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Orsucci D, Tessa A, Caldarazzo Ienco E, Trovato R, Natale G, Bilancieri G, Giuntini M, Napolitano A, Salvetti S, Vista M, Santorelli FM. Clinical and genetic features of dominant Essential Tremor in Tuscany, Italy: FUS, CAMTA1, ATXN1 and beyond. J Neurol Sci 2024; 460:123012. [PMID: 38626532 DOI: 10.1016/j.jns.2024.123012] [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: 02/03/2024] [Revised: 04/07/2024] [Accepted: 04/09/2024] [Indexed: 04/18/2024]
Abstract
OBJECTIVE Essential Tremor (ET) is one of the most common neurological disorders. In most instances ET is inherited as an autosomal dominant trait with age-related penetrance (virtually complete in advanced age); however, ET genetics remains elusive. The current study aims to identify possibly pathogenic genetic variants in a group of well-characterized ET families. METHODS 34 individuals from 14 families with dominant ET were clinically evaluated and studied by whole exome sequencing studies (after excluding trinucleotide expansion disorders). RESULTS Most patients had pure ET. In 4 families, exome studies could identify a genetic variant potentially able to significantly alter the protein structure (CADD >20, REVEL score > 0.25), shared by all the affected individuals (in CAMTA1, FUS, MYH14, SGCE genes). In another family there were two variants in dominant genes (PCDH9 and SQSTM1). Moreover, an interrupted "intermediate" trinucleotide expansion in ATXN1 ("SCA1") was identified in a further family with pure ET. CONCLUSION Combining our observations together with earlier reports, we can conclude that ET genes confirmed in at least two families to date include CAMTA1 and FUS (reported here), as well as CACNA1G, NOTCH2NLC and TENM4. Most cases of familial ET, inherited with an autosomal dominant inheritance, may result from "mild" variants of many different genes that, when affected by more harmful genetic variants, lead to more severe neurological syndromes (still autosomal dominant). Thus, ET phenotype may be the "mild", incomplete manifestation of many other dominant neurogenetic diseases. These findings further support evidence of genetic heterogeneity for such disease(s). Author's keywords: cerebellar ataxias, movement disorders, neurogenetics, rare neurological disorders, tremor.
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Affiliation(s)
- D Orsucci
- Unit of Neurology, San Luca Hospital, Lucca, Italy.
| | - A Tessa
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | | | - R Trovato
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - G Natale
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - G Bilancieri
- IRCCS Stella Maris Foundation, Calambrone, Pisa, Italy
| | - M Giuntini
- Unit of Neurology, San Luca Hospital, Lucca, Italy
| | - A Napolitano
- Unit of Neurology, Apuane Hospital, Massa Carrara, Italy
| | - S Salvetti
- Unit of Neurology, San Luca Hospital, Lucca, Italy
| | - M Vista
- Unit of Neurology, San Luca Hospital, Lucca, Italy
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Napolitano A, Thway K, Huang P, Jones RL. Centralisation of care improves overall survival for sarcoma patients. Ann Oncol 2024; 35:338-339. [PMID: 38342185 DOI: 10.1016/j.annonc.2024.01.009] [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: 01/30/2024] [Accepted: 01/30/2024] [Indexed: 02/13/2024] Open
Affiliation(s)
- A Napolitano
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - K Thway
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London
| | - P Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London
| | - R L Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust, London; Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Li Z, Napolitano A, Fedele M, Gao X, Napolitano F. AI identifies potent inducers of breast cancer stem cell differentiation based on adversarial learning from gene expression data. Brief Bioinform 2024; 25:bbae207. [PMID: 38701411 PMCID: PMC11066897 DOI: 10.1093/bib/bbae207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 04/08/2024] [Accepted: 04/11/2024] [Indexed: 05/05/2024] Open
Abstract
Cancer stem cells (CSCs) are a subpopulation of cancer cells within tumors that exhibit stem-like properties and represent a potentially effective therapeutic target toward long-term remission by means of differentiation induction. By leveraging an artificial intelligence approach solely based on transcriptomics data, this study scored a large library of small molecules based on their predicted ability to induce differentiation in stem-like cells. In particular, a deep neural network model was trained using publicly available single-cell RNA-Seq data obtained from untreated human-induced pluripotent stem cells at various differentiation stages and subsequently utilized to screen drug-induced gene expression profiles from the Library of Integrated Network-based Cellular Signatures (LINCS) database. The challenge of adapting such different data domains was tackled by devising an adversarial learning approach that was able to effectively identify and remove domain-specific bias during the training phase. Experimental validation in MDA-MB-231 and MCF7 cells demonstrated the efficacy of five out of six tested molecules among those scored highest by the model. In particular, the efficacy of triptolide, OTS-167, quinacrine, granisetron and A-443654 offer a potential avenue for targeted therapies against breast CSCs.
