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Lechartier B, Boucly A, Solinas S, Gopalan D, Dorfmüller P, Radonic T, Sitbon O, Montani D. Pulmonary veno-occlusive disease: illustrative cases and literature review. Eur Respir Rev 2024; 33:230156. [PMID: 38232988 DOI: 10.1183/16000617.0156-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 11/11/2023] [Indexed: 01/19/2024] Open
Abstract
Pulmonary veno-occlusive disease (PVOD), also known as "pulmonary arterial hypertension (PAH) with overt features of venous/capillary involvement", is a rare cause of PAH characterised by substantial small pulmonary vein and capillary involvement, leading to increased pulmonary vascular resistance and right ventricular failure. Environmental risk factors have been associated with the development of PVOD, such as occupational exposure to organic solvents and chemotherapy, notably mitomycin. PVOD may also be associated with a mutation in the EIF2AK4 gene in heritable forms of disease. Distinguishing PVOD from PAH is critical for guiding appropriate management. Chest computed tomography typically displays interlobular septal thickening, ground-glass opacities and mediastinal lymphadenopathy. Life-threatening pulmonary oedema is a complication of pulmonary vasodilator therapy that can occur with any class of PAH drugs in PVOD. Early referral to a lung transplant centre is essential due to the poor response to therapy when compared with other forms of PAH. Histopathological analysis of lung explants reveals microvascular remodelling with typical fibrous veno-occlusive lesions. This review covers the main features distinguishing PVOD from PAH and two clinical cases that illustrate the challenges of PVOD management.
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Affiliation(s)
- Benoit Lechartier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Respiratory Division, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Athénaïs Boucly
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sabina Solinas
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Deepa Gopalan
- Department of Radiology, Imperial College Hospital NHS Trust, London, UK
| | - Peter Dorfmüller
- Institut für Pathologie, Universitätsklinikum Giessen/Marburg, Giessen, Germany
- Deutsches Zentrum für Lungenforschung (DZL), Giessen, Germany
| | - Teodora Radonic
- Amsterdam UMC location Vrije Universiteit Amsterdam, Department of Pathology, Boelelaan Amsterdam, The Netherlands Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - Olivier Sitbon
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - David Montani
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Université Paris-Saclay, School of Medicine, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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Boucly A, Solinas S, Beurnier A, Jaïs X, Keddache S, Eyries M, Seferian A, Jevnikar M, Roche A, Bulifon S, Bourdin A, Chaouat A, Cottin V, Bertoletti L, Savale L, Humbert M, Sitbon O, Montani D. Outcomes and risk assessment in pulmonary veno-occlusive disease. ERJ Open Res 2024; 10:00612-2023. [PMID: 38226059 PMCID: PMC10789263 DOI: 10.1183/23120541.00612-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/13/2023] [Indexed: 01/17/2024] Open
Abstract
Introduction Pulmonary veno-occlusive disease (PVOD) is a rare and severe subtype of pulmonary arterial hypertension (PAH). Although European Society of Cardiology/European Respiratory Society (ESC/ERS) guidelines advise assessing PAH severity at baseline and during follow-up, no existing risk assessment methods have been validated for PVOD. This study aimed to identify prognostic factors, examine the impact of treatment strategies and evaluate risk assessment methods for PVOD patients. Methods The study analysed all incident PVOD patients included in the French Pulmonary Hypertension Registry between 2006 and 2021. Survival was assessed based on initial treatment strategy and risk status and compared to a matched (age, sex, pulmonary vascular resistance) PAH group. Six risk assessment methods (number of four low-risk and three noninvasive low-risk variables, ESC/ERS guidelines three-strata and four-strata models, REVEAL 2.0 and Lite 2) were applied at baseline and early follow-up, and their accuracy was compared using Harrell's c-statistic. Results Among the 327 included PVOD patients, survival rates at 1, 3 and 5 years were 86%, 50% and 27%, respectively. Multivariate analysis showed that only 6-min walk distance was associated with survival, with no significant difference based on initial treatment strategy. All six risk assessment methods could discriminate mortality risk, and the ESC/ERS four-strata model was the most accurate at both baseline and follow-up (C-index 0.64 and 0.74). PVOD survival rates were consistently lower than PAH when comparing baseline risk status using the ESC/ERS four-strata model. Conclusion PVOD is associated with poor outcomes, and initial treatment strategies do not significantly affect survival. Risk assessment methods can be useful in predicting survival for PVOD patients.
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Affiliation(s)
- Athénaïs Boucly
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Sabina Solinas
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Antoine Beurnier
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Physiologie et Explorations Fonctionnelles Respiratoires, Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Sophia Keddache
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Mélanie Eyries
- Sorbonne Université, AP-HP, Département de Génétique, Hôpital Pitié-Salpêtrière, Paris, France
- INSERM UMRS1166, ICAN – Institute of CardioMetabolism and Nutrition, Sorbonne Université, Paris, France
| | - Andrei Seferian
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Anne Roche
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Sophie Bulifon
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Univ Montpellier, CHU Montpellier, Montpellier, France
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Ari Chaouat
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S1116, Faculté de Médecine de Nancy, Université de Lorraine, Département de Pneumologie, CHRU de Nancy, Vandœuvre-lès-Nancy, France
| | - Vincent Cottin
- Centre Hospitalier Universitaire de Lyon HCL, Service de Pneumologie, Centre de Référence des Maladies Pulmonaires Rares, Groupement Hospitalier Est, Hôpital Louis Pradel, Université Claude Bernard Lyon 1, Lyon, France
| | - Laurent Bertoletti
- Université Jean Monnet Saint-Etienne, CHU Saint Etienne, Mines Saint-Etienne, Département de Médecine Vasculaire et Thérapeutique, Saint-Etienne, France
| | - Laurent Savale
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
- These authors contributed equally
| | - David Montani
- Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
- Institut National de la Santé et de la Recherche Scientifique, Unité Mixte de Recherche S_999 “Pulmonary Hypertension: Pathophysiology and Novel Therapies”, Faculté de Médecine de Bicêtre et Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique – Hôpitaux de Paris, Groupe Hospitalo-Universitaire Paris-Saclay, Hôpital Bicêtre, Département Médico-Universitaire “THORINNO”, Service de Pneumologie et Soins Intensifs, Centre de Référence de l'Hypertension Pulmonaire PULMOTENSION, Le Kremlin-Bicêtre, France
- These authors contributed equally
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Jevnikar M, Solinas S, Brenot P, Lechartier B, Kularatne M, Montani D, Savale L, Garcia-Alonso C, Sitbon O, Beurnier A, Boucly A, Bulifon S, Seferian A, Roche A, Mercier O, Simonneau G, Fadel E, Humbert M, Jaïs X. Sequential multimodal therapy in chronic thromboembolic pulmonary hypertension with mixed anatomical lesions: a proof of concept. Eur Respir J 2023; 62:2300517. [PMID: 37802632 DOI: 10.1183/13993003.00517-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/18/2023] [Indexed: 10/09/2023]
Affiliation(s)
- Mitja Jevnikar
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally
| | - Sabina Solinas
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- These authors contributed equally
| | - Philippe Brenot
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Benoit Lechartier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
- Respiratory division, Lausanne University Hospitals, Lausanne, Switzerland
| | - Mithum Kularatne
- Department of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Montani
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Laurent Savale
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Carlos Garcia-Alonso
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Radiology, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Olivier Sitbon
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Antoine Beurnier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Athénaïs Boucly
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Sophie Bulifon
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Andrei Seferian
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Anne Roche
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Olaf Mercier
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Gérald Simonneau
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Elie Fadel
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- Department of Thoracic and Vascular Surgery and Heart-Lung Transplantation, Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Marc Humbert
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
| | - Xavier Jaïs
