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Morciano C, Spila Alegiani S, Menniti Ippolito F, Belleudi V, Trifirò G, Zanoni G, Puccini A, Sapigni E, Mores N, Leoni O, Monaco G, Clagnan E, Zappetti C, Bovo E, Cutillo M, Da Cas R, Massari M. Post-marketing active surveillance of Guillain Barré Syndrome following COVID-19 vaccination in persons aged ≥12 years in Italy: A multi-database self-controlled case series study. PLoS One 2024; 19:e0290879. [PMID: 38241309 PMCID: PMC10798452 DOI: 10.1371/journal.pone.0290879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 08/17/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Recently published studies have reported association of COVID-19 vaccine ChAdOx1-S (Vaxzevria) with Guillain Barré Syndrome (GBS). Less is known about the safety of other COVID-19 vaccines with respect to GBS outcome. This study investigated the association of COVID-19 vaccines with GBS in more than 15 million persons aged ≥12 years in Italy. METHODS Study population was all individuals aged ≥12 years who received at least one dose of COVID-19 vaccines, admitted to emergency care/hospital for GBS from 27 December 2020-30 September 2021 in Italy. Identification of GBS cases and receipt of at least one dose of mRNA-1273 (Elasomeran), BNT162b2 (Tozinameran), ChAdOx1-S (Vaxzevria) and Ad26.COV2.S (Janssen) through record linkage between regional health care and vaccination registries. Relative Incidence (RI) was estimated Self-controlled case series method adapted to event-dependent exposure using in the 42-day exposure risk period after each dose compared with other observation periods. RESULTS Increased risk of GBS was found after first (RI = 6.83; 95% CI 2.14-21.85) and second dose (RI = 7.41; 2.35-23.38) of mRNA-1273 and first dose of ChAdOx1-S (RI = 6.52; 2.88-14.77). Analysis by age found an increased risk among those aged≥60 years after first (RI = 8.03; 2.08-31.03) and second dose (RI = 7.71; 2.38-24.97) of mRNA-1273. The first dose of ChAdOx1-S was associated with GBS in those aged 40-59 (RI = 4.50; 1.37-14.79) and in those aged ≥ 60 years (RI = 6.84; 2.56-18.28). CONCLUSIONS mRNA-1273 and ChAdOx1-S vaccines were associated with an increased risk of GBS however this risk resulted in a small number of excess cases. Limitations were loss of GBS outpatient cases and imprecision of the estimates in the subgroup analysis due to a low number of events.
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Affiliation(s)
- Cristina Morciano
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Stefania Spila Alegiani
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Francesca Menniti Ippolito
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy
| | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Aurora Puccini
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Ester Sapigni
- Hospital Assistance Service, General Directorate for Personal Care, Health and Welfare, Emilia-Romagna Region, Bologna, Italy
| | - Nadia Mores
- Institute of Pharmacology, Pharmacovigilance, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Giuseppe Monaco
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Elena Clagnan
- Regional Health Authority, Friuli Venezia Giulia Region, Udine, Italy
| | - Cristina Zappetti
- Central Directorate for Health, Social Policies, Friuli Venezia Giulia Region, Trieste, Italy
| | | | - Maria Cutillo
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Roberto Da Cas
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Marco Massari
- Pharmacoepidemiology and Pharmacosurveillance Unit, National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
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Menniti-Ippolito F, Aiello E, Arzenton E, Assisi A, Blaznik U, Castenmiller JJM, Crevani M, de Clock D, Di Giacomo S, Emendi S, Gonella LA, Ippoliti I, Lindquist M, Magro L, Mazzanti G, Mores N, Moretti U, Moro PA, Novakovic B, Raschi E, Siksna I, Valetto MR, Vitalone A, Vo Van Regnault G. Erice Manifesto 2022: On the Surveillance of Potential Harms Caused by Food Supplements in Europe. Drug Saf 2023; 46:435-437. [PMID: 37022637 DOI: 10.1007/s40264-023-01284-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 04/07/2023]
Affiliation(s)
| | | | - Elena Arzenton
- Department of Diagnostic and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | | | - Urška Blaznik
- NIJZ: National Institute of Public Health, Ljubljana, Slovenia
| | - Jacqueline J M Castenmiller
- Netherlands Food and Consumer Product Safety Authority (NVWA), Office for Risk Assessment and Research, Utrecht, The Netherlands
| | - Marta Crevani
- Poison Control Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Silvia Di Giacomo
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | | | - Laura Augusta Gonella
- Department of Diagnostic and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Ilaria Ippoliti
- National Center for Drug Research and Evaluation, National Institute of Health, Rome, Italy
| | | | - Lara Magro
- Department of Diagnostic and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Gabriela Mazzanti
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Nadia Mores
- Department of Healthcare Surveillance and Bioethics, Section of Pharmacology "A. Gemelli" School of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ugo Moretti
- Department of Diagnostic and Public Health, Section of Pharmacology, University of Verona, Verona, Italy
| | - Paola Angela Moro
- Poison Control Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | - Emanuel Raschi
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy.
| | - Inese Siksna
- Department of Risk Assessment and Epidemiology, Institute of Food Safety, Animal Health and Environment "BIOR", Riga, Latvia
| | | | - Annabella Vitalone
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Gwenn Vo Van Regnault
- French Agency for Food, Environmental and Occupational Health and Safety, ANSES, Maisons-Alfort Cedex, France
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Beccia F, Regazzi L, Marziali E, Beccia V, Pascucci D, Mores N, Vetrugno G, Laurenti P. BNT162b2 COVID-19 Vaccine Safety among Healthcare Workers of a Tertiary Hospital in Italy. Vaccines (Basel) 2023; 11:vaccines11020477. [PMID: 36851354 PMCID: PMC9964542 DOI: 10.3390/vaccines11020477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Millions of people have died because of the COVID-19 pandemic. The vaccination campaign helped tackle the pandemic and saved millions of lives. In a retrospective pharmacovigilance study, we explored the safety of the BNT162b2 (Comirnaty) vaccine among healthcare workers (HCWs) in a large Italian teaching hospital, and 2428 Adverse Events Reports (AERs) filed by HCWs after the administration of the first dose of vaccine were collected and analyzed, reporting the results quantitively and comparing them to the vaccine Summary of Product Characteristics (SPC). Spearman's correlation coefficients were computed to investigate the correlation among reported adverse effects, and recurrent clusters of symptoms were investigated through the Principal Component Analysis (PCA) and k-means Cluster Analysis. The BNT162b2 vaccine's safety profile was favorable, with predominant reports of early onset, mild, non-serious and short-term resolved symptoms. We observed higher than the expected frequency for various non-serious undesirable effects, especially among those listed and classified as less common in the SPC. Furthermore, we identified three clusters of adverse effects that were frequently reported together, defined by the presence/absence of fatigue, malaise, localized pain, chills, pyrexia, insomnia, nausea and injection site pain. Post-marketing pharmacovigilance activities, together with targeted public health interventions, can be valuable tools to promote vaccination and improve the control of the spread of the pandemic, especially in sensitive settings and populations such as hospitals and healthcare professionals.
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Affiliation(s)
- Flavia Beccia
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luca Regazzi
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Correspondence:
| | - Eleonora Marziali
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Viria Beccia
- Medical Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Domenico Pascucci
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Patrizia Laurenti
- Section of Hygiene, Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Massari M, Spila Alegiani S, Morciano C, Spuri M, Marchione P, Felicetti P, Belleudi V, Poggi FR, Lazzeretti M, Ercolanoni M, Clagnan E, Bovo E, Trifirò G, Moretti U, Monaco G, Leoni O, Da Cas R, Petronzelli F, Tartaglia L, Mores N, Zanoni G, Rossi P, Samez S, Zappetti C, Marra AR, Menniti Ippolito F. Postmarketing active surveillance of myocarditis and pericarditis following vaccination with COVID-19 mRNA vaccines in persons aged 12 to 39 years in Italy: A multi-database, self-controlled case series study. PLoS Med 2022; 19:e1004056. [PMID: 35900992 PMCID: PMC9333264 DOI: 10.1371/journal.pmed.1004056] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 06/22/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Myocarditis and pericarditis following the Coronavirus Disease 2019 (COVID-19) mRNA vaccines administration have been reported, but their frequency is still uncertain in the younger population. This study investigated the association between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) mRNA vaccines, BNT162b2, and mRNA-1273 and myocarditis/pericarditis in the population of vaccinated persons aged 12 to 39 years in Italy. METHODS AND FINDINGS We conducted a self-controlled case series study (SCCS) using national data on COVID-19 vaccination linked to emergency care/hospital discharge databases. The outcome was the first diagnosis of myocarditis/pericarditis between 27 December 2020 and 30 September 2021. Exposure risk period (0 to 21 days from the vaccination day, subdivided in 3 equal intervals) for first and second dose was compared with baseline period. The SCCS model, adapted to event-dependent exposures, was fitted using unbiased estimating equations to estimate relative incidences (RIs) and excess of cases (EC) per 100,000 vaccinated by dose, age, sex, and vaccine product. Calendar period was included as time-varying confounder in the model. During the study period 2,861,809 persons aged 12 to 39 years received mRNA vaccines (2,405,759 BNT162b2; 456,050 mRNA-1273); 441 participants developed myocarditis/pericarditis (346 BNT162b2; 95 mRNA-1273). Within the 21-day risk interval, 114 myocarditis/pericarditis events occurred, the RI was 1.99 (1.30 to 3.05) after second dose of BNT162b2 and 2.22 (1.00 to 4.91) and 2.63 (1.21 to 5.71) after first and second dose of mRNA-1273. During the [0 to 7) days risk period, an increased risk of myocarditis/pericarditis was observed after first dose of mRNA-1273, with RI of 6.55 (2.73 to 15.72), and after second dose of BNT162b2 and mRNA-1273, with RIs of 3.39 (2.02 to 5.68) and 7.59 (3.26 to 17.65). The number of EC for second dose of mRNA-1273 was 5.5 per 100,000 vaccinated (3.0 to 7.9). The highest risk was observed in males, at [0 to 7) days after first and second dose of mRNA-1273 with RI of 12.28 (4.09 to 36.83) and RI of 11.91 (3.88 to 36.53); the number of EC after the second dose of mRNA-1273 was 8.8 (4.9 to 12.9). Among those aged 12 to 17 years, the RI was of 5.74 (1.52 to 21.72) after second dose of BNT162b2; for this age group, the number of events was insufficient for estimating RIs after mRNA-1273. Among those aged 18 to 29 years, the RIs were 7.58 (2.62 to 21.94) after first dose of mRNA-1273 and 4.02 (1.81 to 8.91) and 9.58 (3.32 to 27.58) after second dose of BNT162b2 and mRNA-1273; the numbers of EC were 3.4 (1.1 to 6.0) and 8.6 (4.4 to 12.6) after first and second dose of mRNA-1273. The main study limitations were that the outcome was not validated through review of clinical records, and there was an absence of information on the length of hospitalization and, thus, the severity of the outcome. CONCLUSIONS This population-based study of about 3 millions of residents in Italy suggested that mRNA vaccines were associated with myocarditis/pericarditis in the population younger than 40 years. According to our results, increased risk of myocarditis/pericarditis was associated with the second dose of BNT162b2 and both doses of mRNA-1273. The highest risks were observed in males of 12 to 39 years and in males and females 18 to 29 years vaccinated with mRNA-1273. The public health implication of these findings should be considered in the light of the proven mRNA vaccine effectiveness in preventing serious COVID-19 disease and death.
