before organ retrieval may play a role on the graft functional recovery assessed with Model for Early Allograft Function (MEAF) Score. METHODS Single-center retrospective study evaluating all liver transplants performed at the University Hospital of Udine from January 2010 to August 2020. Patients receiving grafts from DBD donors fed with artificial enteral nutrition in the 48 h prior to organ procurement (EN-group) or who did not (No-EN-group). Caloric debt was calculated using the difference between the calculated caloric needs and the effective calories delivered through enteral nutrition. RESULTS Livers from EN-group presented a lower mean MEAF score compared to the no-EN-group: 3.39 ± 1.46 versus 4.15 ± 1.51, respectively (p = .04). A positive correlation between caloric debt and the MEAF score was found within the overall population (r = .227, p = .043) as well as in EN-group (r = .306, p = .049). CONCLUSIONS Donor's nutritional intake in the final 48 h before organ procurement correlates with MEAF score, and nutrition probably plays a positive role on the functional recovery of the graft. Large future randomized controlled trials are needed to confirm this preliminary results.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Cristian Deana
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Federico Barbariol
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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7
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Ventin M, Cattaneo G, Maggs L, Jia J, Arya S, Ferrone S, Wang X, Ferrone CR. B7-H3-targeted CAR T cell activity is enhanced by radiotherapy in solid cancers. Front Oncol 2023; 13:1193963. [PMID: 37483496 PMCID: PMC10361748 DOI: 10.3389/fonc.2023.1193963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/16/2023] [Indexed: 07/25/2023] Open
Abstract
Adoptive cell therapy utilizing T cells genetically modified to express a chimeric antigen receptor (CAR) has demonstrated promising clinical results in hematological malignancies. However, solid cancers have not seen a similar success due to multiple obstacles. Investigating these escape mechanisms and designing strategies to counteract such limitations is crucial and timely. Growing evidence in the literature supports the hypothesis that radiotherapy has the potential to enhance the susceptibility of solid tumors to CAR T cell therapy, by overcoming mechanisms of resistance. Radiation treatment can increase the susceptibility of different types of solid cancers (TNBC, HNSCC, PDAC) to B7-H3 CAR T cell-mediated eradication. Multiple mechanisms, including reduced cancer cell proliferation, upregulation of the targeted antigen, modulation of apoptotic molecules may contribute to this signal. The information in the literature and the results we describesupport the ability of radiotherapy to improve the efficacy of CAR T cell therapy in solid tumors.
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Affiliation(s)
- Marco Ventin
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Giulia Cattaneo
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Luke Maggs
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Jingyu Jia
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Shahrzad Arya
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Soldano Ferrone
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Xinhui Wang
- Division of Gastrointestinal and Oncologic Surgery, Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Cristina R. Ferrone
- Department of Surgery, Cedars Sinai Medical Center, Los Angeles, CA, United States
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8
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Cherchi V, Intini S, Velkoski J, Calandra S, Ventin M, Della Martina M, Lorenzin D, Driul L, Terrosu G. A rare case of duplication of the descending colon in a pregnant woman: case report and literature review. Acta Biomed 2023; 94:e2023042. [PMID: 36718780 DOI: 10.23750/abm.v94is1.12169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 09/02/2021] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Gastrointestinal duplications are uncommon congenital abnormalities that can occur anywhere throughout the intestinal tract. The small bowel is more interested than the large one. Duplications are schematically classified as spherical and tubular, respectively representing 80% and 20% of cases, with different relationships and communications with the native intestinal wall. Although typically diagnosed during infancy and early childhood, tubular colonic sub-type stays frequently hidden for several years until a complication occurs. CASE PRESENTATION we report the case of a T-shaped tubular duplication in a 20-year-old woman at the 30th week of gestation, who underwent an urgent exploratory laparotomy for intestinal occlusion, treated with the resection of the aberrant large bowel. The patient was notable for a long history of constipation and chronic pain. Diagnostic possibilities were limited by the on-going pregnancy. CONCLUSION Intestinal duplications are uncommon malformations, and, of these, the T-shaped subtype of the colon is among the rarest ones. In the adulthood, diagnosis is usually established in the operating room during urgent or even emergency surgery performed for abdominal complications. A duplication of the descending colon is extremely rare, and this is, to our knowledge, the only article describing a case found in advanced state of pregnancy.