- Université Paris-Saclay, Faculty of Medicine, Le Kremlin-Bicêtre, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999, "Pulmonary Hypertension: Pathophysiology and Novel Therapies", Groupe Hospitalier Saint Joseph - Hôpital Marie Lannelongue, Le Plessis-Robinson, France
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4
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Kularatne M, Boucly A, Savale L, Solinas S, Cheron C, Roche A, Jevnikar M, Jaïs X, Montani D, Humbert M, Sitbon O. Pharmacological management of connective tissue disease-associated pulmonary arterial hypertension. Expert Opin Pharmacother 2023; 24:2101-2115. [PMID: 37869785 DOI: 10.1080/14656566.2023.2273395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/17/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Pulmonary arterial hypertension (PAH) is a severe, progressive pulmonary vasculopathy (Group 1 Pulmonary Hypertension (PH)) that complicates the course of many connective tissue diseases (CTD). Detailed testing is required to differentiate PAH from other types of PH caused by CTD such as left heart disease (Group 2 PH), pulmonary parenchymal disease (Group 3 PH), and chronic thromboembolic pulmonary hypertension (Group 4 PH). PAH is most frequently seen in systemic sclerosis but can also be seen with systemic lupus erythematosus, mixed CTD, and primary Sjogren's syndrome. AREAS COVERED This review discusses the epidemiology of CTD-associated PAH, outlines the complex diagnosis approach, and finishes with an in-depth discussion on the current treatment paradigm. Focus is placed on challenges faced in the treatment of CTD-associated PAH, (decreased efficacy and poorer tolerance of pharmacological therapies) and includes a discussion on the future investigational treatments. EXPERT OPINION Despite significant advances over the past decades with more aggressive treatment algorithms, CTD-associated PAH patients continue to have poorer survival compared to those with idiopathic PAH. This review highlights factors leading to disparate outcomes compared to other forms of PAH, and discusses on further improvements that may increase quality of life and survival for CTD-associated PAH patients.
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Affiliation(s)
- Mithum Kularatne
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Athénaïs Boucly
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Laurent Savale
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Sabina Solinas
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Céline Cheron
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Anne Roche
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mitja Jevnikar
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Xavier Jaïs
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France
- INSERM UMR_S 999 Pulmonary Hypertension: Pathophysiology and Novel Therapies, Le Kremlin-Bicêtre, France
- AP-HP, Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, DMU 5 Thorinno, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
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Solinas S, Boucly A, Beurnier A, Kularatne M, Grynblat J, Eyries M, Dorfmüller P, Sitbon O, Humbert M, Montani D. Diagnosis and management of pulmonary veno-occlusive disease. Expert Rev Respir Med 2023; 17:635-649. [PMID: 37578057 DOI: 10.1080/17476348.2023.2247989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 07/08/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
INTRODUCTION Pulmonary veno-occlusive disease (PVOD) is an orphan disease and uncommon etiology of pulmonary arterial hypertension (PAH) characterized by substantial small pulmonary vein and capillary involvement. AREAS COVERED PVOD, also known as 'PAH with features of venous/capillary involvement' in the current ESC/ERS classification. EXPERT OPINION In recent years, particular risk factors for PVOD have been recognized, including genetic susceptibilities and environmental factors (such as exposure to occupational organic solvents, chemotherapy, and potentially tobacco). The discovery of biallelic mutations in the EIF2AK4 gene as the cause of heritable PVOD has been a breakthrough in understanding the molecular basis of PVOD. Venous and capillary involvement (PVOD-like) has also been reported to be relatively common in connective tissue disease-associated PAH (especially systemic sclerosis), and in rare pulmonary diseases like sarcoidosis and pulmonary Langerhans cell granulomatosis. Although PVOD and pulmonary arterial hypertension (PAH) exhibit similarities, including severe precapillary PH, it is essential to differentiate between them since PVOD has a worse prognosis and requires specific management. Indeed, PVOD patients are characterized by poor response to PAH-approved drugs, which can lead to pulmonary edema and clinical deterioration. Due to the lack of effective treatments, early referral to a lung transplantation center is crucial.
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Affiliation(s)
- Sabina Solinas
- School of Medicine, Université Paris- Saclay, Paris, France
- Service de Pneumologie et Soins Intensifs Respiratoires, AP-HP, Hopital Bicetre, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Athénaïs Boucly
- School of Medicine, Université Paris- Saclay, Paris, France
- Service de Pneumologie et Soins Intensifs Respiratoires, AP-HP, Hopital Bicetre, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Antoine Beurnier
- School of Medicine, Université Paris- Saclay, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, ERN-LUNG, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Mithum Kularatne
- Division of Respiratory Medicine, Department of Medicine, University of Calgary, Calgary, Canada
| | - Julien Grynblat
- School of Medicine, Université Paris- Saclay, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Mélanie Eyries
- Sorbonne Université, Departement de genetique, Assistance Publique- Hopitaux de Paris, Hopital Pitié-Salpetriere, Paris, France
- INSERM UMRS 1166, ICAN- Institute of CardioMetabolism and Nutrition, Sorbonne Université, Paris, France
| | - Peter Dorfmüller
- Department of Pathology, University of Giessen and Marburg Lung Center, Justus-Liebig University Giessen, Giessen, Germany
| | - Olivier Sitbon
- School of Medicine, Université Paris- Saclay, Paris, France
- Service de Pneumologie et Soins Intensifs Respiratoires, AP-HP, Hopital Bicetre, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Marc Humbert
- School of Medicine, Université Paris- Saclay, Paris, France
- Service de Pneumologie et Soins Intensifs Respiratoires, AP-HP, Hopital Bicetre, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - David Montani
- School of Medicine, Université Paris- Saclay, Paris, France
- Service de Pneumologie et Soins Intensifs Respiratoires, AP-HP, Hopital Bicetre, Paris, France
- INSERM UMRS 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
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6
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Montani D, Certain MC, Weatherald J, Jaïs X, Bulifon S, Noel-Savina E, Nieves A, Renard S, Traclet J, Bouvaist H, Riou M, de Groote P, Moceri P, Bertoletti L, Favrolt N, Guillaumot A, Jutant EM, Beurnier A, Boucly A, Ebstein N, Jevnikar M, Pichon J, Keddache S, Preda M, Roche A, Solinas S, Seferian A, Reynaud-Gaubert M, Cottin V, Savale L, Humbert M, Sitbon O. COVID-19 in Patients with Pulmonary Hypertension: A National Prospective Cohort Study. Am J Respir Crit Care Med 2022; 206:573-583. [PMID: 35549842 PMCID: PMC9716894 DOI: 10.1164/rccm.202112-2761oc] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Rationale: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with pulmonary endothelial dysfunction. There are limited data available on the outcomes of coronavirus disease (COVID-19) in patients with pulmonary hypertension (PH), a disease characterized by pulmonary endothelial dysfunction. Objectives: To describe characteristics and outcomes of patients with precapillary PH and COVID-19. Methods: We prospectively collected characteristics, management, and outcomes of adult patients with precapillary PH in the French PH network who had COVID-19 between February 1, 2020, and April 30, 2021. Clinical, functional, and hemodynamic characteristics of PH before COVID-19 were collected from the French PH registry. Measurements and Main Results: A total of 211 patients with PH (including 123 with pulmonary arterial hypertension, 47 with chronic thromboembolic PH, and 41 with other types of PH) experienced COVID-19, and 40.3% of them were outpatients, 32.2% were hospitalized in a conventional ward, and 27.5% were in an ICU. Among hospitalized patients (n = 126), 54.0% received corticosteroids, 37.3% high-flow oxygen, and 11.1% invasive ventilation. Right ventricular and acute renal failure occurred in 30.2% and 19.8% of patients, respectively. Fifty-two patients (all hospitalized) died from COVID-19. Overall mortality was 24.6% (95% CI [confidence interval], 18.8-30.5) and in-hospital mortality 41.3% (95% CI, 32.7-49.9). Nonsurvivors were significantly older, more frequently male and suffering comorbidities (diabetes, chronic respiratory diseases, systemic hypertension, chronic cardiac diseases, and/or chronic renal failure), and had more severe PH at their most recent evaluation preceding COVID-19 diagnosis (in terms of functional class and 6-minute-walk distance; all P < 0.05). Use of pulmonary arterial hypertension therapy was similar between survivors and nonsurvivors. Conclusions: COVID-19 in patients with precapillary PH was associated with a high in-hospital mortality. The typical risk factors for severe COVID-19 and severity of PH were associated with mortality in this population.