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Affiliation(s)
- Marco Massari
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Stefania Spila Alegiani
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Cristina Morciano
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
- * E-mail:
| | - Matteo Spuri
- Department of Infectious Diseases, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Pasquale Marchione
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Patrizia Felicetti
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Valeria Belleudi
- Department of Epidemiology ASL Roma 1, Lazio Regional Health Service, Rome, Italy
| | | | - Marco Lazzeretti
- Business Intelligence, Data Science e Data Analysis, ARIA S.p.A., Milan, Italy
| | - Michele Ercolanoni
- Business Intelligence, Data Science e Data Analysis, ARIA S.p.A., Milan, Italy
| | - Elena Clagnan
- ARCS–Azienda Regionale di Coordinamento per la Salute, Udine, Italy
| | | | - Gianluca Trifirò
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ugo Moretti
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuseppe Monaco
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Olivia Leoni
- Department of Health of Lombardy Region, Epidemiology Observatory, Milan, Italy
| | - Roberto Da Cas
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
| | - Fiorella Petronzelli
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Loriana Tartaglia
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Nadia Mores
- Institute of Pharmacology, Pharmacovigilance, Policlinico Universitario A. Gemelli, Catholic University of Sacred Heart, Rome, Italy
| | | | - Paola Rossi
- Direzione centrale salute, politiche sociali e disabilità, Friuli Venezia Giulia Region, Trieste, Italy
| | - Sarah Samez
- Centro Regionale di Farmacovigilanza, Friuli Venezia Giulia Region, Trieste, Italy
| | - Cristina Zappetti
- Direzione centrale salute, politiche sociali e disabilità, Friuli Venezia Giulia Region, Trieste, Italy
| | - Anna Rosa Marra
- Department of post-marketing surveillance, Agenzia Italiana del Farmaco (Italian Medicines Agency), Rome, Italy
| | - Francesca Menniti Ippolito
- National Centre for Drug Research and Evaluation, Istituto Superiore di Sanità (National Institute of Health), Rome, Italy
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Pascucci D, Nurchis MC, Sapienza M, Castrini F, Beccia F, D’Ambrosio F, Grossi A, Castagna C, Pezzullo AM, Zega M, Staiti D, De Simone FM, Mores N, Cambieri A, Vetrugno G, Damiani G, Laurenti P. Evaluation of the Effectiveness and Safety of the BNT162b2 COVID-19 Vaccine in the Vaccination Campaign among the Health Workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS. Int J Environ Res Public Health 2021; 18:ijerph182111098. [PMID: 34769618 PMCID: PMC8582885 DOI: 10.3390/ijerph182111098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/13/2022]
Abstract
Health workers, especially those in patient-facing roles, had a significantly increased risk of COVID-19 infection, having serious outcomes, and risking spreading the virus to patients and staff. Vaccination campaign planning suggests allocating initial supplies of BNT162b2 vaccine to health workers given the importance of early protection to safeguard the continuity of care to patients. The aim of the study is to assess the effectiveness and safety of BNT162b2 vaccine among the health workers of Fondazione Policlinico Universitario Agostino Gemelli IRCCS (FPG). The retrospective cohort study was conducted among health staff working at the FPG. Vaccination data were collected from hospital records. The primary end points were vaccine effectiveness and safety. A total of 6649 health workers were included, of whom 5162 received injections. There were 14 cases of COVID-19 with onset at least 14 days after the second dose among vaccinated health workers and 45 cases among unvaccinated ones. BNT162b2 was 91.5% effective against COVID-19 (95% credible interval, 84.7% to 95.3%). The safety profile of BNT162b2 vaccine consisted of short-term, non-serious events. The promotion and boost of the COVID-19 vaccination campaign represents a key public health measure useful to curb the spread of the pandemic especially in vulnerable contexts, such as hospitals, where health workers carry out a paramount role for the entire community, and requires further protection with a possible booster dose in view of autumn-winter 2021.
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Affiliation(s)
- Domenico Pascucci
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Mario Cesare Nurchis
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
- Correspondence: ; Tel.: +39-063-015-4396
| | - Martina Sapienza
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Francesco Castrini
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Flavia Beccia
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Floriana D’Ambrosio
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Adriano Grossi
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Carolina Castagna
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Angelo Maria Pezzullo
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
| | - Maurizio Zega
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Domenico Staiti
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Francesco Maria De Simone
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Nadia Mores
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Andrea Cambieri
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Giuseppe Vetrugno
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Gianfranco Damiani
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
| | - Patrizia Laurenti
- Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (D.P.); (M.S.); (F.C.); (F.B.); (F.D.); (A.G.); (C.C.); (A.M.P.); (D.S.); (N.M.); (G.V.); (G.D.); (P.L.)
- Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (M.Z.); (F.M.D.S.); (A.C.)
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Lucchetti D, Santini G, Perelli L, Ricciardi-Tenore C, Colella F, Mores N, Macis G, Bush A, Sgambato A, Montuschi P. Detection and characterisation of extracellular vesicles in exhaled breath condensate and sputum of COPD and severe asthma patients. Eur Respir J 2021; 58:13993003.03024-2020. [PMID: 33795323 DOI: 10.1183/13993003.03024-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 03/22/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Donatella Lucchetti
- Dept of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,These authors contributed equally to this study
| | - Giuseppe Santini
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,These authors contributed equally to this study
| | - Luigi Perelli
- Dept of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,These authors contributed equally to this study
| | - Claudio Ricciardi-Tenore
- Dept of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Filomena Colella
- Dept of Translational Medicine and Surgery, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Mores
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Macis
- Imaging Diagnostics, University Hospital Agostino Gemelli Foundation IRCCS, Rome, Italy
| | - Andrew Bush
- Dept of Paediatrics, Imperial College London, London, UK
| | - Alessandro Sgambato
- Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy.,These authors share senior authorship of this article
| | - Paolo Montuschi
- Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.,These authors share senior authorship of this article
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Foti F, Sica S, Alma E, De Cristofaro R, Mores N, Vetrugno G. Sudden nasal bleeding and brodifacoum: A case of accidental exposure or attempted homicide? Leg Med (Tokyo) 2020; 47:101772. [PMID: 32771937 DOI: 10.1016/j.legalmed.2020.101772] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 11/29/2022]
Abstract
A 50-year-old man was admitted to the emergency department with abrupt massive epistaxis. An accurate anamnesis and physical evaluation could not reveal any other anomalies, while coagulation tests showed potentially life threatening prolonged prothrombin time, with activated partial thromboplastin and thrombin time, with fibrinogen and antithrombin III within limits. Despite the prompt pharmacological and compressive local treatment, bleeding continued and the patient was therefore hospitalized. Highly specific coagulation and toxicological testing-among others high-performance liquid chromatography assessment on plasma-were performed, leading to the unexpected identification of brodifacoum. Police and criminal justice authorities revealed the source of exposure to brodifacoum after several months of investigation, residing in his everyday life. Brodifacoum is a long-lasting anticoagulant, acting as a vitamin K antagonist, and belongs to the family of superwarfarins. Brodifacoum use is authorized as rodenticide in many countries worldwide, but has been reported as cause of severe coagulopathies in humans, both intentional or involuntary, even consumed as a contaminant of herbal drugs, such as cannabis. The original contribution of this case to the knowledges of human brodifacoum intoxication resides in the multidisciplinary approach and the collaborative interplay of clinical and toxicology experts as well as judicial authorities.
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Affiliation(s)
- Federica Foti
- Risk Management Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
| | - Simona Sica
- Unit of Vascular Surgery, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Eleonora Alma
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome - Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Raimondo De Cristofaro
- Servizio Malattie Emorragiche e Trombotiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome-Università Cattolica S. Cuore, Rome, Italy
| | - Nadia Mores
- Unit of Pharmacovigilance, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome-Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Vetrugno
- Risk Management Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Healthcare Surveillance and Bioethics, Section of Legal Medicine, Università Cattolica del Sacro Cuore, Rome, Italy
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8
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Freddi S, Emelianov AV, Bobrinetskiy II, Drera G, Pagliara S, Kopylova DS, Chiesa M, Santini G, Mores N, Moscato U, Nasibulin AG, Montuschi P, Sangaletti L. Development of a Sensing Array for Human Breath Analysis Based on SWCNT Layers Functionalized with Semiconductor Organic Molecules. Adv Healthc Mater 2020; 9:e2000377. [PMID: 32378358 DOI: 10.1002/adhm.202000377] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/09/2020] [Indexed: 02/04/2023]
Abstract
A sensor array based on heterojunctions between semiconducting organic layers and single walled carbon nanotube (SWCNT) films is produced to explore applications in breathomics, the molecular analysis of exhaled breath. The array is exposed to gas/volatiles relevant to specific diseases (ammonia, ethanol, acetone, 2-propanol, sodium hypochlorite, benzene, hydrogen sulfide, and nitrogen dioxide). Then, to evaluate its capability to operate with real relevant biological samples the array is exposed to human breath exhaled from healthy subjects. Finally, to provide a proof of concept of its diagnostic potential, the array is exposed to exhaled breath samples collected from subjects with chronic obstructive pulmonary disease (COPD), an airway chronic inflammatory disease not yet investigated with CNT-based sensor arrays, and breathprints are compared with those obtained from of healthy subjects. Principal component analysis shows that the sensor array is able to detect various target gas/volatiles with a clear fingerprint on a 2D subspace, is suitable for breath profiling in exhaled human breath, and is able to distinguish subjects with COPD from healthy subjects based on their breathprints. This classification ability is further improved by selecting the most responsive sensors to nitrogen dioxide, a potential biomarker of COPD.
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Affiliation(s)
- Sonia Freddi
- Mathematics and Physics DepartmentUniversità Cattolica del Sacro Cuore via dei Musei 41 Brescia 25121 Italy
- Surface Science and Spectroscopy Lab @ I‐LampUniversità Cattolica del Sacro Cuore Brescia 25121 Italy
- Department of ChemistryDivision of Molecular Imaging and PhotonicsKU Leuven Celestijnenlaan 200F Leuven 3001 Belgium
| | - Aleksei V. Emelianov
- National Research University of Electronic Technology Zelenograd Moscow 124498 Russia
- P.N. Lebedev Physical Institute of the Russian Academy of Sciences Moscow 119991 Russia
| | - Ivan I. Bobrinetskiy
- National Research University of Electronic Technology Zelenograd Moscow 124498 Russia
- BioSense Institute – Research and Development Institute for Information Technologies in BiosystemsUniversity of Novi Sad Dr Zorana Djindjica 1a Novi Sad 21000 Serbia
| | - Giovanni Drera
- Mathematics and Physics DepartmentUniversità Cattolica del Sacro Cuore via dei Musei 41 Brescia 25121 Italy
- Surface Science and Spectroscopy Lab @ I‐LampUniversità Cattolica del Sacro Cuore Brescia 25121 Italy
| | - Stefania Pagliara
- Mathematics and Physics DepartmentUniversità Cattolica del Sacro Cuore via dei Musei 41 Brescia 25121 Italy
- Surface Science and Spectroscopy Lab @ I‐LampUniversità Cattolica del Sacro Cuore Brescia 25121 Italy
| | | | - Maria Chiesa
- Mathematics and Physics DepartmentUniversità Cattolica del Sacro Cuore via dei Musei 41 Brescia 25121 Italy
| | - Giuseppe Santini
- Department of PharmacologyFaculty of MedicineCatholic University of the Sacred HeartFondazione Policlinico Universitario Agostino GemelliIRCCS Largo Francesco Vito, 1 Roma 00168 Italy
| | - Nadia Mores
- Department of PharmacologyFaculty of MedicineCatholic University of the Sacred HeartFondazione Policlinico Universitario Agostino GemelliIRCCS Largo Francesco Vito, 1 Roma 00168 Italy
| | - Umberto Moscato
- Occupational MedicineFaculty of MedicineCatholic University of the Sacred HeartFondazione Policlinico Universitario Agostino GemelliIRCCS Largo Francesco Vito, 1 Roma 00168 Italy
| | - Albert G. Nasibulin
- Skolkovo Institute of Science and Technology Moscow 121205 Russia
- Aalto University P. O. Box 16100 Aalto FI‐00076 Finland
| | - Paolo Montuschi
- Department of PharmacologyFaculty of MedicineCatholic University of the Sacred HeartFondazione Policlinico Universitario Agostino GemelliIRCCS Largo Francesco Vito, 1 Roma 00168 Italy
| | - Luigi Sangaletti
- Mathematics and Physics DepartmentUniversità Cattolica del Sacro Cuore via dei Musei 41 Brescia 25121 Italy
- Surface Science and Spectroscopy Lab @ I‐LampUniversità Cattolica del Sacro Cuore Brescia 25121 Italy
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D’Alò F, Malafronte R, Piludu F, Bellesi S, Cuccaro A, Maiolo E, Modoni A, Leccisotti L, Macis G, Mores N, De Stefano V, Hohaus S. Progressive multifocal leukoencephalopathy in patients with follicular lymphoma treated with bendamustine plus rituximab followed by rituximab maintenance. Br J Haematol 2020; 189:e140-e144. [DOI: 10.1111/bjh.16563] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Francesco D’Alò
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Rosalia Malafronte
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Francesca Piludu
- Unit of Radiology and Neuroradiology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Silvia Bellesi
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Annarosa Cuccaro
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Elena Maiolo
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Anna Modoni
- Unit of Neurology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Lucia Leccisotti
- Unit of Nuclear Medicine Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Giuseppe Macis
- Università Cattolica del Sacro Cuore Rome Italy
- Unit of Radiology and Neuroradiology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Nadia Mores
- Università Cattolica del Sacro Cuore Rome Italy
- Unit of Pharmacovigilance Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
| | - Valerio De Stefano
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
| | - Stefan Hohaus
- Area of Hematology Fondazione Policlinico Universitario Agostino Gemelli IRCCS Rome Italy
- Università Cattolica del Sacro Cuore Rome Italy
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10
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Vignoli A, Santini G, Tenori L, Macis G, Mores N, Macagno F, Pagano F, Higenbottam T, Luchinat C, Montuschi P. NMR-Based Metabolomics for the Assessment of Inhaled Pharmacotherapy in Chronic Obstructive Pulmonary Disease Patients. J Proteome Res 2019; 19:64-74. [PMID: 31621329 DOI: 10.1021/acs.jproteome.9b00345] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 02/07/2023]
Abstract
The aim of this proof-of-concept, pilot study was the evaluation of the effects of steroid administration and suspension of an inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) extrafine fixed dose combination (FDC) on metabolomic fingerprints in subjects with chronic obstructive pulmonary disease (COPD). We hypothesized that a comprehensive metabolomics approach discriminates across inhaled pharmacotherapies and that their effects on metabolomic signatures depend on the biological fluids analyzed. We performed metabolomics via nuclear magnetic resonance (NMR) spectroscopy in exhaled breath condensate (EBC), sputum supernatants, serum, and urine. Fourteen patients suffering from COPD who were on regular inhaled fluticasone propionate/salmeterol therapy (visit 1) were consecutively treated with 2-week beclomethasone dipropionate/formoterol (visit 2), 4-week formoterol alone (visit 3), and 4-week beclomethasone/formoterol (visit 4). The comprehensive NMR-based metabolomics approach showed differences across all pharmacotherapies and that different biofluids provided orthogonal information. Serum formate was lower at visits 1 versus 3 (P = 0.03), EBC formate was higher at visit 1 versus 4 (P = 0.03), and urinary 1-methyl-nicotinamide was lower at 3 versus 4 visit (P = 0.002). NMR-based metabolomics of different biofluids distinguishes across inhaled pharmacotherapies, provides complementary information on the effects of an extrafine ICS/LABA FDC on metabolic fingerprints in COPD patients, and might be useful for elucidating the ICS mechanism of action.