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Affiliation(s)
- Vittorio Cherchi
- a:1:{s:5:"en_US";s:81:"University Hospital of Udine - General Surgery Clinic and Liver Transplant Center";}.
| | - Sergio Intini
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.
| | - Jaqueline Velkoski
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.
| | - Sergio Calandra
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.
| | - Marco Ventin
- Department of Medical Area (DAME), University of Udine, Udine, Italy.
| | - Monica Della Martina
- Clinic of Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy.
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.
| | - Lorenza Driul
- Clinic of Obstetrics and Gynecology, University Hospital of Udine, Udine, Italy.
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.
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9
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Vetrugno L, Zanini V, Ventin M, Cherchi V, Baccarani U. Diastolic dysfunction and early liver allograft dysfunction: Like Oedipus. Echocardiography 2022; 39:918-919. [PMID: 35775094 DOI: 10.1111/echo.15409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 06/09/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
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10
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Vetrugno L, Cherchi V, Zanini V, Cotrozzi S, Ventin M, Terrosu G, Baccarani U, Bove T. Association between preoperative diastolic dysfunction and early allograft dysfunction after orthotopic liver transplantation: An observational study. Echocardiography 2022; 39:561-567. [PMID: 35224775 DOI: 10.1111/echo.15328] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/30/2022] [Accepted: 02/16/2022] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To investigate the association between the grade of diastolic dysfunction (DD) and the occurrence of early allograft dysfunction (EAD) in liver transplant patients following the new 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) guidelines. METHODS From January 2015 to December 2019, we retrospectively analyzed 83 patients who underwent orthotopic liver transplantation (OLTx) and their susceptibility to develop EAD according to the grade of preoperative DD. EAD was defined according to the criteria proposed by Olfhoff et al.; DD was defined with four parameters: E/A, e/e', Left Atrium volume, and Tricuspid Regurgitation velocity. RESULTS According to the ASE/EACVI guidelines grade II DD was detected in 20 patients (24.1%) undergoing OLTx. A statistically significant association was found between grade II DD and the occurrence of EAD (p-value < 0.003). The Kaplan-Meier analysis failed to find any significant difference between the survival probability, nevertheless at the end of a 90-day follow-up period, mortality showed a different trend in classes with more severe diastolic dysfunction. CONCLUSION According to the ASE/EACVI guidelines from 2016, patients with grade II DD seem to have a higher propensity to develop early allograft dysfunction EAD after OLTx. Our study advises a need for an urgent prospective multicenter study to elucidate the long-term outcomes of liver transplants patients with diastolic dysfunction.
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Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral, and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Marco Ventin
- Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy
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11
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Vetrugno L, Ventin M, Maggiore SM. Focus clinical ultrasonography: again competency differs from the patient outcome. Ultrasound J 2022; 14:8. [PMID: 35138450 PMCID: PMC8828807 DOI: 10.1186/s13089-022-00258-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/26/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy.,Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy
| | - Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02114, USA.