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Affiliation(s)
- David Montani
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Marie-Caroline Certain
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Jason Weatherald
- Division of Respirology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada;,Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Xavier Jaïs
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Sophie Bulifon
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | | | - Ana Nieves
- Service de Pneumologie Centre Hospitalier Universitaire Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Sébastien Renard
- Service de Cardiologie, Centre Régional de Compétences de l'Hypertension Pulmonaire, Hôpital La Timone, Marseille, France
| | - Julie Traclet
- Université Lyon-1, Hospices Civils de Lyon, Centre de Référence des Maladies Pulmonaires Rares, Centre de Compétences de l'Hypertension Pulmonaire, Hôpital Louis Pradel, Lyon, France
| | - Hélène Bouvaist
- Service de Cardiologie, Hôpital Universitaire Grenoble-Alpes, Grenoble, France
| | - Marianne Riou
- Département de Pneumologie, Nouvel Hôpital Civil, Strasbourg, France
| | - Pascal de Groote
- Hôpital Cardiologique de Lille, Centre de Compétences de l'Hypertension Pulmonaire, Lille, France
| | - Pamela Moceri
- Unité de Recherche Clinique Côte d'Azur, Service de Cardiologie, Centre Hospitalier Universitaire de Nice, Université Côte d'Azur, Nice, France
| | - Laurent Bertoletti
- Service de Médecine Vasculaire et Thérapeutique, Institut National de la Santé et de la Recherche Médicale Unité 1059 et Centre d'Investigation Clinique 1408, Centre Hospitalier Universitaire de Saint-Etienne, Université Jean-Monnet, Saint-Etienne, France
| | - Nicolas Favrolt
- Service de Pneumologie et Soins Intensifs Respiratoires, Centre Hospitalier Universitaire de Dijon, Dijon, France
| | - Anne Guillaumot
- Université de Lorraine, Centre Hospitalo-Universitaire Nancy, Pôle des Spécialités Médicales, Département de Pneumologie, Vandoeuvre-lès-Nancy, France; and
| | - Etienne-Marie Jutant
- Université de Poitiers, Centre Hospitalo-Universitaire de Poitiers, Service de pneumologie, Institut National de la Santé et de la Recherche Médicale Centre d'Investigation Clinique 1402, Poitiers, France
| | - Antoine Beurnier
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Physiology – Pulmonary Function Testing, Assistance Publique – Hôpitaux de Paris, Hôpital Bicêtre, Département Médico-Universitaire 5 Thorinno, Le Kremlin-Bicêtre, France
| | - Athénaïs Boucly
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Nathan Ebstein
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Mitja Jevnikar
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Jérémie Pichon
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Sophia Keddache
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Mariana Preda
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Anne Roche
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Sabina Solinas
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Andrei Seferian
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Martine Reynaud-Gaubert
- Service de Pneumologie Centre Hospitalier Universitaire Nord, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Vincent Cottin
- Université Lyon-1, Hospices Civils de Lyon, Centre de Référence des Maladies Pulmonaires Rares, Centre de Compétences de l'Hypertension Pulmonaire, Hôpital Louis Pradel, Lyon, France
| | - Laurent Savale
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Marc Humbert
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
| | - Olivier Sitbon
- Faculty of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, France;,Institut National de la Santé et de la Recherche Médicale Unité Mixte de Recherche _S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France;,Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Centre, and
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Pelaia C, Busceti MT, Solinas S, Terracciano R, Pelaia G. Real-life evaluation of the clinical, functional, and hematological effects of mepolizumab in patients with severe eosinophilic asthma: Results of a single-centre observational study. Pulm Pharmacol Ther 2018; 53:1-5. [PMID: 30217438 DOI: 10.1016/j.pupt.2018.09.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/10/2018] [Indexed: 10/28/2022]
Abstract
Mepolizumab is a humanized monoclonal antibody which targets interleukin-5 (IL-5) and is nowadays available in many countries for add-on biological therapy of severe eosinophilic asthma. Although the approval of mepolizumab use in clinical practice has been made possible by several successful pre-marketing controlled trials, so far only a very few studies have been performed in a real-life setting. Within such a context, our present observational investigation refers to 14 patients with refractory eosinophilic asthma, currently treated with mepolizumab at the Respiratory Unit of "Magna Græcia" University Hospital located in Catanzaro, Italy, whose anti-IL-5 treatment began between June 2017 and January 2018. These patients experienced a significant increase in asthma control test (ACT) score, that was evaluated at baseline (13.64 ± 3.00), as well as after 4 weeks (18.86 ± 3.15; p < 0.0001) and 24 weeks (20.07 ± 1.94; p < 0.0001) of add-on therapy with mepolizumab. This relevant improvement in symptom control was paralleled by a dramatic fall of blood eosinophil numbers, counted at baseline (647.1 ± 274.7 cells/μl), and at the 4th (147.8 ± 66.5 cells/μl; p < 0.0001) and 24th week (98.6 ± 40.3 cells/μl; p < 0.0001) after starting add-on treatment with mepolizumab. These changes were associated with significant and stable increases in FEV1, which was recorded at baseline (1389 ± 454.3 mL), as well as after 4 weeks (1711 ± 482.3 mL; p < 0.001) and 24 weeks (1701 ± 456.0 mL; p < 0.01). Moreover, in comparison to the 6 months preceding the beginning of treatment with mepolizumab, after 24 weeks of anti-IL-5 therapy significant decreases were detected with regard to exacerbation numbers (from 3.64 ± 1.86 to 1.0 ± 0.78; p < 0.001) and oral intake of prednisone (from 24.11 ± 10.36 mg/day to 1.78 ± 3.82 mg/day). Therefore, these preliminary data referring to our single-centre observational study corroborate, in a real-life environment, the efficacy of mepolizumab for treatment of patients with exacerbation-prone, corticosteroid-refractory, severe eosinophilic asthma.