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Affiliation(s)
- Alessia Vignoli
- Magnetic Resonance Center (CERM) , University of Florence , Via Luigi Sacconi 6 , Sesto Fiorentino , Italy 50019.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP) , Piazza San Marco 4 , Florence , Italy 50121
| | - Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, Rome, Italy 00168,Pharmacology Unit, University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM) , University of Florence , Via Luigi Sacconi 6 , Sesto Fiorentino , Italy 50019.,Department of Experimental and Clinical Medicine , University of Florence , Largo Brambilla 3 , Florence , Italy 50100
| | - Giuseppe Macis
- Imaging Diagnostics,University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, Rome, Italy 00168,Pharmacology Unit, University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168
| | - Francesco Macagno
- Respiratory Medicine Unit,University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168
| | - Francesco Pagano
- Ageing Unit, University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168,Department of Internal Medicine and Geriatrics, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, Rome, Italy 00168
| | - Tim Higenbottam
- Faculty of Pharmaceutical Medicine , Royal College of Physicians , London NW1 4LE , United Kingdom
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM) , University of Florence , Via Luigi Sacconi 6 , Sesto Fiorentino , Italy 50019.,Consorzio Interuniversitario Risonanze Magnetiche di Metallo Proteine (CIRMMP) , Piazza San Marco 4 , Florence , Italy 50121.,Department of Chemistry "Ugo Schiff" , University of Florence , Via della Lastruccia 3 , Sesto Fiorentino , Italy 50019
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo F. Vito, 1, Rome, Italy 00168,Pharmacology Unit, University Hospital Agostino Gemelli Foundation, IRCCS, Largo Agostino Gemelli, 8, Rome, Italy 00168
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11
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Montuschi P, Lucidi V, Paris D, Montemitro E, Shohreh R, Mores N, Melck D, Santini G, Majo F, Motta A. Metabolomic Analysis by Nuclear Magnetic Resonance Spectroscopy as a New Approach to Understanding Inflammation and Monitoring of Pharmacological Therapy in Children and Young Adults With Cystic Fibrosis. Front Pharmacol 2018; 9:595. [PMID: 29967580 PMCID: PMC6015879 DOI: 10.3389/fphar.2018.00595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/17/2018] [Indexed: 01/05/2023] Open
Abstract
15-F2t-Isoprostane, a reliable biomarker of oxidative stress, has been found elevated in exhaled breath condensate (EBC), a non-invasive technique for sampling of airway secretions, in patients with cystic fibrosis (CF). Azithromycin has antioxidant properties in experimental models of CF, but its effects on oxidative stress in CF patients are largely unknown. Primary objective of this pilot, proof-of-concept, prospective, parallel group, pharmacological study, was investigating the potential antioxidant effects of azithromycin in CF patients as reflected by EBC 15-F2t-isoprostane. Secondary objectives included studying the effect of azithromycin on EBC and serum metabolic profiles, and on serum 15-F2t-isoprostane. In CF patients who were on maintenance treatment with oral vitamin E (200 UI once daily), treatment with oral azithromycin (250 or 500 mg depending on body weight) plus vitamin E (400 UI once daily) (group A) (n = 24) or oral vitamin E alone (400 UI once daily) (group B) (n = 21) was not associated with changes in EBC 15-F2t-isoprostane concentrations compared with baseline values after 8-weeks treatment or 2 weeks after treatment suspension. There was no between-group difference in post-treatment EBC 15-F2t-isoprostane. Likewise, no within- or between-group differences in serum 15-F2t-isoprostane concentrations were observed in either study group. NMR spectroscopy-based metabolomics of EBC shows that suspension of both azithromycin plus vitamin E and vitamin E alone has a striking effect on metabolic profiles in EBC. Between-group comparisons show that EBC metabolite distribution after treatment and 2 weeks after treatment suspension is different. Quantitative differences in ethanol, saturated fatty acids, acetate, acetoin/acetone, and methanol are responsible for these differences. Our study was unable to show antioxidant effect of azithromycin as add-on treatment with doubling the dose of oral vitamin E as reflected by 15-F2t-isoprostane concentrations in EBC. Add-on therapy with azithromycin itself does not induce EBC metabolite changes, but its suspension is associated with EBC metabolic profiles that are different from those observed after vitamin E suspension. The pathophysiological and therapeutic implications of these findings in patients with stable CF are unknown and require further research. Preliminary data suggest that EBC NMR-based metabolomics might be used for assessing the effects of pharmacological treatment suspension in stable CF patients.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Pharmacology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | | | - Debora Paris
- Institute of Biomolecular Chemistry, Italian National Research Council, Pozzuoli, Italy
| | - Enza Montemitro
- Cystic Fibrosis Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Rugia Shohreh
- Department of Drug Sciences, Faculty of Pharmacy, University “G. d’Annunzio” Chieti-Pescara, Chieti, Italy
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Pharmacology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dominique Melck
- Institute of Biomolecular Chemistry, Italian National Research Council, Pozzuoli, Italy
| | - Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
- Pharmacology Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Fabio Majo
- Cystic Fibrosis Unit, Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, Italian National Research Council, Pozzuoli, Italy
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Montuschi P, Santini G, Mores N, Vignoli A, Macagno F, Shoreh R, Tenori L, Zini G, Fuso L, Mondino C, Di Natale C, D'Amico A, Luchinat C, Barnes PJ, Higenbottam T. Breathomics for Assessing the Effects of Treatment and Withdrawal With Inhaled Beclomethasone/Formoterol in Patients With COPD. Front Pharmacol 2018; 9:258. [PMID: 29719507 PMCID: PMC5914154 DOI: 10.3389/fphar.2018.00258] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 03/08/2018] [Indexed: 01/15/2023] Open
Abstract
Background: Prospective pharmacological studies on breathomics profiles in COPD patients have not been previously reported. We assessed the effects of treatment and withdrawal of an extrafine inhaled corticosteroid (ICS)-long-acting β2-agonist (LABA) fixed dose combination (FDC) using a multidimensional classification model including breathomics. Methods: A pilot, proof-of-concept, pharmacological study was undertaken in 14 COPD patients on maintenance treatment with inhaled fluticasone propionate/salmeterol (500/50 μg b.i.d.) for at least 8 weeks (visit 1). Patients received 2-week treatment with inhaled beclomethasone dipropionate/formoterol (100/6 μg b.i.d.) (visit 2), 4-week treatment with formoterol alone (6 μg b.i.d.) (visit 3), and 4-week treatment with beclomethasone/formoterol (100/6 μg b.i.d.) (visit 4). Exhaled breath analysis with two e-noses, based on different technologies, and exhaled breath condensate (EBC) NMR-based metabolomics were performed. Sputum cell counts, sputum supernatant and EBC prostaglandin E2 (PGE2) and 15-F2t-isoprostane, fraction of exhaled nitric oxide, and spirometry were measured. Results: Compared with formoterol alone, EBC acetate and sputum PGE2, reflecting airway inflammation, were reduced after 4-week beclomethasone/formoterol. Three independent breathomics techniques showed that extrafine beclomethasone/formoterol short-term treatment was associated with different breathprints compared with regular fluticasone propionate/salmeterol. Either ICS/LABA FDC vs. formoterol alone was associated with increased pre-bronchodilator FEF25−75% and FEV1/FVC (P = 0.008–0.029). The multidimensional model distinguished fluticasone propionate/salmeterol vs. beclomethasone/formoterol, fluticasone propionate/salmeterol vs. formoterol, and formoterol vs. beclomethasone/formoterol (accuracy > 70%, P < 0.01). Conclusions: Breathomics could be used for assessing ICS treatment and withdrawal in COPD patients. Large, controlled, prospective pharmacological trials are required to clarify the biological implications of breathomics changes. EUDRACT number: 2012-001749-42.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Alessia Vignoli
- Magnetic Resonance Center (CERM), University of Florence, Florence, Italy
| | - Francesco Macagno
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Rugia Shoreh
- Department of Drug Sciences, Faculty of Pharmacy, University "G. d'Annunzio", Chieti, Italy
| | - Leonardo Tenori
- Magnetic Resonance Center (CERM), University of Florence, Florence, Italy
| | - Gina Zini
- Department of Hematology, Faculty of Medicine, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Leonello Fuso
- Department of Internal Medicine and Geriatrics, Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation, Rome, Italy
| | - Chiara Mondino
- Department of Allergology, 'Bellinzona e Valli' Hospital, Bellinzona, Switzerland
| | - Corrado Di Natale
- Department of Electronic Engineering, University of Tor Vergata, Rome, Italy
| | - Arnaldo D'Amico
- Department of Electronic Engineering, University of Tor Vergata, Rome, Italy
| | - Claudio Luchinat
- Magnetic Resonance Center (CERM), University of Florence, Florence, Italy
| | - Peter J Barnes
- Airway Disease Section, Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Tim Higenbottam
- Faculty of Pharmaceutical Medicine, Royal College of Physicians, London, United Kingdom
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Malerba M, Radaeli A, Santini G, Morjaria J, Mores N, Mondino C, Macis G, Montuschi P. The discovery and development of aclidinium bromide for the treatment of chronic obstructive pulmonary disease. Expert Opin Drug Discov 2018; 13:563-577. [PMID: 29616842 DOI: 10.1080/17460441.2018.1455661] [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] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Bronchodilators, including long-acting muscarinic receptor antagonists (LAMAs), are a mainstay of the pharmacological treatment of chronic obstructive pulmonary disease (COPD). LAMAs act as bronchodilators principally by antagonizing airway smooth muscle cells M3 muscarinic receptors. Aclidinium bromide is a twice-daily LAMA which was developed to improve on the efficacy and/or safety of previous LAMAs. Area covered: Herein, the authors present the pharmacotherapeutic role of aclidinium in COPD and point out unmet need in this research area. The following aspects are covered: a) the discovery and medicinal chemistry of aclidinium bromide; b) an overview of the market; c) its mechanism of action; d) its pharmacokinetic/pharmacodynamic profile derived from pre-clinical studies; e) the clinical studies which led to its licensing; f) the evidence from meta-analyses; g) the aclidinium/formoterol fixed dose combination for COPD and h) priorities in this area of research. Expert opinion: Aclidinium bromide has the pharmacological properties, safety and efficacy profile and inhaler characteristics which makes it a valuable therapeutic option for pharmacological management of patients with COPD. Due to its rapid biotransformation into inactive metabolites, aclidinium is potentially one of the safest LAMAs. Further head-to-head randomized clinical trials are required to define efficacy and safety of aclidinium when compared to once-daily LAMAs. The clinical relevance of airway anti-remodeling effects of aclidinium has to be defined.
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Affiliation(s)
- Mario Malerba
- a Department of Translational Medicine-Respiratory Medicine , University of "Piemonte Orientale" , Vercelli , Italy
| | - Alessandro Radaeli
- b Department of Internal Medicine , University of Brescia , Brescia , Italy
| | - Giuseppe Santini
- c Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy.,d Pharmacology Unit , Agostino Gemelli University Hospital Foundation , Rome , Italy
| | - Jaymin Morjaria
- e Department of Respiratory Medicine , RBHT Foundation Trust, Harefield Hospital , Harefield , UK
| | - Nadia Mores
- c Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy.,d Pharmacology Unit , Agostino Gemelli University Hospital Foundation , Rome , Italy
| | - Chiara Mondino
- f Department of Allergology , "Bellinzona e Valli" Hospital , Bellinzona , Switzerland
| | - Giuseppe Macis
- g Department of Radiological Sciences, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy.,h Radiology Unit , Agostino Gemelli University Hospital Foundation , Rome , Italy
| | - Paolo Montuschi
- c Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy.,d Pharmacology Unit , Agostino Gemelli University Hospital Foundation , Rome , Italy
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14
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Malerba M, Nardin M, Santini G, Mores N, Radaeli A, Montuschi P. Single-inhaler triple therapy utilizing the once-daily combination of fluticasone furoate, umeclidinium and vilanterol in the management of COPD: the current evidence base and future prospects. Ther Adv Respir Dis 2018; 12:1753466618760779. [PMID: 29537340 PMCID: PMC5941662 DOI: 10.1177/1753466618760779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Accepted: 01/31/2018] [Indexed: 12/13/2022] Open
Abstract
Maintenance pharmacological treatment for stable chronic obstructive pulmonary disease (COPD) is based on inhaled drugs, including long-acting muscarinic receptor antagonists (LAMA), long-acting β2-adrenoceptor agonists (LABA) and inhaled corticosteroids (ICS). Inhaled pharmacological treatment can improve patients' daily symptoms and reduce decline of pulmonary function and acute exacerbation rate. Treatment with all three inhaled drug classes is reserved for selected, more severe, patients with COPD when symptoms are not sufficiently controlled by dual LABA/LAMA therapy and exacerbations are frequent. This review focuses on the role of single-inhaler triple therapy with once-daily fluticasone furoate/umeclidinium/vilanterol fixed-dose combination, which is in phase III clinical development for maintenance treatment of severe-to-very severe COPD. In this review, we summarize evidence providing the rationale for its use in COPD and discuss the gaps to be filled in this pharmacotherapeutic area.