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Affiliation(s)
- Zhongxiao Li
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955, Saudi Arabia
- Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
| | - Antonella Napolitano
- Institute of Experimental Endocrinology and Oncology “G. Salvatore” (IEOS), National Research Council (CNR), Via De Amicis, 95 - 80131 Napoli, Italy
| | - Monica Fedele
- Institute of Experimental Endocrinology and Oncology “G. Salvatore” (IEOS), National Research Council (CNR), Via De Amicis, 95 - 80131 Napoli, Italy
| | - Xin Gao
- Computer Science Program, Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology (KAUST), Thuwal, 23955, Saudi Arabia
- Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
| | - Francesco Napolitano
- Computational Bioscience Research Center, King Abdullah University of Science and Technology, Thuwal, 23955, Saudi Arabia
- Department of Science and Technology, University of Sannio, Via dei Mulini 74, 82100 Benevento, Italy
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Lucà S, Franco R, Napolitano A, Soria V, Ronchi A, Zito Marino F, Della Corte CM, Morgillo F, Fiorelli A, Luciano A, Palma G, Arra C, Battista S, Cerchia L, Fedele M. PATZ1 in Non-Small Cell Lung Cancer: A New Biomarker That Negatively Correlates with PD-L1 Expression and Suppresses the Malignant Phenotype. Cancers (Basel) 2023; 15:cancers15072190. [PMID: 37046851 PMCID: PMC10093756 DOI: 10.3390/cancers15072190] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
Non-small cell lung cancer (NSCLC), the leading cause of cancer death worldwide, is still an unmet medical problem due to the lack of both effective therapies against advanced stages and markers to allow a diagnosis of the disease at early stages before its progression. Immunotherapy targeting the PD-1/PD-L1 checkpoint is promising for many cancers, including NSCLC, but its success depends on the tumor expression of PD-L1. PATZ1 is an emerging cancer-related transcriptional regulator and diagnostic/prognostic biomarker in different malignant tumors, but its role in lung cancer is still obscure. Here we investigated expression and role of PATZ1 in NSCLC, in correlation with NSCLC subtypes and PD-L1 expression. A cohort of 104 NSCLCs, including lung squamous cell carcinomas (LUSCs) and adenocarcinomas (LUADs), was retrospectively analyzed by immunohistochemistry for the expression of PATZ1 and PD-L1. The results were correlated with each other and with the clinical characteristics, showing on the one hand a positive correlation between the high expression of PATZ1 and the LUSC subtype and, on the other hand, a negative correlation between PATZ1 and PD-L1, validated at the mRNA level in independent NSCLC datasets. Consistently, two NSCLC cell lines transfected with a PATZ1-overexpressing plasmid showed PD-L1 downregulation, suggesting a role for PATZ1 in the negative regulation of PD-L1. We also showed that PATZ1 overexpression inhibits NSCLC cell proliferation, migration, and invasion, and that Patz1-knockout mice develop LUAD. Overall, this suggests that PATZ1 may act as a tumor suppressor in NSCLC.