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Affiliation(s)
- Corrado Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Maria Teresa Busceti
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Sabina Solinas
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy
| | - Rosa Terracciano
- Department of Health Science, University "Magna Græcia" of Catanzaro, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University "Magna Græcia" of Catanzaro, Italy.
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Mariani G, Solinas S, Pasqualetti D, Ghirardini A, Verani P, Buttó S, Lopez M, Moretti T. Induction of Immunotolerance in Hemophilia for High Titre Inhibitor Eradication: A Long-Term Follow-Up. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1651013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThree hemophiliacs with high titre inhibitor were treated with a medium-high FVIII dose schedule (100 IU/kg bw daily) with the aim of inducing the immunotolerance. These patients were followed-up extensively concerning their immunological status and HIV serology. In all of them the inhibitor disappeared and normal FVIII kinetics were obtained after 22, 15 and 29 months. After eradication of the inhibitor, no recurrence took place in any of the patients. All the patients were HIV Ab positive before the beginning of the treatment. In one of them CD4+ cells fell progessively 32 months after the treatment was started, a fullblown AIDS showed up, and the patient died 5½ years after the beginning of the treatment. In the second and third patient the CD4+ cells varied widely but remained >400/μl during the whole immunotolerance treatment. The latter two patients are AIDS and ARC free so far, but patient No. 2 developed a mild-to-severe thrombocytopenia.Considering the high cost of the treatment and the possibility that such an intensive administration of FVIII concentrates might worsen the immunological status of patients, this therapeutic procedure should only be applied with caution.
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Affiliation(s)
- G Mariani
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
| | - S Solinas
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
| | - D Pasqualetti
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
| | - A Ghirardini
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
| | - P Verani
- Laboratorio di Virologia, Instituto Superiore di Sanita' Roma, Italy
| | - S Buttó
- Laboratorio di Virologia, Instituto Superiore di Sanita' Roma, Italy
| | - M Lopez
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
| | - T Moretti
- Dipartimento di Biopatologia Umana, Sezione di Ematologia Universita' di Roma “La Sapienza”, Roma, Italy
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Ghirardini A, Mariani G, lacopino G, Tirindelli MC, Solinas S, Moretti T. Concentrated DDAVP: Further Improvement in the Management of Mild Factor VIII Deficiencies. Thromb Haemost 2018. [DOI: 10.1055/s-0038-1646011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
SummaryThis study was carried out to evaluate the pharmacological efficacy of a new concentrated 1 Deamino - (8-D-arginine) - vasopressin (DDAVP) preparation. Concentrated DDAVP (C- DDAVP), (40 μg/mL) was given subcutaneously (s.c.) in hemophilia and von Willebrand Disease (vWD), and the response was evaluated in terms of factor VIII/vWF (VUI/von Willebrand Factor) complex response. This response was also compared to that obtained using the currently available commercial preparation (4 μg/mL) given either s.c. or intravenously (i. v.). The maximal f. VIII response after s.c. C-DDAVP was reached one hour after the injection (x:3.6 times the resting values) with an average decline of 15% at two hours. The response to s.c. C- DDAVP in patients with hemophilia was slightly better than thut obtained with the diluted brand, but the difference did not reach any statistical significance even when the schedules were compared in the same patients. In type I (placed normal subtype) vWD, a higher response in terms of factor VIII :C increase in comparison with hemophiliacs was obtained. Doth Ristocetin cofactor activity (RiCof) and bleeding time responded to this vasopressin analogue, when administered subcutaneously.
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Affiliation(s)
- A Ghirardini
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
| | - G Mariani
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
| | - G lacopino
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
| | - M C Tirindelli
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
| | - S Solinas
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
| | - T Moretti
- The Department of Human Biopathology, Section of Hematology, University of Roma “La Sapienza”, Rome, Italy
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D'Angelo E, Mazzarello P, Prestori F, Mapelli J, Solinas S, Lombardo P, Cesana E, Gandolfi D, Congi L. The cerebellar network: from structure to function and dynamics. ACTA ACUST UNITED AC 2010; 66:5-15. [PMID: 20950649 DOI: 10.1016/j.brainresrev.2010.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Revised: 10/04/2010] [Accepted: 10/06/2010] [Indexed: 10/19/2022]
Abstract
Since the discoveries of Camillo Golgi and Ramón y Cajal, the precise cellular organization of the cerebellum has inspired major computational theories, which have then influenced the scientific thought not only on the cerebellar function but also on the brain as a whole. However, six major issues revealing a discrepancy between morphologically inspired hypothesis and function have emerged. (1) The cerebellar granular layer does not simply operate a simple combinatorial decorrelation of the inputs but performs more complex non-linear spatio-temporal transformations and is endowed with synaptic plasticity. (2) Transmission along the ascending axon and parallel fibers does not lead to beam formation but rather to vertical columns of activation. (3) The olivo-cerebellar loop could perform complex timing operations rather than error detection and teaching. (4) Purkinje cell firing dynamics are much more complex than for a linear integrator and include pacemaking, burst-pause discharges, and bistable states in response to mossy and climbing fiber synaptic inputs. (5) Long-term synaptic plasticity is far more complex than traditional parallel fiber LTD and involves also other cerebellar synapses. (6) Oscillation and resonance could set up coherent cycles of activity designing a functional geometry that goes far beyond pre-wired anatomical circuits. These observations clearly show that structure is not sufficient to explain function and that a precise knowledge on dynamics is critical to understand how the cerebellar circuit operates.
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Affiliation(s)
- E D'Angelo
- Department of Physiology, University of Pavia, I-27100 Pavia, Italy.
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11
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Solinas S, Pauli U, Kuhnert P, Peterhans E, Fries R. Assignment of the porcine tumour necrosis factor alpha and beta genes to the chromosome region 7p11-q11 by in situ hybridization. Anim Genet 2009; 23:267-71. [PMID: 1503261 DOI: 10.1111/j.1365-2052.1992.tb00140.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The loci of the porcine tumour necrosis factor genes, alpha (TNFA) and beta (TNFB), have been chromosomally assigned by radioactive in situ hybridization. The genomic probes for TNFA and TNFB yielded signals above 7p11-q11, a region that has been shown earlier to carry the porcine major histocompatibility locus (SLA). These mapping data along with preliminary molecular studies suggest a genomic organization of the SLA that is similar to that of human and murine major histocompatibility complexes.