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Affiliation(s)
- Mario Malerba
- Department of Translational Medicine-Respiratory Medicine, University of Piemonte Orientale, Novara/Vercelli, Italy
| | - Matteo Nardin
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Santini
- Department of Pharmacology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Catholic University of the Sacred Heart, Agostino Gemelli University Hospital Foundation, Rome, Italy
| | - Alessandro Radaeli
- Department of Emergency Medicine, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Agostino Gemelli, University Hospital Foundation, Largo Francesco Vito, 1 – 00168, Rome, Italy
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15
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Schinzari F, Tesauro M, Veneziani A, Mores N, Di Daniele N, Cardillo C. Favorable Vascular Actions of Angiotensin-(1-7) in Human Obesity. Hypertension 2017; 71:185-191. [PMID: 29203627 DOI: 10.1161/hypertensionaha.117.10280] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 09/20/2017] [Accepted: 10/06/2017] [Indexed: 12/28/2022]
Abstract
Obese patients have vascular dysfunction related to impaired insulin-stimulated vasodilation and increased endothelin-1-mediated vasoconstriction. In contrast to the harmful vascular actions of angiotensin (Ang) II, the angiotensin-converting enzyme 2 product Ang-(1-7) has shown to exert cardiovascular and metabolic benefits in experimental models through stimulation of the Mas receptor. We, therefore, examined the effects of exogenous Ang-(1-7) on vasodilator tone and endothelin-1-dependent vasoconstriction in obese patients. Intra-arterial infusion of Ang-(1-7) (10 nmol/min) resulted in significant increase in unstimulated forearm flow (P=0.03), an effect that was not affected by the Mas receptor antagonist A779 (10 nmol/min; P>0.05). In the absence of hyperinsulinemia, however, forearm flow responses to graded doses of acetylcholine and sodium nitroprusside were not different during Ang-(1-7) administration compared with saline (both P>0.05). During infusion of regular insulin (0.15 mU/kg per minute), by contrast, endothelium-dependent vasodilator response to acetylcholine was significantly enhanced by Ang-(1-7) (P=0.04 versus saline), whereas endothelium-independent response to sodium nitroprusside was not modified (P=0.91). Finally, Ang-(1-7) decreased the vasodilator response to endothelin A receptor blockade (BQ-123; 10 nmol/min) compared with saline (6±1% versus 93±17%; P<0.001); nitric oxide inhibition by l-N-monomethylarginine (4 µmol/min) during concurrent endothelin A antagonism resulted in similar vasoconstriction in the absence or presence of Ang-(1-7 Ang-(1-7) (P=0.69). Our findings indicate that in obese patients Ang-(1-7) has favorable effects not only to improve insulin-stimulated endothelium-dependent vasodilation but also to blunt endothelin-1-dependent vasoconstrictor tone. These findings provide support for targeting Ang-(1-7) to counteract the hemodynamic abnormalities of human obesity.
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Affiliation(s)
- Francesca Schinzari
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy
| | - Manfredi Tesauro
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy
| | - Augusto Veneziani
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy
| | - Nadia Mores
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy
| | - Nicola Di Daniele
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy
| | - Carmine Cardillo
- From the Policlinico A. Gemelli, Rome, Italy (F.S., A.V., N.M., C.C.); Department of Internal Medicine, University of Tor Vergata, Rome, Italy (M.T., N.D.D.); and Departments of Surgery (A.V.), Pharmacology (N.M.), and Internal Medicine (C.C.), Catholic University, Rome, Italy.
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16
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Lefaudeux D, De Meulder B, Loza MJ, Peffer N, Rowe A, Baribaud F, Bansal AT, Lutter R, Sousa AR, Corfield J, Pandis I, Bakke PS, Caruso M, Chanez P, Dahlén SE, Fleming LJ, Fowler SJ, Horvath I, Krug N, Montuschi P, Sanak M, Sandstrom T, Shaw DE, Singer F, Sterk PJ, Roberts G, Adcock IM, Djukanovic R, Auffray C, Chung KF, Adriaens N, Ahmed H, Aliprantis A, Alving K, Badorek P, Balgoma D, Barber C, Bautmans A, Behndig AF, Bel E, Beleta J, Berglind A, Berton A, Bigler J, Bisgaard H, Bochenek G, Boedigheimer MJ, Bøonnelykke K, Brandsma J, Braun A, Brinkman P, Burg D, Campagna D, Carayannopoulos L, Carvalho da Purfição Rocha JP, Chaiboonchoe A, Chaleckis R, Coleman C, Compton C, D'Amico A, Dahlén B, De Alba J, de Boer P, De Lepeleire I, Dekker T, Delin I, Dennison P, Dijkhuis A, Draper A, Edwards J, Emma R, Ericsson M, Erpenbeck V, Erzen D, Faulenbach C, Fichtner K, Fitch N, Flood B, Frey U, Gahlemann M, Galffy G, Gallart H, Garret T, Geiser T, Gent J, Gerhardsson de Verdier M, Gibeon D, Gomez C, Gove K, Gozzard N, Guo YK, Hashimoto S, Haughney J, Hedlin G, Hekking PP, Henriksson E, Hewitt L, Higgenbottam T, Hoda U, Hohlfeld J, Holweg C, Howarth P, Hu R, Hu S, Hu X, Hudson V, James AJ, Kamphuis J, Kennington EJ, Kerry D, Klüglich M, Knobel H, Knowles R, Knox A, Kolmert J, Konradsen J, Kots M, Krueger L, Kuo S, Kupczyk M, Lambrecht B, Lantz AS, Larsson L, Lazarinis N, Lone-Satif S, Marouzet L, Martin J, Masefield S, Mathon C, Matthews JG, Mazein A, Meah S, Maiser A, Menzies-Gow A, Metcalf L, Middelveld R, Mikus M, Miralpeix M, Monk P, Mores N, Murray CS, Musial J, Myles D, Naz S, Nething K, Nicholas B, Nihlen U, Nilsson P, Nordlund B, Östling J, Pacino A, Pahus L, Palkonnen S, Pavlidis S, Pennazza G, Petrén A, Pink S, Postle A, Powel P, Rahman-Amin M, Rao N, Ravanetti L, Ray E, Reinke S, Reynolds L, Riemann K, Riley J, Robberechts M, Roberts A, Rossios C, Russell K, Rutgers M, Santini G, Sentoninco M, Schoelch C, Schofield JP, Seibold W, Sigmund R, Sjödin M, Skipp PJ, Smids B, Smith C, Smith J, Smith KM, Söderman P, Sogbesan A, Staykova D, Strandberg K, Sun K, Supple D, Szentkereszty M, Tamasi L, Tariq K, Thörngren JO, Thornton B, Thorsen J, Valente S, van Aalderenm W, van de Pol M, van Drunen K, van Geest M, Versnel J, Vestbo J, Vink A, Vissing N, von Garnier C, Wagerner A, Wagers S, Wald F, Walker S, Ward J, Weiszhart Z, Wetzel K, Wheelock CE, Wiegman C, Williams S, Wilson SJ, Woosdcock A, Yang X, Yeyashingham E, Yu W, Zetterquist W, Zwinderman K. U-BIOPRED clinical adult asthma clusters linked to a subset of sputum omics. J Allergy Clin Immunol 2017; 139:1797-1807. [DOI: 10.1016/j.jaci.2016.08.048] [Citation(s) in RCA: 145] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 07/23/2016] [Accepted: 08/08/2016] [Indexed: 01/20/2023]
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17
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Schinzari F, Veneziani A, Mores N, Barini A, Di Daniele N, Cardillo C, Tesauro M. Vascular Effects of Obestatin in Lean and Obese Subjects. Diabetes 2017; 66:1214-1221. [PMID: 28174289 DOI: 10.2337/db16-1067] [Citation(s) in RCA: 7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 01/29/2017] [Indexed: 11/13/2022]
Abstract
Obese patients have impaired vasodilator reactivity and increased endothelin 1 (ET-1)-mediated vasoconstriction, two abnormalities contributing to vascular dysfunction. Obestatin, a product of the ghrelin gene, in addition to favorable effects on glucose and lipid metabolism, has shown nitric oxide (NO)-dependent vasodilator properties in experimental models. Given these premises, we compared the effects of exogenous obestatin on forearm flow in lean and obese subjects and assessed its influence on ET-1-dependent vasoconstrictor tone in obesity. In both lean and obese participants, infusion of escalating doses of obestatin resulted in a progressive increase in blood flow from baseline (both P < 0.001). This vasodilation was predominantly mediated by enhanced NO activity, because NG-monomethyl-l-arginine markedly blunted the flow response to obestatin in both groups (both P < 0.05 vs. saline). In obese subjects, antagonism of ETA receptors by BQ-123 increased forearm flow during saline (P < 0.001) but did not induce additional vasodilation (P > 0.05) during obestatin. Circulating obestatin levels were not different between lean and obese participants (P = 0.41). Our findings indicate that obestatin causes NO-dependent vasodilation in the human circulation. This effect is preserved in obesity, where it is accompanied by reduced ET-1-mediated vasoconstriction. These latter observations make obestatin a promising target for vascular prevention in obesity and diabetes.
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Affiliation(s)
| | | | - Nadia Mores
- Department of Pharmacology, Catholic University, Rome, Italy
| | - Angela Barini
- Department of Biochemistry, Catholic University, Rome, Italy
| | - Nicola Di Daniele
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Carmine Cardillo
- Department of Internal Medicine, Catholic University, Rome, Italy
| | - Manfredi Tesauro
- Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy
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18
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Schinzari F, Veneziani A, Mores N, Barini A, Di Daniele N, Cardillo C, Tesauro M. Beneficial Effects of Apelin on Vascular Function in Patients With Central Obesity. Hypertension 2017; 69:942-949. [DOI: 10.1161/hypertensionaha.116.08916] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 01/04/2017] [Accepted: 02/03/2017] [Indexed: 12/21/2022]
Abstract
Patients with central obesity have impaired insulin-stimulated vasodilation and increased ET-1 (endothelin 1) vasoconstriction, which may contribute to insulin resistance and vascular damage. Apelin enhances insulin sensitivity and glucose disposal but also acts as a nitric oxide (NO)–dependent vasodilator and a counter-regulator of AT
1
(angiotensin [Ang] II type 1) receptor–induced vasoconstriction. We, therefore, examined the effects of exogenous (Pyr
1
)apelin on NO-mediated vasodilation and Ang II– or ET-1–dependent vasoconstrictor tone in obese patients. In the absence of hyperinsulinemia, forearm blood flow responses to graded doses of acetylcholine and sodium nitroprusside were not different during saline or apelin administration (both
P
>0.05). During intra-arterial infusion of regular insulin, however, apelin enhanced the vasodilation induced by both acetylcholine and nitroprusside (both
P
<0.05). Interestingly, the vasodilator effect of concurrent blockade of AT
1
(telmisartan) and AT
2
(PD 123,319) receptors was blunted by apelin (3±5% versus 32±9%;
P
<0.05). Similarly, during apelin administration, blockade of ET
A
receptors (BQ-123) resulted in lower vasodilator response than during saline (23±10% versus 65±12%;
P
<0.05). NO synthase inhibition by L-NMMA (
l
-
N
-monometylarginine) during the concurrent blockade of either Ang II or ET
A
receptors resulted in similar vasoconstriction in the absence or presence of apelin (
P
>0.05). In conclusion, in patients with central obesity, apelin has favorable effects not only to improve insulin-stimulated endothelium-dependent and endothelium-independent vasodilator responses but also to blunt Ang II– and ET-1–dependent vasoconstriction by a mechanism not involving NO. Taken together, our results suggest that targeting the apelin system might favorably impact some hemodynamic abnormalities of insulin-resistant states like obesity.
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Affiliation(s)
- Francesca Schinzari
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Augusto Veneziani
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Nadia Mores
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Angela Barini
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Nicola Di Daniele
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Carmine Cardillo
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
| | - Manfredi Tesauro
- From the Departments of Internal Medicine (F.S., C.C.), Surgery (A.V.), Pharmacology (N.M.), and Biochemistry (A.B.), Catholic University, Rome, Italy; and Department of Internal Medicine, University of Tor Vergata, Rome, Italy (N.D.D., M.T.)