| | - Salvatore Maurizio Maggiore
- Department of Anesthesiology, Critical Care Medicine and Emergency, SS. Annunziata Hospital, Chieti, Italy.,Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy
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12
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Cherchi V, Baccarani U, Ventin M, Pravisani R, Puggioni A, Zanini V, Lorenzin D, Vetrugno L, Risaliti A, Terrosu G, Adani GL. Current practice with grafts with multiple renal arteries in kidney transplantation: role of the methylene blue in the lower pole. Acta Biomed 2022; 93:e2022006. [PMID: 35315402 PMCID: PMC8972855 DOI: 10.23750/abm.v93i1.12081] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 09/08/2021] [Indexed: 11/23/2022]
Abstract
Kidneys with multiple renal arteries (MRAs) from different patches, may provide to the surgeon additional technical difficulties that make kidney transplants very challenging. MRAs have been largely debated over the years whether to be anastomosed or not due to the disappointing outcomes when it comes to inappropriate ligation or anastomosis. Some authors empirically reassure that smaller branches can be safely ligated and dissected without intraoperative and postoperative complications or compromising the functional recovery of the graft. Literature is poor about the possible differences in the management of superior and inferior polar arteries. Inferior polar arteries represent a topic of great interest as they may also supply the proximal ureter. The aim of this article is to merge the current knowledge about the management of inferior polar arteries and to highlight if there is any role of the methylene blue dye (MB) in the study of the ureteral vascularization in kidney transplantation. MB can be considered a safe and simple tool of vascular perfusion assessment in kidney transplantation. By injecting the dye-solution into the inferior MRA hidden ureteral branches can be unmasked and guide the surgeon to preserve important vessels. In view of their fundamental role in the vascularization of the ureter, the lower polar arteries of the graft, should be invariably studied by MB. It provides an objective, simple and fast tool for the evaluation of the ureteral vascularization when injected through the inferior MRA of the graft.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Medicine, University of Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Italy
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Medicine, University of Udine, Italy
| | - Alessandro Puggioni
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Medicine, University of Udine, Italy
| | - Victor Zanini
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy
| | - Luigi Vetrugno
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Andrea Risaliti
- Department of General Surgery, Dubai Hospital, DHA, Dubai, UAE
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy, Department of Medicine, University of Udine, Italy
| | - Gian Luigi Adani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Italy
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13
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Zanini V, Vetrugno L, Ventin M, Cherchi V, Lugano M, Baccarani U, Bove T. Is the indocyanine green clearance test useful in viral acute liver failure? Maybe! Acta Biomed 2022; 93:e2022131. [PMID: 36043982 PMCID: PMC9534256 DOI: 10.23750/abm.v93i4.12067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 01/26/2023]
Affiliation(s)
- Victor Zanini
- Department of Medicine, University of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Manuela Lugano
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
| | - Umberto Baccarani
- Department of Medicine, University of Udine, Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Udine, Italy, Department of Anesthesia and Intensive Care, University-Hospital of Udine, Italy
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14
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Cherchi V, Mea VD, Terrosu G, Brollo PP, Pravisani R, Calandra S, Scarpa E, Ventin M, D'Alì L, Lorenzin D, Loreto CD, Risaliti A, Baccarani U. Assessment of hepatic steatosis based on needle biopsy images from deceased donor livers. Clin Transplant 2021; 36:e14557. [PMID: 34890087 DOI: 10.1111/ctr.14557] [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: 08/14/2021] [Revised: 11/25/2021] [Accepted: 12/03/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Assessment of hepatic steatosis (HS) before transplantation requires the pathologist to read a graft biopsy. A simple method based on the evaluation of images from tissue samples with a smartphone could expedite and facilitate the liver selection. This study aims to assess the degree of HS by analysing photographic images from liver needle biopsy samples. METHODS Thirty-three biopsy-images were acquired with a smartphone. Image processing was carried out using ImageJ: background subtraction, conversion to HSB colour space, segmentation of the biopsy area and evaluation of statistical features of Hue, Saturation, Brightness, Red, Green, and Blue channels on the biopsy area. After feature extraction, correlations were made with gold standard HS percentage assessed at two levels (frozen-section vs. glass-slide). Sensitivity, specificity, and accuracy were calculated for each feature. RESULTS Correlations were found for H, S, R. The sensitivity, specificity and accuracy of the final classifier based on the K* algorithm were 94%, 92%, 94%. LIMITATIONS Accuracy assessment was performed considering macrovesicular steatosis on specimens with mostly < 30% HS. CONCLUSIONS The steatosis assessment based on needle biopsy images, proved to be an effective and promising method. Deep learning approaches could also be experimented with a larger set of images This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Vincenzo Della Mea