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Affiliation(s)
- S Solinas
- Institut für Nutztierwissenschaften, Gruppe Züchtungsbiologie, Zürich, Switzerland
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12
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D'Angelo E, Koekkoek SKE, Lombardo P, Solinas S, Ros E, Garrido J, Schonewille M, De Zeeuw CI. Timing in the cerebellum: oscillations and resonance in the granular layer. Neuroscience 2009; 162:805-15. [PMID: 19409229 DOI: 10.1016/j.neuroscience.2009.01.048] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Revised: 01/21/2009] [Accepted: 01/24/2009] [Indexed: 11/16/2022]
Abstract
The brain generates many rhythmic activities, and the olivo-cerebellar system is not an exception. In recent years, the cerebellum has revealed activities ranging from low frequency to very high-frequency oscillations. These rhythms depend on the brain functional state and are typical of certain circuit sections or specific neurons. Interestingly, the granular layer, which gates sensorimotor and cognitive signals to the cerebellar cortex, can also sustain low frequency (7-25 Hz) and perhaps higher-frequency oscillations. In this review we have considered (i) how these oscillations are generated in the granular layer network depending on intrinsic electroresponsiveness and circuit connections, (ii) how these oscillations are correlated with those in other cerebellar circuit sections, and (iii) how the oscillating cerebellum communicates with extracerebellar structures. It is suggested that the granular layer can generate oscillations that integrate well with those generated in the inferior olive, in deep-cerebellar nuclei and in Purkinje cells. These rhythms, in turn, might play a role in cognition and memory consolidation by interacting with the mechanisms of long-term synaptic plasticity.
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Affiliation(s)
- E D'Angelo
- Department of Physiology, University of Pavia, CNISM (Consorzio Nazionale Interuniversitario per le Scienze Fisiche della Materia), Via Forlanini 6, I-27100, Pavia, Italy.
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13
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Mariana G, Ciavarella N, Mazzucconi MG, Antoncecchi S, Solinas S, Ranieri P, Pettini P, Agrestini F, Mandelli F. Evaluation of the effectiveness of DDAVP in surgery and in bleeding episodes in haemophilia and von Willebrand's disease. A study on 43 patients. Clin Lab Haematol 2008; 6:229-38. [PMID: 6440729 DOI: 10.1111/j.1365-2257.1984.tb00548.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
1-deamino-8-D-arginine-vasopressin (DDAVP), was used in a wide spectrum of clinical situations employing two different dosages (0.3 and 0.4 microgram/kg b.w.) for the management of 43 patients with factor VIII deficiencies--mild and moderate haemophilia A and von Willebrand's disease (vWD). In most instances, the drug was given in association with antifibrinolytics. Twenty-five dental extractions were carried out with two different protocols: one based upon a single infusion and the other based upon three infusions. Bleeding occurred in three patients regardless of the protocol used. The vasopressin analogue promptly stopped bleeding in 12 'spontaneous' open bleeds (haematuria, epistaxis, menometrorrhagia, gum bleeding) and it appears to be also effective in closed bleeds. DDAVP was used to minimize blood loss during surgical interventions and to avoid haemorrhage in the postoperative period. Nine surgical procedures were carried out in six vWD patients and three haemophiliacs. Bleeding occurred late in the postoperative period on one occasion only. No difference was demonstrated between the two doses of the drug either in terms of clinical benefit or rise of factor VIII coagulant activity. The efficacy of DDAVP and the absence of side-effects make this vasopressin analogue worthy of consideration as a reliable alternative to factor VIII concentrates in a wide variety of clinical situations.
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14
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Tosti ME, Solinas S, Prati D, Salvaneschi L, Manca M, Francesconi M, Ciuffreda M, Girelli G, Mele A. An estimate of the current risk of transmitting blood-borne infections through blood transfusion in Italy. Br J Haematol 2002; 117:215-9. [PMID: 11918558 DOI: 10.1046/j.1365-2141.2002.03334.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [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: 11/20/2022]
Abstract
We conducted a retrospective cohort study to estimate the incidence of major blood-borne agents among Italian blood donors and calculated the risk of infection among blood recipients using the 'incidence/window period model'. The study was conducted among 46 180 blood donors enrolled in six blood centres between 1994 and 1999. During follow-up, seven new infections were confirmed: three donors seroconverted for anti-human immunodeficiency virus (HIV); two for anti-hepatitis C virus (HCV); and two showed hepatitis B surface antigen (HBsAg) reactivity; no cases of syphilis were observed. The incidence rates per 100 000 person/years were: 4.06 (95% CI: 0.82-11.85) for HIV; 2.41 (95% CI: 0.29-8.70) for HCV; and 2.70 (95% CI: 0.32-9.77) for HBsAg; the incidence for total hepatitis B virus (HBV) infection was 9.77 per 100 000 person/years (95% CI: 1.16-35.36). The estimated risk of an infectious blood unit not being detected was: 2.45 (95% CI: 0.13-12.33) per 1 million units for HIV; 4.35 (95% CI: 0.30-22.39) for HCV; and 15.78 (95% CI: 1.16-84.23) for HBV. Overall, an estimated 22.58 per 1 million units are infected. In Italy, the risk of transfusion-transmitted infections is low and is similar to that in other western countries. The introduction of new more sensitive screening tests could reduce the residual risk of transfusion-transmitted infection by 40-80%.
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Affiliation(s)
- M E Tosti
- Reparto di Epidemiologia Clinica, Istituto Superiore di Sanità, Servizio Trasfusionale e Immunoematologia, Università La Sapienza, Rome, Italy.
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15
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Celik I, Krack W, Zeiler T, Kretschmer V, Solinas S, Gajek H, Lorenz W. Plasma histamine levels during plasmapheresis: difficult interpretation of adverse reactions to plasma substitutes. Inflamm Res 2001; 50 Suppl 2:S65-7. [PMID: 11411607 DOI: 10.1007/pl00020784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- I Celik
- Institute of Theoretical Surgery, Philipps University, Marburg, Germany.
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16
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D'Amato A, Nigri G, Pronio A, Montesani C, Ferrazza G, Rusignolo A, Solinas S, Ribotta G. [The use of autotransfusion in general surgery]. Ann Ital Chir 2000; 71:643-7; discussion 647-8. [PMID: 11347315] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Authors expose their experience with autotransfusion, made during several years in a general surgery university department. Discussion is made about ethic and economical aspect of the philosophy guiding the most general concept of blood sparing, and different methods of autotransfusion; attention is then focused on practical experience made during two years (1995-1997) when the program worked well. On the whole, in 94 patients, 172 blood units were collected plus 10 plasma units obtained by aferesis. No method-related complications are have been observed. Elements who corresponded to difficulties or obstacles to the fully application of the method have been critically analyzed. Authors propose finally guide-lines which want to be valid proposal to increase method use while respecting at the best ethics, economics, efficacy and efficiency that must guide our work.
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Affiliation(s)
- A D'Amato
- Clinica Chirurgica VI, Dipartimento di II Clinica Chirurgica, Università di Roma La Sapienza.
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17
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D'Amato A, Ferrazza G, Solinas S, Pronio AM, Montesani C, Ribotta G. Use of autologous blood in general surgery. Hepatogastroenterology 2000; 47:1241-4. [PMID: 11100323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND/AIMS Autologous blood predonation is still not as widespread as it should be in general surgery practice, even if the method is well-known and has benefits established in international literature. Authors describe the impact of an autotransfusion program, in a general surgery university department, focusing on management and cost problems. METHODOLOGY A description of the efficacy of the program during a yearlong activity period is presented. An analysis has been made about the quantity of predonated blood/plasma units, the quantity actually transfused and use of homologous blood. The problems which occurred and the cost are discussed. RESULTS The most used autotransfusion method was preoperative predeposit of autologous blood. The analysis of results focused on some organizational problems that need to be avoided in order to show the methods maximum benefits. In a large number of cases (some 50%) predeposit was not made because of several managing/technical problems. In another large number of cases (38%) the quantity of units predonated did not fully supply the needs and several patients received homologous products. In another number of cases predonated blood units were not used at all (61/34%). CONCLUSIONS Predeposit, preoperative hemodilution and intraoperative recovery, are methods that should all be available in a general surgery department to manage in the best way the single patients blood/plasma needs, reducing post-transfusion complication. To optimize the program and minimize waste some guidelines must be established, with the aim of a rational and correct use of the procedure. Despite the value of the method, and the favor encountered by the patients, we must not forget that the use of autologous blood is not costless.