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19
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Marrone G, Vaccaro FG, Biolato M, Miele L, Liguori A, Araneo C, Ponziani FR, Mores N, Gasbarrini A, Grieco A. Drug-induced liver injury 2017: the diagnosis is not easy but always to keep in mind. Eur Rev Med Pharmacol Sci 2017; 21:122-134. [PMID: 28379587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A drug-induced liver injury (DILI) is defined as a liver injury caused by exposure to a drug or a non-infectious toxic agent with a variable degree of organ dysfunction. A better understanding of DILI epidemiology has been obtained in recent years with the institution of international registries in the United States and Europe. Despite the advances in the understanding and characterization of the phenomenon, DILI remains an exclusion diagnosis so, probability scores and the analysis of literature reports are useful tools in dealing with a suspected DILI. Idiosyncratic DILI can be considered a relatively rare event but it is one of the leading causes of acute liver failure. Thus, proper management is essential to avoid serious consequences. Here, we present an updated review of diagnostic and classification criteria of DILI. Prognostic tools, and principles of management and therapy have also been briefly discussed.
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Affiliation(s)
- G Marrone
- Gastroenterology Area, Fondazione Policlinico Universitario A. Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
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20
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Abstract
INTRODUCTION Dupilumab (REGN668/SAR231893), produced by a collaboration between Regeneron and Sanofi, is a monoclonal antibody currently in phase III for moderate-to-severe asthma. Dupilumab is directed against the α-subunit of the interleukin (IL)-4 receptor and blocks the IL-4 and IL-13 signal transduction. Areas covered: Pathophysiological role of IL-4 and IL-13 in asthma; mechanism of action of dupilumab; pharmacology of IL-4 receptor; phase I and phase II studies with dupilumab; regulatory affairs. Expert opinion: Patients with severe asthma who are not sufficiently controlled with standard-of-care represent the target asthma population for dupilumab. If confirmed, efficacy of dupilumab in both eosinophilic and non-eosinophilic severe asthma phenotype might represent an advantage over approved biologics for asthma, including omalizumab, mepolizumab, and reslizumab. Head-to-head studies to compare dupilumab versus other biologics with different mechanism of action are required. Pediatric studies with dupilumab are currently lacking and should be undertaken to assess efficacy and safety of this drug in children with severe asthma. The lack of preclinical data and published results of the completed four phase I studies precludes a complete assessment of the pharmacological profile of dupilumab. Dupilumab seems to be generally well tolerated, but large studies are required to establish its long-term safety and tolerability.
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Affiliation(s)
- Giuseppe Santini
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation , Rome , Italy
| | - Nadia Mores
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation , Rome , Italy
| | - Mario Malerba
- b Department of Internal Medicine , University of Brescia , Brescia , Italy
| | - Chiara Mondino
- c Department of Allergology , 'Bellinzona e Valli' Hospital , Bellinzona , Switzerland
| | - Roberta Anzivino
- d Department of Otorhinolaryngology, Faculty of Medicine , Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation , Rome , Italy
| | - Giuseppe Macis
- e Department of Radiological Sciences, Faculty of Medicine , Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation , Rome , Italy
| | - Paolo Montuschi
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart, University Hospital Agostino Gemelli Foundation , Rome , Italy
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Santini G, Mores N, Penas A, Capuano R, Mondino C, Trové A, Macagno F, Zini G, Cattani P, Martinelli E, Motta A, Macis G, Ciabattoni G, Montuschi P. Electronic Nose and Exhaled Breath NMR-based Metabolomics Applications in Airways Disease. Curr Top Med Chem 2016; 16:1610-30. [PMID: 26693732 DOI: 10.2174/1568026616666151223113540] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 04/06/2015] [Accepted: 05/30/2015] [Indexed: 11/22/2022]
Abstract
Breathomics, the multidimensional molecular analysis of exhaled breath, includes analysis of exhaled breath with gas-chromatography/mass spectrometry (GC/MS) and electronic noses (e-noses), and metabolomics of exhaled breath condensate (EBC), a non-invasive technique which provides information on the composition of airway lining fluid, generally by high-resolution nuclear magnetic resonance (NMR) spectroscopy or MS methods. Metabolomics is the identification and quantification of small molecular weight metabolites in a biofluid. Specific profiles of volatile compounds in exhaled breath and metabolites in EBC (breathprints) are potentially useful surrogate markers of inflammatory respiratory diseases. Electronic noses (e-noses) are artificial sensor systems, usually consisting of chemical cross-reactive sensor arrays for characterization of patterns of breath volatile compounds, and algorithms for breathprints classification. E-noses are handheld, portable, and provide real-time data. E-nose breathprints can reflect respiratory inflammation. E-noses and NMR-based metabolomics of EBC can distinguish patients with respiratory diseases such as asthma, COPD, and lung cancer, or diseases with a clinically relevant respiratory component including cystic fibrosis and primary ciliary dyskinesia, and healthy individuals. Breathomics has also been reported to identify patients affected by different types of respiratory diseases. Patterns of breath volatile compounds detected by e-nose and EBC metabolic profiles have been associated with asthma phenotypes. In combination with other -omics platforms, breathomics might provide a molecular approach to respiratory disease phenotyping and a molecular basis to tailored pharmacotherapeutic strategies. Breathomics might also contribute to identify new surrogate markers of respiratory inflammation, thus, facilitating drug discovery. Validation in newly recruited, prospective independent cohorts is essential for development of e-nose and EBC NMRbased metabolomics techniques.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, 00168 Rome, Italy.
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22
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Cardillo C, Mettimano M, Mores N, Koh KK, Campia U, Panza JA. Plasma levels of cell adhesion molecules during hyperinsulinemia and modulation of vasoactive mediators. Vasc Med 2016; 9:185-8. [PMID: 15675182 DOI: 10.1191/1358863x04vm546oa] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Endothelial expression of cell adhesion molecules (CAMs) plays an important role in atherosclerosis. Atherosclerosis is increased in hyperinsulinemic states, but whether insulin per se is proatherogenic remains unclear. To investigate the effects of hyperinsulinemia on CAM expression, plasma levels of ICAM-1, VCAM-1 and E-selectin were measured before and after forearm infusion of insulin in healthy subjects. Insulin administration for 2 h resulted in signifi-cant hyperinsulinemia, whereas no significant change was observed in soluble CAMs (all p > 0.05). Because insulin stimulates endothelial release of both endothelin-1 (ET-1) and nitric oxide (NO), which may modulate the expression of CAMs, we also investigated the response of CAMs to ET-1 receptor blockade, alone and in combination with NO synthesis inhibition. ET-1 receptor blockade during hyperinsulinemia resulted in a vasodilator response, but did not affect soluble CAMs (all p > 0.05). Superimposition of NO inhibition by l-NMMA reversed the vasodilator effect of ET-1 blockade, without affecting soluble CAMs (all p > 0.05). In conclusion, acute hyperinsulinemia, alone or during ET-1 and NO pathway blockade, does not affect soluble CAMs. These results do not support a direct effect of insulin on endothelial cells to affect leukocyte adhesiveness to the vascular wall.
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23
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Kirchmayer U, Mayer F, Basso M, De Cristofaro R, Mores N, Cappai G, Agabiti N, Fusco D, Davoli M, Gambassi G. Polypharmacy in the elderly: A population based cross-sectional study in Lazio, Italy. Eur Geriatr Med 2016. [DOI: 10.1016/j.eurger.2016.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Montuschi P, Malerba M, Macis G, Mores N, Santini G. Triple inhaled therapy for chronic obstructive pulmonary disease. Drug Discov Today 2016; 21:1820-1827. [PMID: 27452453 DOI: 10.1016/j.drudis.2016.07.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/15/2016] [Accepted: 07/14/2016] [Indexed: 02/05/2023]
Abstract
Combining individual drugs in a single inhaler is the most convenient way to deliver triple therapy. A long-acting muscarinic receptor antagonist (LAMA) added to an inhaled corticosteroid (ICS)/long-acting β2-adrenoceptor agonist (LABA) fixed-dose combination (FDC) can improve efficacy of pharmacological treatment of patients with chronic obstructive pulmonary disease (COPD). New inhaled ICS/LABA/LAMA FDCs, including fluticasone furoate/vilanterol/umeclidinium, budesonide/formoterol/glycopyrronium and beclometasone/formoterol/glycopyrronium, are in Phase III of clinical development for COPD. Triple inhaled therapy might be particularly useful in patients with severe to very severe COPD, above all in those with peripheral blood or sputum eosinophilia, asthma-COPD overlap syndrome (ACOS) or frequent exacerbators. Future prospective studies should assess efficacy and safety of triple ICS/LABA/LAMA therapy in selected COPD phenotypes.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy.
| | - Mario Malerba
- Department of Internal Medicine, University of Brescia, Brescia, Italy
| | - Giuseppe Macis
- Department of Radiological Sciences, Faculty of Medicine, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
| | - Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, University Hospital Agostino Gemelli, Catholic University of the Sacred Heart, Rome, Italy
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Da Dalt L, Zerbinati C, Strafella MS, Renna S, Riceputi L, Di Pietro P, Barabino P, Scanferla S, Raucci U, Mores N, Compagnone A, Da Cas R, Menniti-Ippolito F. Henoch-Schönlein purpura and drug and vaccine use in childhood: a case-control study. Ital J Pediatr 2016; 42:60. [PMID: 27316345 PMCID: PMC4912703 DOI: 10.1186/s13052-016-0267-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 02/11/2016] [Accepted: 05/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Henoch-Schönlein purpura (HSP) is the most common vasculitis in childhood; nevertheless, its etiology and pathogenesis remain unknown despite the fact that a variety of factors, mainly infectious agents, drugs and vaccines have been suggested as triggers for the disease. The aim of this study was to estimate the association of HSP with drug and vaccine administration in a pediatric population. METHODS An active surveillance on drug and vaccine safety in children is ongoing in 11 clinical centers in Italy. All children hospitalized through the local Paediatric Emergency Department for selected acute clinical conditions of interest were enrolled in the study. Data on drug and vaccine use in children before the onset of symptoms leading to hospitalization were collected by parents interview. A case-control design was applied for risk estimates: exposure in children with HSP, included as cases, was compared with similar exposure in children with gastroduodenal lesions, enrolled as controls. HSP cases were validated according to EULAR/PRINTO/PRES criteria. Validation was conducted retrieving data from individual patient clinical record. RESULTS During the study period (November 1999-April 2013), 288 cases and 617 controls were included. No increased risk of HSP was estimated for any drug. Among vaccines, measles-mumps-rubella (MMR) vaccine showed an increased risk of HSP (OR 3.4; 95 % CI 1.2-10.0). CONCLUSIONS This study provides further evidence on the possible role of MMR vaccine in HSP occurrence.
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Affiliation(s)
- Liviana Da Dalt
- Department of Woman and Child Health, University of Padua, Padua, Italy
| | | | | | | | | | | | | | | | - Umberto Raucci
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Nadia Mores
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Adele Compagnone
- Pharmacology and Pediatrics, Università Cattolica S. Cuore, Rome, Italy
| | - Roberto Da Cas
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy
| | - Francesca Menniti-Ippolito
- National Center for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Viale Regina Elena, 299 - 00161, Rome, Italy.
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Santini G, Mores N, Malerba M, Mondino C, Macis G, Montuschi P. Investigational prostaglandin D2 receptor antagonists for airway inflammation. Expert Opin Investig Drugs 2016; 25:639-52. [PMID: 27094922 DOI: 10.1080/13543784.2016.1175434] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION By activating DP1 and DP2 receptors on immune and non-immune cells, prostaglandin D2 (PGD2), a major metabolic product of cyclo-oxygenase pathway released after IgE-mediated mast cell activation, has pro-inflammatory effects, which are relevant to the pathophysiology of allergic airway disease. At least 15 selective, orally active, DP2 receptor antagonists and one DP1 receptor antagonist (asapiprant) are under development for asthma and/or allergic rhinitis. AREAS COVERED In this review, the authors cover the pharmacology of PGD2 and PGD2 receptor antagonists and look at the preclinical, phase I and phase II studies with selective DP1 and DP2 receptor antagonists. EXPERT OPINION Future research should aim to develop once daily compounds and increase the drug clinical potency which, apart from OC000459 and ADC-3680, seems to be relatively low. Further research and development of DP2 receptor antagonists is warranted, particularly in patients with severe uncontrolled asthma, whose management is a top priority. Pediatric studies, which are not available, are required for assessing the efficacy and safety of this novel drug class in children with asthma and allergic rhinitis. Studies on the efficacy of DP2 receptor antagonists in various asthma phenotypes including: smokers, obese subjects, early vs late asthma onset, fixed vs reversible airflow limitation, are required for establishing their pharmacotherapeutic role.