- Department of Mathematics and Computer Science, University of Udine, Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
| | - Sergio Calandra
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Edoardo Scarpa
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Lorenzo D'Alì
- Department of Pathology, University Hospital of Udine, Udine, Italy
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy
| | - Carla Di Loreto
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Pathology, University Hospital of Udine, Udine, Italy
| | - Andrea Risaliti
- Department of General Surgery, Dubai Hospital (DHA), Dubai, UAE
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University Hospital of Udine, Udine, Italy.,Department of Medical Area (DAME), University of Udine, Udine, Italy
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15
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Vetrugno L, Cherchi V, Lorenzin D, De Lorenzo F, Ventin M, Zanini V, Terrosu G, Risaliti A, Baccarani U, Bove T. The Challenging Management of an Intracardiac Thrombus in a Liver Transplant Patient at the Reperfusion Phase: A Case Report and Brief Literature Review. Transplant Direct 2021; 7:e746. [PMID: 34476291 PMCID: PMC8405129 DOI: 10.1097/txd.0000000000001200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/25/2022] Open
Abstract
The exact origin of intracardiac thrombi formation during orthotopic liver transplant remains unknown. The altered balance between hypercoagulability, hypocoagulation, and endothelial dysfunction associated with end-stage liver disease is thought to play a pivotal role. Venous stasis, vascular clamping, and reperfusion could also contribute to clot formation. The incidence of intracardiac thrombi formation stands at 4.2%, associated with a mortality rate of 45.5%, and to date, no consensus exists regarding the best way to treat this complication. Intraoperative transesophageal echocardiography is the only effective method for diagnosing intracardiac thrombi formation early, while point-of-care coagulation testing could guide the coagulation management potentially improving patient outcomes.
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Affiliation(s)
- Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Francesco De Lorenzo
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Giovanni Terrosu
- Department of Medicine, University of Udine, Italy, Udine, Italy.,General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Andrea Risaliti
- Department of Medicine, University of Udine, Italy, Udine, Italy
| | - Umberto Baccarani
- Department of Medicine, University of Udine, Italy, Udine, Italy.,General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy.,Department of Medicine, University of Udine, Italy, Udine, Italy
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16
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Cherchi V, Vetrugno L, Terrosu G, Zanini V, Ventin M, Pravisani R, Tumminelli F, Brollo PP, Boscolo E, Peressutti R, Lorenzin D, Bove T, Risaliti A, Baccarani U. Association between the donor to recipient ICG-PDR variation rate and the functional recovery of the graft after orthotopic liver transplantation: A case series. PLoS One 2021; 16:e0256786. [PMID: 34449820 PMCID: PMC8396715 DOI: 10.1371/journal.pone.0256786] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Despite current advances in liver transplant surgery, post-operative early allograft dysfunction still complicates the patient prognosis and graft survival. The transition from the donor has not been yet fully understood, and no study quantifies if and how the liver function changes through its transfer to the recipient. The indocyanine green dye plasma disappearance rate (ICG-PDR) is a simple validated tool of liver function assessment. The variation rate between the donor and recipient ICG-PDR still needs to be investigated. Materials and methods Single-center retrospective study. ICG-PDR determinations were performed before graft retrieval (T1) and 24 hours after transplant (T2). The ICG-PDR relative variation rate between T1 and T2 was calculated to assess the graft function and suffering/recovering. Matched data were compared with the MEAF model of graft dysfunction. Objective To investigate whether the variation rate between the donor ICG-PDR value and the recipient ICG-PDR measurement on first postoperative day (POD1) can be associated with the MEAF score. Results 36 ICG-PDR measurements between 18 donors and 18 graft recipients were performed. The mean donor ICG-PDR was 22.64 (SD 6.35), and the mean receiver’s ICG-PDR on 1st POD was 17.68 (SD 6.60), with a mean MEAF value of 4.51 (SD 1.23). Pearson’s test stressed a good, linear inverse correlation between the ICG-PDR relative variation and the MEAF values, correlation coefficient -0.580 (p = 0.012). Conclusion The direct correlation between the donor to recipient ICG-PDR variation rate and MEAF was found. Measurements at T1 and T2 showed an up- or downtrend of the graft performance that reflect the MEAF values.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Luigi Vetrugno