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Affiliation(s)
- A D'Amato
- Clinica Chirurgica VI, Università La Sapienza Rome, Italy.
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18
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Locasciulli A, Testa M, Valsecchi MG, Bacigalupo A, Solinas S, Tomas JF, Ljungman P, Alberti A. The role of hepatitis C and B virus infections as risk factors for severe liver complications following allogeneic BMT: a prospective study by the Infectious Disease Working Party of the European Blood and Marrow Transplantation Group. Transplantation 1999; 68:1486-91. [PMID: 10589944 DOI: 10.1097/00007890-199911270-00010] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [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: 11/26/2022]
Abstract
BACKGROUND Severe liver disease, including fulminant hepatic failure and venoocclusive disease can occur after bone marrow transplantation (BMT). The aim of our study was to assess risk factors for veno occlusive disease and severe liver disease occurring within 6 months from BMT. METHODS A total of 193 consecutive patients from 15 BMT Centers were prospectively enrolled between January and June 1995. Data on donors and recipients before and after transplant were collected and included age, gender, alanine aminotransferase (ALT), hepatitis B (HBV), and hepatitis C virus (HCV) markers, hematological disease, status and type of BMT, conditioning regimen and graft versus host disease prophylaxis. Statistical analysis included univariate descriptive and multivariate analysis based on logistic regression on major end-points. RESULTS Forty-three of 193 patients died during the study period, and liver disease was the main cause of death (13 of 43, 30%). Incidence of severe veno occlusive disease was 8%, fulminant hepatic failure 0.5% and 12% of cases had ALT >500 U/L (normal < or =42 U/L). A de novo HBV or HCV infection occurred in 3.2 and 7% of patients respectively. Predictive risk factors for life-threatening liver disease were: unrelated donors (relative risk=5.8, confidence interval=1.7-19.8) and abnormal BMT donor ALT (relative risk=6.3, confidence interval=1. 5- 25.5). CONCLUSIONS This study indicates that ongoing or previous infection with HBV or HCV in donor or recipient is not an absolute contraindication for BMT. However, abnormal ALT levels in BMT donors were a significant predictor of potentially lethal liver complications. The occurrence of de novo HBV or HCV infection did not correlate with severity of liver disease observed in the first 6 months posttransplant. These findings should be carefully evaluated before disregarding HBV or HCV positive siblings with normal transaminase levels in favor of unrelated donors.
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Affiliation(s)
- A Locasciulli
- Clinica Pediatrica Università di Milano, Ematologia Pediatrica, Ospedal San Gerardo, Monza (Milano), Itlay
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19
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Corrias A, Mountjoy G, Piccaluga G, Solinas S. An X-ray Absorption Spectroscopy Study of the Ni K Edge in NiO−SiO2 Nanocomposite Materials Prepared by the Sol−Gel Method. J Phys Chem B 1999. [DOI: 10.1021/jp9927911] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- A. Corrias
- Dipartimento di Scienze Chimiche, Università di Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale per Sestu Km 0.70, 09042 Monserrato, Cagliari, Italy, and School of Physical Sciences, University of Kent, Canterbury, CT2 7NR, U.K
| | - G. Mountjoy
- Dipartimento di Scienze Chimiche, Università di Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale per Sestu Km 0.70, 09042 Monserrato, Cagliari, Italy, and School of Physical Sciences, University of Kent, Canterbury, CT2 7NR, U.K
| | - G. Piccaluga
- Dipartimento di Scienze Chimiche, Università di Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale per Sestu Km 0.70, 09042 Monserrato, Cagliari, Italy, and School of Physical Sciences, University of Kent, Canterbury, CT2 7NR, U.K
| | - S. Solinas
- Dipartimento di Scienze Chimiche, Università di Cagliari, Cittadella Universitaria di Monserrato, Strada Provinciale per Sestu Km 0.70, 09042 Monserrato, Cagliari, Italy, and School of Physical Sciences, University of Kent, Canterbury, CT2 7NR, U.K
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20
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Devoti D, Affanni M, Ampollini A, D'Angelo G, Guasti D, Melissari M, Solinas S. An atypical case of osteoid osteoma. Chir Organi Mov 1997; 82:423-6. [PMID: 9618982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- D Devoti
- Divisione Ortopedica, Azienda Ospedaliera, Parma
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21
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Popescu NC, Chen MC, Simpson S, Solinas S, DiPaolo JA. A Burkitt lymphoma cell line with integrated Epstein-Barr virus at a stable chromosome modification site. Virology 1993; 195:248-51. [PMID: 8391183 DOI: 10.1006/viro.1993.1367] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Fluorescence in situ hybridization (FISH), Southern, and slot blotting were used to detect Epstein-Barr virus (EBV) DNA and RNA sequences in a Burkitt's lymphoma (BL) cell line derived from a North American patient (NAB-2). FISH analysis after hybridization with a BamHI "V" region of EBV showed that NAB-2 cells have EBV genome integrated at a single site on the short arm of chromosome 2(p13). Single hybridization signals were detected at homologous sites on both chromatoids and nuclei. Furthermore, hybridization of intact nuclei without formamide denaturation and heat allowed the detection of single specific viral RNA transcripts visible as "tracks" or "traces." Southern blot analysis confirmed the integration of EBV genome into the host DNA. Quantification of slot blot hybridization revealed that NAB-2 cells have on average one copy of EBV per cell. Virus insertion into chromosomal DNA caused a stable modification site expressed as a distinctive achromatic region adjacent to the band 2p13. The chromatid lesion at the site of EBV integration involving a recombinogenic and fragile site may have contributed to the development of the NAB-2 BL.
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Affiliation(s)
- N C Popescu
- Laboratory of Biology, National Cancer Institute, Bethesda, Maryland 20892
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22
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Shamay A, Solinas S, Pursel VG, McKnight RA, Alexander L, Beattie C, Hennighausen L, Wall RJ. Production of the mouse whey acidic protein in transgenic pigs during lactation. J Anim Sci 1991; 69:4552-62. [PMID: 1721617 DOI: 10.2527/1991.69114552x] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The mouse whey acidic protein (WAP) gene was introduced into the genome of pigs and its expression was analyzed in the mammary gland. Mouse WAP was detected in milk of lactating females from five lines at levels between .5 and 1.5 g/liter, thereby representing as much as 2% of the total milk proteins. The corresponding mRNA was expressed in mammary tissue at levels similar to those of pig beta-lactoglobulin and beta-casein. The pattern of WAP secretion in three pigs over a period of 6 wk was quantitatively similar to that of pig beta-lactoglobulin. From the eight transgenic pigs analyzed, three successfully completed one lactational period, but five pigs stopped lactating a few days after parturition. Our results show that it is possible to produce large quantities of a foreign protein in milk of pigs over a full lactational period. However, expression of WAP can compromise the mammary gland and render it nonfunctional.