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Affiliation(s)
- Giuseppe Santini
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy
| | - Nadia Mores
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy
| | - Mario Malerba
- b Department of Internal Medicine , University of Brescia , Brescia , Italy
| | - Chiara Mondino
- c Department of Allergology , 'Bellinzona e Valli' Hospital , Bellinzona , Switzerland
| | - Giuseppe Macis
- d Department of Radiological Sciences, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy
| | - Paolo Montuschi
- a Department of Pharmacology, Faculty of Medicine , Catholic University of the Sacred Heart , Rome , Italy
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Santini G, Mores N, Shohreh R, Valente S, Dabrowska M, Trové A, Zini G, Cattani P, Fuso L, Mautone A, Mondino C, Pagliari G, Sala A, Folco G, Aiello M, Pisi R, Chetta A, Losi M, Clini E, Ciabattoni G, Montuschi P. Exhaled and non-exhaled non-invasive markers for assessment of respiratory inflammation in patients with stable COPD and healthy smokers. J Breath Res 2016; 10:017102. [PMID: 26814886 DOI: 10.1088/1752-7155/10/1/017102] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We aimed at comparing exhaled and non-exhaled non-invasive markers of respiratory inflammation in patients with chronic obstructive pulmonary disease (COPD) and healthy subjects and define their relationships with smoking habit. Forty-eight patients with stable COPD who were ex-smokers, 17 patients with stable COPD who were current smokers, 12 healthy current smokers and 12 healthy ex-smokers were included in a cross-sectional, observational study. Inflammatory outcomes, including prostaglandin (PG) E2 and 15-F2t-isoprostane (15-F2t-IsoP) concentrations in exhaled breath condensate (EBC) and sputum supernatants, fraction of exhaled nitric oxide (FENO) and sputum cell counts, and functional (spirometry) outcomes were measured. Sputum PGE2 was elevated in both groups of smokers compared with ex-smoker counterpart (COPD: P < 0.02; healthy subjects: P < 0.03), whereas EBC PGE2 was elevated in current (P = 0.0065) and ex-smokers with COPD (P = 0.0029) versus healthy ex-smokers. EBC 15-F2t-IsoP, a marker of oxidative stress, was increased in current and ex-smokers with COPD (P < 0.0001 for both) compared with healthy ex-smokers, whereas urinary 15-F2t-IsoP was elevated in both smoker groups (COPD: P < 0.01; healthy subjects: P < 0.02) versus healthy ex-smokers. FENO was elevated in ex-smokers with COPD versus smoker groups (P = 0.0001 for both). These data suggest that the biological meaning of these inflammatory markers depends on type of marker and biological matrix in which is measured. An approach combining different types of outcomes can be used for assessing respiratory inflammation in patients with COPD. Large studies are required to establish the clinical utility of this strategy.
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Affiliation(s)
- Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Schinzari F, Iantorno M, Campia U, Mores N, Rovella V, Tesauro M, Di Daniele N, Cardillo C. Vasodilator responses and endothelin-dependent vasoconstriction in metabolically healthy obesity and the metabolic syndrome. Am J Physiol Endocrinol Metab 2015; 309:E787-92. [PMID: 26374766 PMCID: PMC4628941 DOI: 10.1152/ajpendo.00278.2015] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [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: 06/17/2015] [Accepted: 09/08/2015] [Indexed: 02/06/2023]
Abstract
Patients with metabolically healthy obesity (MHO) do not present the cluster of metabolic abnormalities that define the metabolic syndrome (MetS). Whether MHO is associated with lower impairment of vasoreactivity than the MetS is unknown. For this purpose, forearm blood flow (FBF) responses were measured by strain-gauge plethysmography during the intra-arterial infusion of acetylcholine (ACh), sodium nitroprusside (SNP), and/or the selective endothelin type A (ETA) receptor blocker BQ-123 in 119 obese individuals with MHO (n = 34) or with the MetS (n = 85) and in healthy lean controls (n = 56). ACh and SNP caused a significant vasodilation in both obese and lean participants (all P < 0.001). However, the response to both agents was significantly lower in the obese than in the control group (both P < 0.001). Among the obese participants, the reactivity to ACh was higher in MHO than in MetS patients, whereas the responsiveness to SNP was equally impaired in both groups (P = 0.45). Infusion of BQ-123 significantly increased FBF in obese patients (P < 0001), but not in the lean participants; hence, FBF following ETA receptor blockade was higher in both obese groups than in controls (both P < 0.001). FBF response to BQ-123 was significantly higher in patients with the MetS than in those with MHO (P = 0.007). In conclusion, patients with MHO have abnormal vascular reactivity, although their endothelial dysfunction is less pronounced than in patients with the MetS. These findings indicate that obesity is associated with vascular damage independent of those metabolic abnormalities underlying the MetS.
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Affiliation(s)
- Francesca Schinzari
- Department of Internal Medicine, Catholic University Medical School, Rome, Italy
| | - Micaela Iantorno
- Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland; Department of Medicine, Cardiology Division, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Nadia Mores
- Department of Pharmacology, Catholic University Medical School, Rome, Italy; and
| | - Valentina Rovella
- Department of Internal Medicine, University of Tor Vergata, Rome, Italy
| | - Manfredi Tesauro
- Department of Internal Medicine, University of Tor Vergata, Rome, Italy
| | - Nicola Di Daniele
- Department of Internal Medicine, University of Tor Vergata, Rome, Italy
| | - Carmine Cardillo
- Department of Internal Medicine, Catholic University Medical School, Rome, Italy;
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Pistritto G, Ventura L, Mores N, Lacal PM, D'Onofrio C. Regulation of PDGF-B and PDGF receptor expression in the pathogenesis of Kaposi's sarcoma in AIDS. Antibiot Chemother (1971) 2015; 46:73-87. [PMID: 7826042 DOI: 10.1159/000423635] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- G Pistritto
- Department of Experimental Medicine and Biochemical Sciences, University of Rome Tor Vergata, Italy
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Montuschi P, Paris D, Montella S, Melck D, Mirra V, Santini G, Mores N, Montemitro E, Majo F, Lucidi V, Bush A, Motta A, Santamaria F. Nuclear Magnetic Resonance–based Metabolomics Discriminates Primary Ciliary Dyskinesia from Cystic Fibrosis. Am J Respir Crit Care Med 2014; 190:229-33. [DOI: 10.1164/rccm.201402-0249le] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Menniti-Ippolito F, Da Cas R, Traversa G, Santuccio C, Felicetti P, Tartaglia L, Trotta F, Di Pietro P, Barabino P, Renna S, Riceputi L, Tovo PA, Gabiano C, Urbino A, Baroero L, Le Serre D, Virano S, Perilongo G, Daverio M, Gnoato E, Maretti M, Galeazzo B, Rubin G, Scanferla S, Da Dalt L, Stefani C, Zerbinati C, Chiappini E, Sollai S, De Martino M, Mannelli F, Becciani S, Giacalone M, Montano S, Remaschi G, Stival A, Furbetta M, Abate P, Leonardi I, Pirozzi N, Raucci U, Reale A, Rossi R, Russo C, Mancinelli L, Manuela O, Carlo C, Mores N, Romagnoli C, Chiaretti A, Compagnone A, Riccardi R, Delogu G, Sali M, Prete V, Tipo V, Dinardo M, Auricchio F, Polimeno T, Sodano G, Maccariello A, Rafaniello C, Fucà F, Di Rosa E, Altavilla D, Mecchio A, Arrigo T. Vaccine effectiveness against severe laboratory-confirmed influenza in children: results of two consecutive seasons in Italy. Vaccine 2014; 32:4466-4470. [PMID: 24962760 DOI: 10.1016/j.vaccine.2014.06.048] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 03/20/2014] [Accepted: 06/11/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of seasonal influenza vaccine in preventing Emergency Department (ED) visits and hospitalisations for influenza like illness (ILI) in children. METHODS We conducted a test negative case-control study during the 2011-2012 and 2012-2013 influenza seasons. Eleven paediatric hospital/wards in seven Italian regions participated in the study. Consecutive children visiting the ED with an ILI, as diagnosed by the doctor according to the European Centre for Disease Control case definition, were eligible for the study. Data were collected from trained pharmacists/physicians by interviewing parents during the ED visit (or hospital admission) of their children. An influenza microbiological test (RT-PCR) was carried out in all children. RESULTS Seven-hundred and four children, from 6 months to 16 years of age, were enrolled: 262 children tested positive for one of the influenza viruses (cases) and 442 tested negative (controls). Cases were older than controls (median age 46 vs. 29 months), though with a similar prevalence of chronic conditions. Only 25 children (4%) were vaccinated in the study period. The overall age-adjusted vaccine effectiveness (VE) was 38% (95% confidence interval -52% to 75%). A higher VE was estimated for hospitalised children (53%; 95% confidence interval -45% to 85%). DISCUSSION This study supports the effectiveness of the seasonal influenza vaccine in preventing visits to the EDs and hospitalisations for ILI in children, although the estimates were not statistically significant and with wide confidence intervals. Future systematic reviews of available data will provide more robust evidence for recommending influenza vaccination in children.
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Affiliation(s)
| | - Roberto Da Cas
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre of Epidemiology, National Institute of Health, Roma, Italy
| | | | | | | | | | | | | | | | | | | | - Clara Gabiano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Luca Baroero
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Silvia Virano
- Regina Margherita Paediatric Hospital, Torino, Italy
| | | | - Marco Daverio
- Department of Paediatrics, University of Padova, Italy
| | - Elisa Gnoato
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Giulia Rubin
- Department of Paediatrics, University of Padova, Italy
| | | | | | - Chiara Stefani
- Department of Paediatrics, Treviso Hospital, Treviso, Italy
| | | | | | - Sara Sollai
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | | | | | | | - Simona Montano
- Anna Meyer Children's University Hospital, Firenze, Italy
| | | | - Alessia Stival
- Anna Meyer Children's University Hospital, Firenze, Italy
| | - Mario Furbetta
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Piera Abate
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Ilaria Leonardi
- Department of Paediatrics, University Hospital, Perugia, Italy
| | - Nicola Pirozzi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Umberto Raucci
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Antonino Reale
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Rossella Rossi
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Cristina Russo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Livia Mancinelli
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Onori Manuela
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Concato Carlo
- Emergency Department and Virology Unit, Bambino Gesù Children Hospital, Roma, Italy
| | - Nadia Mores
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Costantino Romagnoli
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Antonio Chiaretti
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Adele Compagnone
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Riccardo Riccardi
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Giovanni Delogu
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Michela Sali
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Valentina Prete
- Pharmacology, Microbiology and Virology, Università Cattolica S. Cuore, Roma, Italy
| | - Vincenzo Tipo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Michele Dinardo
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Fabiana Auricchio
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Teodoro Polimeno
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | - Giuseppe Sodano
- Santobono Paediatric Hospital and Virology Unit-Cotugno, Napoli, Italy
| | | | | | - Fortunata Fucà
- Giovanni Di Cristina Paediatric Hospital, Palermo, Italy
| | | | - Domenica Altavilla
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Anna Mecchio
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
| | - Teresa Arrigo
- Department of Paediatric, Gynecologic, Microbiologic and Biomedical Sciences, University Hospital, Messina, Italy
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Sbaraglia F, Mores N, Garra R, Giuratrabocchetta G, Lepore D, Molle F, Savino G, Piastra M, Pulitano' S, Sammartino M. Phenylephrine eye drops in pediatric patients undergoing ophthalmic surgery: incidence, presentation, and management of complications during general anesthesia. Paediatr Anaesth 2014; 24:400-5. [PMID: 24354865 DOI: 10.1111/pan.12329] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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] [Accepted: 11/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Phenylephrine eye drops are widely used as mydriatic agent to reach the posterior segment of the eye. In literature, many reports suggest a systemic absorption of this agent as a source of severe adverse drug reactions. Hence, we reviewed our experience with topical phenylephrine in ophthalmic surgery. METHODS In May 2006, following US guidelines publication, a standard operating procedure was issued in our operating rooms to standardize the use of phenylephrine eye drops in our practice. Two years later, after the occurrence of a cluster of serious adverse drug reactions in infants undergoing surgery, a review of phenylephrine safety and systemic complications incidence was performed. RESULTS We observed 451 pediatric patients, and 187 met the inclusions criteria: Among them, 4 experienced hemodynamic complications due to phenylephrine eye drops. The incidence of major complications was 2.1%. CONCLUSIONS Two different patterns of side effects occurred. The first one was a cardiovascular derangement with severe hypertension and heart rate alterations; the other one involved exclusively pulmonary circuit causing early edema. These clinical manifestations, their duration, and treatment responses are all explainable by alfa1-adrenergic action of phenylephrine. This hypothetic pathogenesis has been confirmed also by the usefulness of direct vasodilators (anesthetic agents) and by the negative outcome occurred in the past with the use of beta-blockers.