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Affiliation(s)
- Stefano Lucà
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonella Napolitano
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Valeria Soria
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Federica Zito Marino
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Carminia Maria Della Corte
- Department of Precision Medicine, Medical Oncology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Floriana Morgillo
- Department of Precision Medicine, Medical Oncology, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Alfonso Fiorelli
- Translational Medical and Surgical Science, Thoracic Surgery, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy
| | - Antonio Luciano
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Giuseppe Palma
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Claudio Arra
- S.S.D. Sperimentazione Animale, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, 80131 Naples, Italy
| | - Sabrina Battista
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Laura Cerchia
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
| | - Monica Fedele
- Institute for Experimental Endocrinology and Oncology (IEOS), National Research Council (CNR), 80145 Naples, Italy
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Vincenzi B, Simonetti S, Iuliani M, Cavaliere S, Napolitano A, Santini D, Tonini G, Guillén M, Avilés P, Pantano F. 101P Pharmacological inhibition of glyoxalase-1 as novel therapeutic strategy to enhance trabectedin anti-tumor effect in soft tissue sarcoma preclinical models. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Napolitano A, Lim S, Ferro Lopez L, Benson C, Jones R. 80P Expanded access program use of ripretinib in advanced GIST patients in the United Kingdom. ESMO Open 2023. [DOI: 10.1016/j.esmoop.2023.101117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Johnston EW, Alves A, Messiou C, Napolitano A, Strauss D, Hayes A, Smith MJ, Benson C, Jones RL, Gennatas S, Fotiadis N. Percutaneous cryoablation for desmoid fibromatosis: initial experience at a UK centre. Clin Radiol 2022; 77:784-793. [PMID: 35850865 DOI: 10.1016/j.crad.2022.06.008] [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: 02/01/2022] [Revised: 05/13/2022] [Accepted: 06/11/2022] [Indexed: 11/03/2022]
Abstract
AIM To report the first UK experience of cryoablation in desmoid fibromatosis (DF) with particular focus on technique, safety, and efficacy. MATERIALS AND METHODS Patients were selected at multidisciplinary tumour board meetings at a specialist cancer hospital. Radiation dose, procedure duration, and number of cryoprobes were compared for small versus large tumours (>10 cm long axis). Response at magnetic resonance imaging (MRI) was evaluated using different criteria, and percentage agreement with clinical response as assessed in oncology clinic calculated. RESULTS Thirteen procedures were performed in 10 patients (eight women, median age 51 years, IQR 42-69 years) between February 2019 and August 2021. Procedures for large tumours had higher radiation dose (2,012 ± 1,012 versus 1,076 ± 519 mGy·cm, p=0.048) used more cryoprobes (13 ± 7 versus 4 ± 2, p=0.009), and were more likely to have residual unablated tumour (38 ± 37% versus 7.5 ± 10%, p=0.045). Adverse events were minor apart from one transient radial nerve palsy. Eight of 10 patients had symptomatic benefit at clinical follow-up (median 353 days, IQR 86-796 days), and three started systemic therapy mean 393 days later. All patients who had complete ablation demonstrated symptomatic response, with no instances of repeat treatment, recurrence, or need for systemic therapy during the study period. All progression occurred outside ablation zones. CONCLUSION Cryoablation for symptomatic DF is a reproducible technique with low, transient toxicity, where one or two treatments can achieve a meaningful response. Where possible, the ablation ice ball should fully cover DF tumours.
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Affiliation(s)
- E W Johnston
- Interventional Radiology, Royal Marsden Hospital, London, UK.
| | - A Alves
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - C Messiou
- Diagnostic Radiology, Royal Marsden Hospital, London, UK
| | - A Napolitano
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - D Strauss
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - A Hayes
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - M J Smith
- Academic Surgical Unit, Royal Marsden Hospital, London, UK
| | - C Benson
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - R L Jones
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - S Gennatas
- Medial Oncology, Royal Marsden Hospital, London, UK
| | - N Fotiadis
- Interventional Radiology, Royal Marsden Hospital, London, UK.