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Affiliation(s)
- A Shamay
- Lab. of Biochem. and Metab., NIDDK, NIH, Bethesda, MD
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23
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Mazzucconi MG, Ferrari A, Solinas S, Vitale A, Chistolini A, Federici AB, Mandelli F. Studies of von Willebrand factor in essential thrombocythemia patients treated with alpha-2b recombinant interferon. Haemostasis 1991; 21:135-40. [PMID: 1773983 DOI: 10.1159/000216217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The crucial role of the von Willebrand Factor (vWF) and its interaction with platelets in myeloproliferative disorders (MPD) have emerged in recent years. Recently, many authors have reported the therapeutical efficacy of interferon (IFN) in MPD with thrombocytosis in decreasing platelet number. The purpose of our report is to study the modifications of vWF in a series of 20 patients affected by essential thrombocythemia (ET) or MPD with thrombocytosis, treated with alpha 2b recombinant IFN (alpha 2b-rIFN). Patients were studied before treatment and after complete or partial response: vWF-related properties, bleeding time (BT) and ristocetin-induced platelet aggregation (RIPA) were evaluated. Before treatment, we found prolonged BT in 5 patients (25%), abnormal RIPA in 8 (40%), reduced factor VIII coagulant activity (VIII:C) in 2 (10%), reduced vWF-related antigen (vWF:Ag) in 5 (25%) and low vWF:ristocetin cofactor (vWF:Ricof) in 5 (25%). Twelve subjects were evaluated after hematologic remission: in all patients, BT, VIII:C, vWF:Ag and vWF:Ricof were within normal range or upper normal limits. RIPA was abnormal in 7 subjects. Multimer patterns of vWF were performed in 3 patients before and after treatment: 2 of them showed loss of high-molecular-weight multimers that seemed to recover at remission. IFN seems to induce improvement of platelet number and their functions in MPD with thrombocytosis.
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Affiliation(s)
- M G Mazzucconi
- Department of Human Biopathology, University La Sapienza, Rome, Italy
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24
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Mariani G, Solinas S, Pasqualetti D, Ghirardini A, Verani P, Buttó S, Lopez M, Moretti T. Induction of immunotolerance in hemophilia for high titre inhibitor eradication: a long-term follow-up. Thromb Haemost 1989; 62:835-9. [PMID: 2512676] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Three hemophiliacs with high titre inhibitor were treated with a medium-high FVIII dose schedule (100 IU/kg bw daily) with the aim of inducing the immunotolerance. These patients were followed-up extensively concerning their immunological status and HIV serology. In all of them the inhibitor disappeared and normal FVIII kinetics were obtained after 22, 15 and 29 months. After eradication of the inhibitor, no recurrence took place in any of the patients. All the patients were HIV Ab positive before the beginning of the treatment. In one of them CD4+ cells fell progressively 32 months after the treatment was started, a full-blown AIDS showed up, and the patient died 5 1/2 years after the beginning of the treatment. In the second and third patient the CD4+ cells varied widely but remained greater than 400/microliter during the whole immunotolerance treatment. The latter two patients are AIDS and ARC free so far, but patient No. 2 developed a mild-to-severe thrombocytopenia. Considering the high cost of the treatment and the possibility that such an intensive administration of FVIII concentrates might worsen the immunological status of patients, this therapeutic procedure should only be applied with caution.
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Affiliation(s)
- G Mariani
- Dipartimento di Biopatologia Umana, Università di Roma La Sapienza, Italy
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25
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Ghirardini A, Mariani G, Iacopino G, Tirindelli MC, Solinas S, Moretti T. Concentrated DDAVP: further improvement in the management of mild factor VIII deficiencies. Thromb Haemost 1987; 58:896-8. [PMID: 3124287] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This study was carried out to evaluate the pharmacological efficacy of a new concentrated 1 Deamino - (8-D-arginine)-vasopressin (DDAVP) preparation. Concentrated DDAVP (C-DDAVP), (40 micrograms/mL) was given subcutaneously (s.c.) in hemophilia and von Willebrand Disease (vWD), and the response was evaluated in terms of factor VIII/vWF (VIII/von Willebrand Factor) complex response. This response was also compared to that obtained using the currently available commercial preparation (4 micrograms/mL) given either s.c. or intravenously (i.v.). The maximal f. VIII response after s.c. C-DDAVP was reached one hour after the injection (means:3.5 times the resting values) with an average decline of 15% at two hours. The response to s.c. C-DDAVP in patients with hemophilia was slightly better than that obtained with the diluted brand, but the difference did not reach any statistical significance even when the schedules were compared in the same patients. In type I (platelet normal subtype) vWD, a higher response in terms of factor VIII:C increase in comparison with hemophiliacs was obtained. Both Ristocetin co-factor activity (RiCof) and bleeding time responded to this vasopressin analogue, when administered subcutaneously.
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Affiliation(s)
- A Ghirardini
- Department of Human Biopathology, Hematology, University of Roma, La Sapienza, Italy
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Mannucci PM, Lombardi R, Bader R, Vianello L, Federici AB, Solinas S, Mazzucconi MG, Mariani G. Heterogeneity of type I von Willebrand disease: evidence for a subgroup with an abnormal von Willebrand factor. Blood 1985; 66:796-802. [PMID: 3876122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Type I von Willebrand disease (vWD) is characterized by equally low plasma concentrations of von Willebrand factor antigen (vWF:Ag) and ristocetin cofactor (RiCof) and by the presence of all vWF multimers in sodium dodecyl sulfate (SDS)-agarose gel electrophoresis. For 17 patients (13 kindreds) diagnosed with these criteria, we have studied the platelet contents of vWF:Ag and RiCof and the changes of these in plasma after DDAVP infusion. Platelet vWF:Ag and RiCof were normal in four kindreds (called "platelet normal" subgroup); following 1-deamino-8-D-arginine vasopressin; plasma vWF:Ag, RiCof and the bleeding time (BT) became normal. In six kindreds, platelet vWF:Ag and RiCof were equally low (platelet low); after DDAVP, plasma vWF:Ag and RiCof remained low, and the BT was prolonged. In three additional kindreds, platelets contained normal concentrations of vWF:Ag, but RiCof was very low (platelet discordant); even though a complete set of multimers was found in plasma and platelets, there was a relatively small amount of large multimers. After DDAVP, plasma vWF:Ag became normal, but RiCof remained low and the BT was very prolonged. These findings demonstrated that there can be an abnormal vWF (RiCof less than vWF:Ag) even in type I vWD, coexisting with a complete set of vWF multimers (platelet discordant); that the abnormal vWF can be shown more clearly in platelets than in plasma or else in plasma after DDAVP infusion; and that DDAVP normalizes the BT only in those patients with normal platelet levels of both vWF:Ag and RiCof (platelet normal).
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Chistolini A, Mazzucconi MG, Motta M, Solinas S, Tirindelli MC, Mariani G. Evaluation of the clotting defect in a factor XII-deficient kindred. Ric Clin Lab 1985; 15:241-5. [PMID: 3853270 DOI: 10.1007/bf03029194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A family with factor XII severe congenital deficiency is described. Factor XII activity and factor XII antigen were both undetectable in the propositus plasma; levels of FXII:C and FXII:Ag were intermediate in heterozygotes. Plasma prekallikrein activity was low in the propositus, whereas normal levels of antigen could be found, suggesting a defect of kallikrein activation due to factor XII deficiency.