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Affiliation(s)
- Fabio Sbaraglia
- Department of Anaesthesia and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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Montuschi P, Santini G, Valente S, Mondino C, Macagno F, Cattani P, Zini G, Mores N. Liquid chromatography-mass spectrometry measurement of leukotrienes in asthma and other respiratory diseases. J Chromatogr B Analyt Technol Biomed Life Sci 2014; 964:12-25. [PMID: 24656639 DOI: 10.1016/j.jchromb.2014.02.059] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 11/28/2022]
Abstract
Leukotrienes (LTs), including cysteinyl-LTs (LTC4, LTD4 and LTE4) and LTB4, are potent inflammatory lipid mediators which have been involved in the pathophysiology of respiratory diseases. LC-MS/MS techniques for measuring LT concentrations in sputum supernatants, serum, urine and exhaled breath condensate (EBC) have been developed. In asthmatic adults, reported LTB4 and LTE4 concentrations in sputum range from 79 to 7,220 pg/ml and from 11.9 to 891 pg/ml, respectively. Data on sputum LT concentrations in healthy subjects are not available. In EBC, reported LTE4 concentrations range from 38 to 126 pg/ml (95% CI) in adult asthma patients and from 34 to 48 pg/ml in healthy subjects. LTB4 concentrations in EBC range from 175 to 315 pg/ml (interquartile range) in asthmatic children, and from 25 to 245 pg/ml in healthy children. Enabling an accurate quantitative assessment of LTs in biological fluids, LC-MS/MS techniques provide a valuable tool for exploring the pathophysiological role of LTs in respiratory disease and might be useful for assessing the effects of therapeutic intervention. This review presents the analytical aspects of the LC-MS/MS techniques for measuring LT concentrations in biological fluids and discusses their potential utility for the assessment of airway inflammation and monitoring of pharmacological treatment in patients with asthma phenotypes and other respiratory diseases.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart , Rome, Italy.
| | - Giuseppe Santini
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart , Rome, Italy
| | - Salvatore Valente
- Department of Internal Medicine and Geriatrics, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Chiara Mondino
- Department of Immunodermatology, Istituto Dermopatico dell'Immacolata, IDI, Rome, Italy
| | - Francesco Macagno
- Department of Internal Medicine and Geriatrics, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Paola Cattani
- Department of Microbiology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Gina Zini
- Department of Hematology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Nadia Mores
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart , Rome, Italy
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Ritterbusch G, Rocha CS, Ciacci-Zanella J, Amaral A, Coldebella A, Ascoli K, Mores N. Avaliação histopatológica de órgãos reprodutivos e bexiga de fêmeas suínas descartadas. ARQ BRAS MED VET ZOO 2014. [DOI: 10.1590/s0102-09352014000100006] [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: 11/21/2022] Open
Abstract
Em um sistema intensivo de produção de suínos, as falhas reprodutivas são uma das principais razões de descarte de matrizes e queda nos índices produtivos. A infecção urinária (cistite) e as endometrites são consideradas importantes causas de descarte em fêmeas suínas, por terem consequências reprodutivas relevantes e elevarem a taxa de reposição do plantel. O presente estudo teve o objetivo de avaliar o aparelho reprodutivo e a bexiga de fêmeas suínas de descarte normal de granjas, bem como investigar a existência de relação entre as patologias encontradas. Foram examinadas 79 matrizes suínas oriundas de 20 rebanhos localizados no Estado de Santa Catarina. De cada fêmea foram coletados os ovários, fragmentos de útero e bexiga. Dentre as fêmeas avaliadas, 32 (40,5%) tinham diferentes graduações de cistite, 24 (30,4%) tinham algum tipo de inflamação uterina, e 9 (11,4%) estavam em anestro, com ovários inativos. Contudo, não foi observada dependência significativa entre cistite e endometrite nas amostras analisadas.
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Fuso L, Mores N, Valente S, Malerba M, Montuschi P. Long-acting beta-agonists and their association with inhaled corticosteroids in COPD. Curr Med Chem 2013; 20:1477-95. [PMID: 23409722 DOI: 10.2174/0929867311320120003] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 01/07/2013] [Accepted: 01/28/2013] [Indexed: 11/22/2022]
Abstract
Inhaled bronchodilators, including beta(2)-agonists and antimuscaric receptor antagonists, are the mainstay of pharmacotherapy in chronic obstructive pulmonary disease (COPD). The short-acting beta(2)-agonists, including salbutamol, and fenoterol, have a rapid onset of action, a bronchodilating effect for 3-6 h and are used on demand. The long-acting beta(2)-agonists (LABAs), including salmeterol and formoterol, have 12-hour duration of action and are used with a twice-daily dosing regimen for long-term COPD treatment. Unlike salmeterol, formoterol has a rapid onset of action. Pharmacological characteristics required by novel inhaled LABAs include 24 h bronchodilator effect in vivo which would make them suitable for once daily administration (ultra-LABA), high potency and selectivity for beta(2)-adrenoceptors, rapid onset of action, low oral bioavailability (< 5%) after inhalation, and high systemic clearance. Indacaterol, which has been approved for long-term treatment of COPD in Europe and in the USA, has a 24-h duration of action and a once-daily dosing regimen. Newer ultra-LABAs, including olodaterol, vilanterol, milveterol, carmoterol, and abediterol, are in development. Combination with ICS (fluticasone/salmeterol, budesonide/formoterol, beclomethasone/formoterol) appears to provide an additional benefit over the monocomponent therapy, although the extent of this benefit is variable and often not clinically significant in all the endpoints assessed. In patients with COPD, treatment with ICS is associated with increased risk of pneumonia which should be carefully considered when assessing the risk/benefit ratio of ICS/LABA combinations. Subphenotyping of patients with COPD (e.g., frequent exacerbations, sputum eosinophilia, mixed asthma/COPD phenotype) might help identify those patients who are most likely to benefit from addition of ICS to bronchodilating treatment. Ultra-LABA/ long-acting muscarinic receptor antagonist (LAMA) combination treatment is under development and is likely to become a standard pharmacological strategy for COPD. Dual-pharmacology inhaled muscarinic antagonist-beta(2) agonist (MABA) molecules provide a new approach to the treatment of COPD.
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Affiliation(s)
- L Fuso
- Department of Internal Medicine and Geriatrics, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Raucci U, Rossi R, Da Cas R, Rafaniello C, Mores N, Bersani G, Reale A, Pirozzi N, Menniti-Ippolito F, Traversa G, in Drug and Children IMSGFVS. Stevens-johnson syndrome associated with drugs and vaccines in children: a case-control study. PLoS One 2013; 8:e68231. [PMID: 23874553 PMCID: PMC3712963 DOI: 10.1371/journal.pone.0068231] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [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: 01/07/2013] [Accepted: 05/28/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Stevens-Johnson Syndrome (SJS) is one of the most severe muco-cutaneous diseases and its occurrence is often attributed to drug use. The aim of the present study is to quantify the risk of SJS in association with drug and vaccine use in children. METHODS A multicenter surveillance of children hospitalized through the emergency departments for acute conditions of interest is currently ongoing in Italy. Cases with a diagnosis of SJS were retrieved from all admissions. Parents were interviewed on child's use of drugs and vaccines preceding the onset of symptoms that led to the hospitalization. We compared the use of drugs and vaccines in cases with the corresponding use in a control group of children hospitalized for acute neurological conditions. RESULTS Twenty-nine children with a diagnosis of SJS and 1,362 with neurological disorders were hospitalized between 1(st) November 1999 and 31(st) October 2012. Cases were more frequently exposed to drugs (79% vs 58% in the control group; adjusted OR 2.4; 95% CI 1.0-6.1). Anticonvulsants presented the highest adjusted OR: 26.8 (95% CI 8.4-86.0). Significantly elevated risks were also estimated for antibiotics use (adjusted OR 3.3; 95% CI 1.5-7.2), corticosteroids (adjusted OR 4.2; 95% CI 1.8-9.9) and paracetamol (adjusted OR 3.2; 95% CI 1.5-6.9). No increased risk was estimated for vaccines (adjusted OR: 0.9; 95% CI 0.3-2.8). DISCUSSION Our study provides additional evidence on the etiologic role of drugs and vaccines in the occurrence of SJS in children.
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Affiliation(s)
- Umberto Raucci
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Rossella Rossi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Roberto Da Cas
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Concita Rafaniello
- Department of Experimental Medicine, Section of Pharmacology “L. Donatelli”, Second University of Napoli, Napoli, Italy
| | - Nadia Mores
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Giulia Bersani
- Pharmacology and Paediatrics, Università Cattolica S. Cuore, Roma, Italy
| | - Antonino Reale
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Nicola Pirozzi
- Paediatric Emergency Department, Bambino Gesù Children’s Hospital, IRCCS, Roma, Italy
| | - Francesca Menniti-Ippolito
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
| | - Giuseppe Traversa
- National Centre for Epidemiology, Surveillance and Health Promotion, National Institute of Health, Roma, Italy
- * E-mail:
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Fuso L, Mores N, Valente S, Malerba M, Montuschi P. Long-Acting Beta-Agonists and their Association with Inhaled Corticosteroids in COPD. Curr Med Chem 2013. [DOI: 10.2174/09298673113209990105] [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: 11/22/2022]
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Tesauro M, Schinzari F, Adamo A, Rovella V, Martini F, Mores N, Barini A, Pitocco D, Ghirlanda G, Lauro D, Campia U, Cardillo C. Effects of GLP-1 on forearm vasodilator function and glucose disposal during hyperinsulinemia in the metabolic syndrome. Diabetes Care 2013; 36:683-9. [PMID: 23069838 PMCID: PMC3579378 DOI: 10.2337/dc12-0763] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Patients with the metabolic syndrome (MetS) have impaired insulin-induced enhancement of vasodilator responses. The incretin hormone glucagon-like peptide 1 (GLP-1), beyond its effects on blood glucose, has beneficial actions on vascular function. This study, therefore, aimed to assess whether GLP-1 affects insulin-stimulated vasodilator reactivity in patients with the MetS. RESEARCH DESIGN AND METHODS Forearm blood flow responses to acetylcholine (ACh) and sodium nitroprusside (SNP) were assessed in MetS patients before and after the addition of GLP-1 to an intra-arterial infusion of saline (n = 5) or insulin (n = 5). The possible involvement of oxidative stress in the vascular effects of GLP-1 in this setting was investigated by infusion of vitamin C (n = 5). The receptor specificity of GLP-1 effect during hyperinsulinemia was assessed by infusing its metabolite GLP-1(9-36) (n = 5). The metabolic actions of GLP-1 were also tested by analyzing forearm glucose disposal during hyperinsulinemia (n = 5). RESULTS In MetS patients, GLP-1 enhanced endothelium-dependent and -independent responses to ACh and SNP, respectively, during hyperinsulinemia (P < 0.001 for both), but not during saline (P > 0.05 for both). No changes in vasodilator reactivity to ACh and SNP were seen after GLP-1 was added to insulin and vitamin C (P > 0.05 for both) and after GLP-1(9-36) was given during hyperinsulinemia (P > 0.05 for both). Also, GLP-1 did not affect forearm glucose extraction and uptake during hyperinsulinemia (P > 0.05 for both). CONCLUSIONS In patients with the MetS, GLP-1 improves insulin-mediated enhancement of endothelium-dependent and -independent vascular reactivity. This effect may be influenced by vascular oxidative stress and is possibly exerted through a receptor-mediated mechanism.
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Affiliation(s)
- Manfredi Tesauro
- Department of Internal Medicine, University of Tor Vergata, Rome, Italy
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Schinzari F, Tesauro M, Rovella V, Di Daniele N, Mores N, Veneziani A, Cardillo C. Leptin stimulates both endothelin-1 and nitric oxide activity in lean subjects but not in patients with obesity-related metabolic syndrome. J Clin Endocrinol Metab 2013; 98:1235-41. [PMID: 23372172 DOI: 10.1210/jc.2012-3424] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Leptin has nitric oxide (NO)-dependent vasodilator actions, but hyperleptinemia is an independent risk factor for cardiovascular disease. OBJECTIVE The objective of the study was to investigate whether, in the human circulation, properties of leptin to release NO are opposed by stimulation of vasculotoxic substances, such as endothelin (ET)-1, and whether this mechanism might contribute to vascular damage in hyperleptinemic states like obesity. METHODS Forearm blood flow responses (plethysmography) to ETA receptor antagonism (BQ-123, 10 nmol/min) and NO synthase inhibition [N(G)-monomethyl L-arginine (L-NMMA), 4 μmol/min] were assessed before and after intraarterial administration of leptin (2 μg/min) in lean controls (n = 8) and patients with obesity-related metabolic syndrome (MetS; n = 8). RESULTS Baseline plasma leptin was higher in patients than in controls (P < .001). Before infusion of leptin, the vasodilator response to BQ-123 was greater in patients than in controls (P < .001), whereas infusion of L-NMMA induced higher vasoconstriction in controls than in patients (P = .04). In lean subjects, hyperleptinemia resulted in increased vasodilator response to ETA receptor antagonism (P < .001 vs before) and enhanced vasoconstrictor effect of L-NMMA during ETA receptor blockade (P = .015 vs before). In patients with the MetS, by contrast, vascular responses to both BQ-123 and L-NMMA were not modified by exogenous leptin (both P > .05 vs before). CONCLUSIONS These findings indicate that, under physiological conditions, leptin stimulates both ET-1 and NO activity in the human circulation. This effect is absent in hyperleptinemic patients with the MetS who are unresponsive to additional leptin. In these patients, therefore, hyperleptinemia may be a biomarker of vascular dysfunction, rather than a mediator of vascular damage.