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Placidi E, Napolitano A, Stimato G, Teodoli S, Greco F, Menna S, Meffe G, Quaranta F, Gambacorta M, Tagliaferri L, Valentini V, Indovina L. The dosimetric impact of applying a model-based dose calculation algorithm for non-melanoma skin cancer interventional radiotherapy. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00378-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Napolitano A, Lucignani M, Tagliente E, Pasquini L, Dellepiane F, Rossi-Espagnet M, Ritrovato M, Vidiri A, Villani V, Ranazzi G, Stoppacciaro A, Romano A, Di Napoli A, Bozzao A. Comparison of machine learning classifiers to predict patient survival and genetics of GBM: towards a standardized model for clinical implementation. Phys Med 2021. [DOI: 10.1016/s1120-1797(22)00035-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Smrke A, Ostler A, Napolitano A, Vergnano M, Asare B, Fotiadis N, Thway K, Zaidi S, Miah A, van der Graaf W, Gennatas S, Benson C, Huang P, Jones R. 1526MO GEMMK: A phase I study of gemcitabine (gem) and pembrolizumab (pem) in patients (pts) with leiomyosarcoma (LMS) and undifferentiated pleomorphic sarcoma UPS). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Di Cerbo A, Quagliano N, Napolitano A, Pezzuto F, Iannitti T, Di Cerbo A. Comparison between an Emerging Point-of-Care Tool for TSH Evaluation and a Centralized Laboratory-Based Method in a Cohort of Patients from Southern Italy. Diagnostics (Basel) 2021; 11:diagnostics11091590. [PMID: 34573932 PMCID: PMC8471571 DOI: 10.3390/diagnostics11091590] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 08/10/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022] Open
Abstract
Endocrine and metabolic disorders are a common condition in Europe and worldwide, and, among these, thyroid dysfunction still remains a problem. The measurement of thyroid stimulating hormone (TSH) levels represents the first-line assay for the assessment of thyroid function. In the present study, we compared serum concentrations of TSH, measured using a commercially available point-of-care test (POCT) method (FastPack® IP) and an established "conventional" laboratory-based method (Beckmann Access 2) in a cohort of patients from Foggia in Southern Italy. A strong correlation (r = 0.994) was found between both methods and was also confirmed by receiver operating characteristic (ROC) curve analysis (0.82). The within-run coefficient of variation (CV) using FastPack® ranged from 4.03% and 8.57% at the TSH concentrations of 39.49 and 0.70 mIU/L, respectively. The between-run CV was 10.34% and 6.33% at the TSH concentrations of 0.87 and 26.55 mIU/L, respectively. The ratios of within- to between-assay CV were 0.83 and 1.06 at the TSH levels of 0.70 and 52.59 mIU/mL, respectively. In this study, we showed that serum TSH levels can be measured in a few minutes and at low-cost in terms of materials and equipment required. We observed that this approach is user-friendly, accurate, reproducible, and suitable for use in the clinic, while also meeting the criteria for effectiveness, impact, efficiency, and sustainability.
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Affiliation(s)
- Alfredo Di Cerbo
- Leonardo da Vinci Private Clinic, Via Nicola De Dominicis, 71121 Foggia, Italy; (A.D.C.); (F.P.)
| | - Nazario Quagliano
- Biometron Laboratory, Viale Aldo Moro, 122/128, 71011 Apricena, Italy; (N.Q.); (A.N.)
| | - Antonella Napolitano
- Biometron Laboratory, Viale Aldo Moro, 122/128, 71011 Apricena, Italy; (N.Q.); (A.N.)
| | - Federica Pezzuto
- Leonardo da Vinci Private Clinic, Via Nicola De Dominicis, 71121 Foggia, Italy; (A.D.C.); (F.P.)
| | - Tommaso Iannitti
- Independent Researcher, Southampton SO16 0BS, UK
- Correspondence: (T.I.); (A.D.C.)
| | - Alessandro Di Cerbo
- School of Biosciences and Veterinary Medicine, University of Camerino, Via Circonvallazione 93/95, 62024 Matelica, Italy
- Correspondence: (T.I.); (A.D.C.)