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Victor Zanini
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Udine, Italy
- * E-mail:
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Francesco Tumminelli
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Pier Paolo Brollo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Erica Boscolo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
| | - Tiziana Bove
- Department of Anesthesia and Intensive Care, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | | | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
- Department of Medicine, University of Udine, Udine, Italy
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17
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Cherchi V, Vetrugno L, Zanini V, Pravisani R, Ventin M, Lorenzin D, Adani GL, Clocchiatti L, Boscolo E, Vit A, Sponza M, D'Alì L, Di Loreto C, Bove T, Terrosu G, Risaliti A, Baccarani U. Association between indocyanine green clearance test and ischemic type biliary lesions within one year after orthotopic liver transplantation. Gastroenterol Hepatol 2021; 44:687-695. [PMID: 34023468 DOI: 10.1016/j.gastrohep.2021.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Revised: 03/03/2021] [Accepted: 03/29/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Ischemic type biliary lesions (ITBLs), a particular subset of non-anastomotic biliary strictures (NAS), are characterized by intra and extrahepatic strictures that occur in the absence of either hepatic artery thrombosis or stenosis. When they occur within the first year after liver transplantation their development is mostly related to ischemia-reperfusion injury (IRI). The indocyanine green plasma disappearance rate (ICG-PDR) might be able to predict the probability of IRI-induced graft damage after liver transplantation. OBJECTIVE Our aim was to evaluate the association between ICG-PDR and the occurrence of ITBLs. Secondly, we searched for evidence of IRI in patients presenting ITBLs. METHODS This retrospective single-center observational study assessed a cohort of 60 liver transplant patients. Each patient underwent ICG-PDR on the 1st postoperative day. ITBLs were identified by means of either cholangiography or magnetic resonance imaging evidence of a deformity and narrowing of the biliary tree in the absence of hepatic artery thrombosis/stenosis. RESULTS ITBLs were discovered in 10 patients out of 60 liver recipients (16.67%) within one year after transplantation. A low ICG-PDR value was found to be a significant predictive factor for ITBL development, with an OR of 0.87 and a 95% CI of 0.77-0.97. Liver biopsies were performed in 56 patients presenting unexplained abnormal liver function test results. A statistically significant association was found between the development of ITBLs and anatomopathological evidence of IRI. LIMITATIONS Retrospective, single-center study. CONCLUSIONS The findings from this study show a relationship between low ICG-PDR values on first post-operative-day and the occurrence of ITBLs within 1 year after transplantation.
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Affiliation(s)
- Vittorio Cherchi
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Luigi Vetrugno
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Victor Zanini
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Riccardo Pravisani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Marco Ventin
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy.
| | - Dario Lorenzin
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Gian Luigi Adani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy
| | - Lucrezia Clocchiatti
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Erica Boscolo
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Alessandro Vit
- Division of Vascular and Interventional Radiology, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Massimo Sponza
- Division of Vascular and Interventional Radiology, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Lorenzo D'Alì
- Anatomic Pathology Institute, ASUFC University Hospital, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Carla Di Loreto
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Anatomic Pathology Institute, ASUFC University Hospital, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Tiziana Bove
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy; Department of Anesthesia and Intensive Care, University-Hospital of Udine, P.le S. Maria della, Misericordia n° 15, 33100 Udine, Italy
| | - Giovanni Terrosu
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Andrea Risaliti
- Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
| | - Umberto Baccarani
- General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, P.le S. Maria della Misericordia 15, 33100 Udine, Italy; Department of Medicine, University of Udine, Via Colugna n° 50, 33100 Udine, Italy
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Cherchi V, Baccarani U, Velkoski J, Ventin M, Pravisani R, Lorenzin D, Risaliti A, Terrosu G, Adani GL. A Simple Trick to Right Renal Vein Elongation in Deceased Donor Kidney Transplantation. EXP CLIN TRANSPLANT 2021; 19:749-750. [PMID: 33928877 DOI: 10.6002/ect.2021.0033] [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: 11/05/2022]