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Viganò S, Mannucci PM, Solinas S, Bottasso B, Mariani G. Decrease in protein C antigen and formation of an abnormal protein soon after starting oral anticoagulant therapy. Br J Haematol 1984; 57:213-20. [PMID: 6547348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Changes in protein C antigen (PC:Ag) have been compared with those in factor II, VII, IX and X antigens (II:Ag; VII:Ag; IX:Ag and X:Ag) in 10 patients starting on oral anticoagulant therapy with warfarin, monitored with thrombotest. Between days 0 and 3 of therapy, PC:Ag decreased at the same rate as VII:Ag, whilst IX:Ag, X:Ag and II:Ag decreased at progressively slower rates. On days 15 and 21, clotting proteins and PC:Ag did not differ significantly. Before and after warfarin, PC:Ag had the same mobility on crossed immunoelectrophoresis in Ca2+-free agarose gel; with Ca2+, a protein with faster anodal mobility appeared on day 1 and became maximal 5 d after warfarin was started. These findings indicate that the rate of PC decrease is closer to that of factor VII than those of factors IX, X and II, and that an abnormal PC with poor Ca2+-binding properties appears soon after treatment is started. The early decrease in the physiological inactivator (i.e. PC) might contribute to the poor antithrombotic efficacy of anticoagulant therapy during the first days.
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Mariani G, Mazzucconi MG, Solinas S, Avvisati G, Chistolini A, Moretti T. Studies on PIVKA VII. Haemostasis 1984; 14:238-43. [PMID: 6469099 DOI: 10.1159/000215063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
In 30 subjects on stabilized oral anticoagulant treatment, factor VII activity (VII:C) and factor VII antigen (VII:Ag) were evaluated. The average VII:C and VII:Ag levels were 8.7 and 30.7, respectively. All plasma samples were treated with 1 M barium chloride: all the activity and a corresponding average amount of antigen were adsorbed by the salt. The cold-promoted activation of factor VII was found in 5/30 subjects. Corresponding amounts of VII:C and VII:Ag were also removed from the plasma of these subjects after cold activation following the addition of barium chloride. It clearly results from these studies that a portion of VII:Ag cannot be adsorbed by barium chloride because of a reduction (or a lack) of the gamma-carboxyglutamic groups. This portion of VII:Ag can therefore be identified as Pivka VII.
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Mariani G, Annino L, Solinas S, Mandelli F. Characterization and Treatment of the Non-Lymphoblastic Crisis of Chronic Myelogenous Leukemia. Tumori 1983; 69:521-6. [PMID: 6582679 DOI: 10.1177/030089168306900606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fifty-six consecutive patients affected by the non-lymphoblastic-like crisis of chronic myelogenous leukemia were the subjects of this study. The cytologic and cytochemical features, together with the extension of clinical involvement, were investigated in all the patients. The most frequent cytologic variant was the « myeloid » one (60% of the patients). All the patients received a standard treatment (hydroxyurea, 6-mercaptopurine ± prednisone). The overall median survival was 5.1 months; however, 22% of the patients survived for one year or more. The length of survival was independent of the cytologic variety and clinical conditions (previous splenectomy, organomegalies, etc.). There was no correlation between drug dosage and length of survival, whereas the disappearance of blast cells from the peripheral blood appeared to be directly correlated with a longer survival. The treatment was well tolerated (slight hematologic and hepatic toxicity) and allowed a reasonably good quality of life: most of the patients were treated on an out-patient basis.
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Mannucci PM, Lombardi R, Pareti FI, Solinas S, Mazzucconi MG, Mariani G. A variant of von Willebrand's disease characterized by recessive inheritance and missing triplet structure of von Willebrand factor multimers. Blood 1983; 62:1000-5. [PMID: 6605165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A 10-yr-old girl had bleeding symptoms of moderate severity; her mother and maternal aunt had milder bleeding symptoms, and other members of the kindred were asymptomatic. In the child, factor VIII coagulant activity (VIII:C) and von Willebrand factor antigen (vWF:Ag) were normal, ristocetin cofactor very low, and the bleeding time (BT) markedly prolonged. These values were normal in the rest of the kindred, but the mother and maternal aunt had prolonged BT and a high VIII:C/vWF:Ag ratio. Crossed immunoelectrophoresis (CIE) showed a vWF:Ag peak migrating more anodally in the propositus, two distinct peaks, one migrating anodally, in the father, paternal uncle, and grandmother, and normal peaks in the rest of the kindred. In the propositus, analysis of vWF multimers in plasma on 1.6% sodium dodecyl sulfate (SDS) agarose revealed that there were no larger multimers and there was a relative increase of the smallest multimer. This relative increase was also seen in her relatives with a double peak on CIE. Using gels of smaller porosity, each multimer of the propositus's plasma consisted of a single band, instead of the repeating triplet seen in normal and von Willebrand's disease varients types IIA and IIB. The abnormalities found in the propositus are tentatively interpreted as being due to double heterozygosity for two different genes. The defective gene carried by the father affects the triplet structure of vWF multimers, whereas a prolonged BT and a high VII:C/vWF:Ag ratio are the only phenotypic expressions of the defective gene of the mother. The findings of aberrant triplet structure in congenital vWD strengthen the view that this structure is an intrinsic feature of the normal vWF molecule.
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Pisano F, Figola A, Ghinelli M, Solinas S. Solitary chondromas of the long bones of the hand (results in 18 cases treated with autoplastic bone grafts). Ital J Orthop Traumatol 1982; 8:103-7. [PMID: 6757178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Eighteen cases are reported of solitary chondroma of the long bones of the hand treated by curettage and packing with autoplastic grafts of spongy bone. The preferred localisation was in the three ulnar rays and in the metaphyseal zones in the neighborhood of the growth cartilage. In the younger patients the site was more often in the diaphysis; in the older patients, almost exclusively meta-epiphyseal. The diagnosis is usually made fortuitously as a result of a pathological fracture (61 per cent of the cases investigated). The results, assessed at an average of two and a half years after operation, were consistently excellent. They demonstrate that, in practice, any variety of this condition can be successfully treated by this method.
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Agrestini F, Mariani G, Capozzi L, Mandelli F, Solinas S, Badia D. A Comprehensive Programme for Dental Care in Haemophilia. Pathophysiol Haemos Thromb 1981. [DOI: 10.1159/000214597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Pisano F, Figola A, Ghinelli M, Solinas S. [Treatment of torpid and traumatic fractures in rheumatoid arthritis]. Chir Organi Mov 1980; 66:197-201. [PMID: 7318549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Solinas S. [Imbalance of the posterior ligaments of the spine in the pathogenetic mechanism of idiopathic scoliosis]. Chir Organi Mov 1978; 64:487-91. [PMID: 754910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Santoro L, Spoto G, Solinas S, Aureli M, Federici G. [Partial purification and properties of 3-mercaptopyruvate sulfurtransferase in the bovine kidney]. Boll Soc Ital Biol Sper 1976; 52:911-6. [PMID: 1023905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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