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Placidi E, Napolitano A, Fionda B, Greco F, Cornacchione P, Cusumano D, Casà C, Stimato G, Lancellotta V, Teodoli S, Ferioli M, Cilla S, Macchia G, Kovacs G, Gambacorta M, Tagliaferri L, Indovina L. PO-1721 Use of a bolus for skin cancer interventional radiotherapy in absence of model-based algorithms. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)08172-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Del Casale A, Rossi-Espagnet MC, Napolitano A, Lucignani M, Bonanni L, Kotzalidis GD, Buscajoni A, Manelfi L, Perrone V, Gualtieri I, Brugnoli R, De Pisa E, Girardi P, Romano A, Ferracuti S, Bozzao A, Pompili M. Cerebral cortical thickness and gyrification changes in first-episode psychoses and multi-episode schizophrenia. Arch Ital Biol 2021; 159:3-20. [PMID: 34159573 DOI: 10.12871/00039829202111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Cortical thickness (CT) and local gyrification index (LGI) in psychotic disorders may show modifications that relate to clinical course. This observational study aimed to analyse such variables in patients with schizophrenia, compared to healthy controls (HCs). We compared CT and LGI of 18 patients with first-episode psychosis with that of 21 with multi-episode schizophrenia and 16 HCs. CT corrected for false-positive cases (Family-Wise Error Rate) showed a reduction in the multi-episode group compared to HCs in left temporal and parietal, and right temporal, parietal, occipital, and hippocampal cortices. Family-wise corrected LGI was increased in the left inferior and middle frontal cortices, and in the right fusiform gyrus, cingulate, lingual, and parahippocampal gyri in first onset patients compared to HCs. Increased LGI was absent from later stages of psychosis, suggesting that specific CT and LGI alterations may underlie different stages of illness.
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Affiliation(s)
- A Del Casale
- Department of Dynamic and Clinical Psychology, and Health Studies, Faculty of Medicine and Psychology, Sapienza University, Rome; Unit of Psychiatry, 'Sant'Andrea' University Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy -
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Frezza AM, Napolitano A, Miceli R, Badalamenti G, Brunello A, Buonomenna C, Casali PG, Caraceni A, Grignani G, Gronchi A, Infante G, Morosi C, Saita L, Simeone N, Zaffaroni N, Vincenzi B, Stacchiotti S. Clinical prognostic factors in advanced epithelioid haemangioendothelioma: a retrospective case series analysis within the Italian Rare Cancers Network. ESMO Open 2021; 6:100083. [PMID: 33714008 PMCID: PMC7957151 DOI: 10.1016/j.esmoop.2021.100083] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/30/2022] Open
Abstract
Background This multicentric, retrospective study conducted within the Italian Rare Cancer Network describes clinical features and explores their possible prognostic relevance in patients with advanced epithelioid haemangioendothelioma (EHE) started on surveillance. Patients and methods We collected data on adult patients with molecularly confirmed, advanced EHE consecutively referred at five sarcoma reference centres between January 2010 and June 2018, with no evidence of progressive disease (PD) and started on surveillance. Overall survival (OS) and progression-free survival (PFS) univariable and multivariable Cox analyses were performed. In the latter, due to the low number of cases and events, penalized likelihood was applied, and variable selection was performed using a random forest model. Results Sixty-seven patients were included. With a median follow-up of 50.2 months, 51 (76%) patients developed PD and 16 (24%) remained stable. PD at treatment start did not meet RECIST version 1.1 in 15/51 (29%) patients. The 3-year PFS and OS were 25.4% and 71.1%, respectively, in the whole population. Tumour-related pain (TRP) was the most common baseline symptom (32.8%), followed by temperature (20.9%), fatigue (17.9%), and weight loss (16.4%). Baseline TRP (P = 0.0002), development of TRP during follow-up (P = 0.005), baseline temperature (P = 0.002), and development of fatigue during follow-up (P = 0.007) were associated with a significantly worst PFS. An association between baseline TRP (P < 0.0001), development of TRP during follow-up (P = 0.0009), evidence of baseline serosal effusion (P = 0.121), and OS was recorded. Conclusion Because of the poor outcome observed in EHE patients presenting with serosal effusion, TRP, temperature, or serosal effusion, upfront treatment in this subgroup could be considered. Prognosis prediction in advanced EHE at presentation remains a challenge. This study explores the prognostic value of clinical and radiological features in advanced EHE patients on surveillance. Given their prognostic impact, symptoms and serosal effusion in EHE patients on surveillance should be regularly checked. In advanced EHE patients presenting with pain, temperature, or serosal effusion, upfront treatment could be considered.