Affiliation(s)
- Vittorio Cherchi
- From the General Surgery Clinic and Liver Transplant Center, University-Hospital of Udine, Udine, Italy
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Angelou A, Antoniou E, Pikouli A, Wang J, Ventin M, Buettner S, Faateh M, Theodoropoulos G, Zografos GC, Theocharis S, Papalois AE, Pikoulis E, Margonis GA. Platelet Depletion/Transfusion as a Lethal Factor in a Colitis-associated Cancer Mouse Model. Anticancer Res 2019; 39:2443-2446. [PMID: 31092437 DOI: 10.21873/anticanres.13362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 03/30/2019] [Accepted: 04/03/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM TLR-4 Knock-out (KO) mice are protected from colitis-associated cancer in the established AOM/DSS mouse model. The aim of this study was to assess whether the TLR4 KO mice would still be protected from carcinogenesis after platelet depletion and transfusion with TLR4 wild-type platelets. MATERIALS AND METHODS Thirty-two female C57BL6 mice were divided into 6 groups. Among the three groups that received Azoxymethane/Dextran Sulfate Sodium (AOM/DSS), one group included TLR4KO mice, which were depleted of their platelets and were then transfused with platelets from TLR4 wild-type mice. The other two groups included wild-type and TLR-4KO mice that only received AOM/DSS. RESULTS All 6 animals in the KO group that underwent platelet depletion/transfusion succumbed. Three of them died before the administration of DSS and three in the week following DSS administration. In contrast, mice in the other two groups experienced less weight loss and only 1 mouse died in each of them. CONCLUSION Platelet depletion/transfusion was detrimental in TLR-4 transgenic mice that received AOM/DSS.
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Affiliation(s)
- Anastasios Angelou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Antoniou
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anastasia Pikouli
- 3rd Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
| | - Jane Wang
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Marco Ventin
- Department of Surgery, University of Udine, Udine, Italy
| | - Stefan Buettner
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - Muhammad Faateh
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, U.S.A
| | - George Theodoropoulos
- First Department of Propaedeutic Surgery, Hippokratio General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios C Zografos
- First Department of Propaedeutic Surgery, Hippokratio General Hospital of Athens, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stamatios Theocharis
- First Department of Pathology, National and Kapodistrian University of Athens, Athens, Greece
| | - Apostolos E Papalois
- Experimental, Educational and Research Centre ELPEN, Athens, Greece.,Medical School, European University Cyprus, Nicosia, Cyprus
| | - Emmanouil Pikoulis
- 3rd Department of Surgery, School of Medicine, National and Kapodistrian University of Athens, "Attikon" University General Hospital, Athens, Greece
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Bolao F, Podzamczer D, Ventin M, Gudiol F. Efficacy of acute phase and maintenance therapy with itraconazole in an AIDS patient with sporotrichosis. Eur J Clin Microbiol Infect Dis 1994; 13:609-12. [PMID: 7805693 DOI: 10.1007/bf01971316] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An AIDS patient with sporotrichosis who improved with itraconazole therapy after consecutive failure of ketoconazole, saturated solution of potassium iodide, fluconazole and amphotericin B is presented. In addition, long-term therapy with high doses of itraconazole was well tolerated and effective in avoiding relapse. Itraconazole may be suitable for use in HIV-infected patients with sporotrichosis, who probably require chronic suppressive therapy to prevent relapse of symptomatic disease.
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Affiliation(s)
- F Bolao
- Infectious Disease Service, Ciutat Sanitaria de Bellvitge, University of Barcelona, Spain
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Ventin M, Ramírez C, Ribera M, Ferrandiz C, Savall R, Peyri J. A significant geographical area for the study of the epidemiological and ecological aspect of Mediterranean sporothricosis. Mycopathologia 1987; 99:41-3. [PMID: 3627220 DOI: 10.1007/bf00436679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Two cases of sporothricosis originating from the same geographical area (Province of Barcelona) are described, including the circumstances of infection and the isolation of a wild strain of Sporothrix schenckii at the same locality. This finding could classify this particular area as a zone of interest in the epidemiological and ecological study of the mediterranean sporothricosis.
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Podzamczer D, Ventin M, Sauca G, Fernandez-Viladrich P, Martin R, Gudiol F. Contaminated lemons as possible source of infection in heroin abusers with disseminated candidiasis. Eur J Clin Microbiol 1986; 5:477. [PMID: 3530753 DOI: 10.1007/bf02075717] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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