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Affiliation(s)
- Francesca Schinzari
- Department of Internal Medicine, Catholic University Medical School, 00168 Rome, Italy
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Bofan M, Mores N, Baron M, Dabrowska M, Valente S, Schmid M, Trové A, Conforto S, Zini G, Cattani P, Fuso L, Mautone A, Mondino C, Pagliari G, D’Alessio T, Montuschi P. Within-day and between-day repeatability of measurements with an electronic nose in patients with COPD. J Breath Res 2013; 7:017103. [DOI: 10.1088/1752-7155/7/1/017103] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Montuschi P, Mores N, Trové A, Mondino C, Barnes PJ. The electronic nose in respiratory medicine. ACTA ACUST UNITED AC 2012; 85:72-84. [PMID: 23018197 DOI: 10.1159/000340044] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 06/08/2012] [Indexed: 12/25/2022]
Abstract
Several volatile organic compounds have been identified in exhaled breath in healthy subjects and patients with respiratory diseases by gas chromatography/mass spectrometry. Identification of selective patterns of volatile organic compounds in exhaled breath could be used as a biomarker of inflammatory lung diseases. An electronic nose (e-nose) is an artificial sensor system that generally consists of an array of chemical sensors for detection of volatile organic compound profiles (breathprints) and an algorithm for pattern recognition. E-noses are handheld, portable devices that provide immediate results. E-noses discriminate between patients with respiratory disease, including asthma, COPD and lung cancer, and healthy control subjects, and also among patients with different respiratory diseases. E-nose breathprints are associated with airway inflammation activity. In combination with other 'omics' platforms, e-nose technology might contribute to the identification of new surrogate markers of pulmonary inflammation and subphenotypes of patients with respiratory diseases, provide a molecular basis to a personalized pharmacological treatment, and facilitate the development of new drugs.
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Affiliation(s)
- Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Schinzari F, Tesauro M, Rovella V, Di Daniele N, Gentileschi P, Mores N, Campia U, Cardillo C. Rho-kinase inhibition improves vasodilator responsiveness during hyperinsulinemia in the metabolic syndrome. Am J Physiol Endocrinol Metab 2012; 303:E806-11. [PMID: 22829585 PMCID: PMC3468433 DOI: 10.1152/ajpendo.00206.2012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In patients with the metabolic syndrome (MetS), the facilitatory effect of insulin on forearm vasodilator responsiveness to different stimuli is impaired. Whether the RhoA/Rho kinase (ROCK) pathway is involved in this abnormality is unknown. We tested the hypotheses that, in MetS patients, ROCK inhibition with fasudil restores insulin-stimulated vasodilator reactivity and that oxidative stress plays a role in this mechanism. Endothelium-dependent and -independent forearm blood flow responses to acetylcholine (ACh) and sodium nitroprusside (SNP), respectively, were assessed in MetS patients (n = 8) and healthy controls (n = 5) before and after the addition of fasudil (200 μg/min) to an intra-arterial infusion of insulin (0.1 mU/kg/min). In MetS patients (n = 5), fasudil was also infused without hyperinsulinemia. The possible involvement of oxidative stress in the effect of fasudil during hyperinsulinemia was investigated in MetS patients (n = 5) by infusing vitamin C (25 mg/min). In MetS patients, compared with saline, fasudil enhanced endothelium-dependent and -independent vasodilator responses during insulin infusion (P < 0.001 and P = 0.008, respectively), but not in the absence of hyperinsulinemia (P = 0.25 and P = 0.13, respectively). By contrast, fasudil did not affect vasoreactivity to ACh and SNP during hyperinsulinemia in controls (P = 0.11 and P = 0.56, respectively). In MetS patients, fasudil added to insulin and vitamin C did not further enhance vasodilation to ACh and SNP (P = 0.15 and P = 0.43, respectively). In the forearm circulation of patients with the MetS, ROCK inhibition by fasudil improves endothelium-dependent and -independent vasodilator responsiveness during hyperinsulinemia; increased oxidative stress seems to be involved in the pathophysiology of this phenomenon.
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Affiliation(s)
- Francesca Schinzari
- Department of Internal Medicine, Catholic University Medical School, Rome, Italy
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Salvatori M, Treglia G, Mores N. Further considerations on adverse reactions to radiopharmaceuticals. Eur J Nucl Med Mol Imaging 2012; 39:1360-2. [PMID: 22526962 DOI: 10.1007/s00259-012-2120-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 03/13/2012] [Indexed: 11/27/2022]
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Schinzari F, Tesauro M, Rovella V, Gentileschi P, Mores N, Adamo A, Cardillo C. RHO-KINASE INHIBITION IMPROVES NITRIC OXIDE-DEPENDENT VASODILATOR REACTIVITY DURING HYPERINSULINEMIA IN PATIENTS WITH METABOLIC SYNDROME. J Hypertens 2011. [DOI: 10.1097/00004872-201106001-01162] [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: 11/25/2022]
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Schinzari F, Tesauro M, Rovella V, Galli A, Mores N, Porzio O, Lauro D, Cardillo C. Generalized impairment of vasodilator reactivity during hyperinsulinemia in patients with obesity-related metabolic syndrome. Am J Physiol Endocrinol Metab 2010; 299:E947-52. [PMID: 20923961 DOI: 10.1152/ajpendo.00426.2010] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Defective insulin-dependent vasodilation might contribute importantly to metabolic and vascular abnormalities of the metabolic syndrome (MetS). However, despite extensive investigation, the precise mechanisms involved in insulin's vasoactive effects have not been fully elucidated. Therefore, this study sought to better characterize insulin's physiological actions on vascular reactivity and their potential derangement in the MetS. Forearm blood flow responses to graded doses of acetylcholine, sodium nitroprusside, and verapamil were assessed by strain-gauge plethysmography in patients with obesity-related MetS (n = 20) and in matched controls (n = 18) before and after intra-arterial infusion of insulin (0.2 mU·kg(-1)·min(-1)). Possible involvement of increased oxidative stress in the impaired insulin-stimulated vasodilator responsiveness of patients with MetS (n = 12) was also investigated using vitamin C (25 mg/min). In control subjects, significant potentiation of the vasodilator responses to acetylcholine, nitroprusside, and verapamil was observed after insulin infusion (all P < 0.05). However, no significant change in vasodilator reactivity to either of these drugs was observed following hyperinsulinemia in patients with MetS (all P > 0.05). Interestingly, administration of vitamin C to patients with MetS during hyperinsulinemia significantly enhanced the vasodilator responsiveness to acetylcholine, nitroprusside, and verapamil (all P < 0.05 vs. hyperinsulinemia alone). In conclusion, insulin exerts a generalized facilitatory action on vasodilator reactivity, and this effect is impaired in patients with MetS likely because of increased oxidative stress. Given the importance of vasodilator reactivity in affecting glucose disposal and vascular homeostasis, this defect may then contribute to the development of metabolic and vascular complications in insulin-resistant states.
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Errico S, Shohreh R, Barone E, Pusateri A, Mores N, Mancuso C. Heme oxygenase-derived carbon monoxide modulates gonadotropin-releasing hormone release in immortalized hypothalamic neurons. Neurosci Lett 2010; 471:175-8. [PMID: 20097264 DOI: 10.1016/j.neulet.2010.01.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 01/14/2010] [Indexed: 11/26/2022]
Abstract
Heme oxygenase (HO), the main enzyme deputed to heme metabolism, has been identified as two main isoforms called HO-1 and HO-2 both present in the central nervous system. Heme oxygenase has been shown to regulate the hypothalamic release of neuropeptides such as corticotrophin-releasing hormone and arginin-vasopressin. The aim of this study was to investigate and further characterize the presence of HO in gonadotropin-releasing hormone (GnRH) secreting hypothalamic neurons, GT1-7 and the role of HO by-products on GnRH secretion. The pulsatile release of GnRH from scattered hypothalamic neurons is the key regulator of mammalian fertility in the central nervous system. GT1-7 cells are immortalized hypothalamic neurons, characterized by spontaneous electrical activity and pulsatile GnRH release, resembling the central control pathway of the hypothalamic pituitary gonadal axis (HPG) in mammals. Hemin, the substrate of HO, significantly stimulated HO activity in static cultures, causing a rapid increase in GnRH release. Neither biliverdin nor bilirubin were able to mimic this rapid stimulatory effect, which was instead caused by carbon monoxide. Evidence of a possible involvement of prostaglandin E(2) in the HO by-product modulated GnRH secretion was reported. The hemin-evoked effect on GT1-7 neurons suggests a direct activity of HO by-products on the hypothalamic neuropeptide secretion, and claims for a possible role of CO in both the modulation of gonadotropin secretion and crosstalk among HPG and stress axis within the mammalian hypothalamus.
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Affiliation(s)
- Stefania Errico
- Institute of Pharmacology, Catholic University School of Medicine, Largo Francesco Vito, 1-00168 Roma, Italy
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Cardillo C, Schinzari F, Melina D, Mores N, Bosello S, Peluso G, Zoli A, Ferraccioli G. Improved endothelial function after endothelin receptor blockade in patients with systemic sclerosis. ACTA ACUST UNITED AC 2009; 60:1840-4. [DOI: 10.1002/art.24502] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Mores N, Errico S, Pusateri A, Barone E, Mancuso C. Heme oxygenase expression and activity in immortalized hypothalamic neurons GT1–7. Neurosci Lett 2008; 444:106-8. [DOI: 10.1016/j.neulet.2008.08.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 08/01/2008] [Accepted: 08/06/2008] [Indexed: 10/21/2022]
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Hu L, Gustofson RL, Feng H, Leung PK, Mores N, Krsmanovic LZ, Catt KJ. Converse regulatory functions of estrogen receptor-alpha and -beta subtypes expressed in hypothalamic gonadotropin-releasing hormone neurons. Mol Endocrinol 2008; 22:2250-9. [PMID: 18701637 DOI: 10.1210/me.2008-0192] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Estradiol (E(2)) acts as a potent feedback molecule between the ovary and hypothalamic GnRH neurons, and exerts both positive and negative regulatory actions on GnRH synthesis and secretion. However, the extent to which these actions are mediated by estrogen receptors (ERs) expressed in GnRH neurons has been controversial. In this study, Single-cell RT-PCR revealed the expression of both ERalpha and ERbeta isoforms in cultured fetal and adult rat hypothalamic GnRH neurons. Both ERalpha and ERbeta or individual ERs were expressed in 94% of cultured fetal GnRH neurons. In adult female rats at diestrus, 68% of GnRH neurons expressed ERs, followed by 54% in estrus and 19% in proestrus. Expression of individual ERs was found in 24% of adult male GnRH neurons. ERalpha exerted marked G(i)-mediated inhibitory effects on spontaneous action potential (AP) firing, cAMP production, and pulsatile GnRH secretion, indicating its capacity for negative regulation of GnRH neuronal function. In contrast, increased E(2) concentration and ERbeta agonists increase the rate of AP firing, GnRH secretion, and cAMP production, consistent with ERbeta-dependent positive regulation of GnRH secretion. Consonant with the coupling of ERalpha to pertussis toxin-sensitive G(i/o) proteins, E(2) also activates G protein-activated inwardly rectifying potassium channels, decreasing membrane excitability and slowing the firing of spontaneous APs in hypothalamic GnRH neurons. These findings demonstrate that the dual actions of E(2) on GnRH neuronal membrane excitability, cAMP production, and GnRH secretion are mediated by the dose-dependent activation of ERalpha and ERbeta expressed in hypothalamic GnRH neurons.
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Affiliation(s)
- Lian Hu
- Endocrinology and Reproduction Research Branch, PDEGEN, National Institue of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland 20892-4510, USA
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Tesauro M, Schinzari F, Rovella V, Melina D, Mores N, Barini A, Mettimano M, Lauro D, Iantorno M, Quon MJ, Cardillo C. Tumor necrosis factor-alpha antagonism improves vasodilation during hyperinsulinemia in metabolic syndrome. Diabetes Care 2008; 31:1439-41. [PMID: 18390795 PMCID: PMC2453644 DOI: 10.2337/dc08-0219] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Obesity is associated with chronic inflammation due to overproduction of proinflammatory cytokines, including tumor necrosis factor (TNF)-alpha. We assessed the effects of TNF-alpha neutralization by infliximab on vascular reactivity during hyperinsulinemia in obesity-related metabolic syndrome. RESEARCH DESIGN AND METHODS Vascular responses to intra-arterial infusion of acetylcholine (ACh) and sodium nitroprusside (SNP) were assessed in patients with metabolic syndrome, before and after administration of infliximab. RESULTS Patients had blunted vasodilator responses to ACh and SNP during hyperinsulinemia compared with control subjects; a potentiation of the responsiveness to both ACh and SNP, however, was observed in patients following infliximab. The antioxidant vitamin C improved the vasodilator response to ACh in patients with metabolic syndrome, but its effect was not further enhanced by concurrent administration of infliximab. CONCLUSIONS TNF-alpha neutralization ameliorates vascular reactivity in metabolic syndrome during hyperinsulinemia, likely in relation to decreased oxidative stress, thereby suggesting an involvement of inflammatory cytokines in vascular dysfunction of these patients.
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