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Affiliation(s)
- A M Frezza
- Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy.
| | - A Napolitano
- Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - R Miceli
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - G Badalamenti
- Medical Oncology, Policlinico Paolo Giaccone, Palermo, Italy
| | - A Brunello
- Department of Oncology, Medical Oncology Unit 1, Veneto Institute of Oncology, IRCCS, Padua, Italy
| | - C Buonomenna
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - P G Casali
- Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - A Caraceni
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - G Grignani
- Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - A Gronchi
- Department of Surgery, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - G Infante
- Department of Clinical Epidemiology and Trial Organisation, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - C Morosi
- Department of Radiology, IRCCS Foundation National Cancer Institute, Milan, Italy
| | - L Saita
- Palliative Care, Pain Therapy and Rehabilitation Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - N Simeone
- Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - N Zaffaroni
- Molecular Pharmacology Unit, Department of Applied Research and Technological Development, Fondazione IRCCS - Istituto Nazionale Tumori, Milan, Italy
| | - B Vincenzi
- Medical Oncology, Università Campus Bio-Medico di Roma, Rome, Italy
| | - S Stacchiotti
- Medical Oncology, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
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Keymeulen B, van Maurik A, Inman D, Oliveira J, McLaughlin R, Gittelman RM, Roep BO, Gillard P, Hilbrands R, Gorus F, Mathieu C, Van de Velde U, Wisniacki N, Napolitano A. A randomised, single-blind, placebo-controlled, dose-finding safety and tolerability study of the anti-CD3 monoclonal antibody otelixizumab in new-onset type 1 diabetes. Diabetologia 2021; 64:313-324. [PMID: 33145642 PMCID: PMC7801303 DOI: 10.1007/s00125-020-05317-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023]
Abstract
AIMS/HYPOTHESIS Numerous clinical studies have investigated the anti-CD3ɛ monoclonal antibody otelixizumab in individuals with type 1 diabetes, but limited progress has been made in identifying the optimal clinical dose with acceptable tolerability and safety. The aim of this study was to evaluate the association between dose-response, safety and tolerability, beta cell function preservation and the immunological effects of otelixizumab in new-onset type 1 diabetes. METHODS In this randomised, single-blind, placebo-controlled, 24 month study, conducted in five centres in Belgium via the Belgian Diabetes Registry, participants (16-27 years old, <32 days from diagnosis of type 1 diabetes) were scheduled to receive placebo or otelixizumab in one of four dose cohorts (cumulative i.v. dose 9, 18, 27 or 36 mg over 6 days; planned n = 40). Randomisation to treatment was by a central computer system; only participants and bedside study personnel were blinded to study treatment. The co-primary endpoints were the incidence of adverse events, the rate of Epstein-Barr virus (EBV) reactivation, and laboratory measures and vital signs. A mixed-meal tolerance test was used to assess beta cell function; exploratory biomarkers were used to measure T cell responses. RESULTS Thirty participants were randomised/28 were analysed (placebo, n = 6/5; otelixizumab 9 mg, n = 9/8; otelixizumab 18 mg, n = 8/8; otelixizumab 27 mg, n = 7/7; otelixizumab 36 mg, n = 0). Dosing was stopped at otelixizumab 27 mg as the predefined EBV reactivation stopping criteria were met. Adverse event frequency and severity were dose dependent; all participants on otelixizumab experienced at least one adverse event related to cytokine release syndrome during the dosing period. EBV reactivation (otelixizumab 9 mg, n = 2/9; 18 mg, n = 4/8: 27 mg, n = 5/7) and clinical manifestations (otelixizumab 9 mg, n = 0/9; 18 mg, n = 1/8; 27 mg, n = 3/7) were rapid, dose dependent and transient, and were associated with increased productive T cell clonality that diminished over time. Change from baseline mixed-meal tolerance test C-peptide weighted mean AUC0-120 min following otelixizumab 9 mg was above baseline for up to 18 months (difference from placebo 0.39 [95% CI 0.06, 0.72]; p = 0.023); no beta cell function preservation was observed at otelixizumab 18 and 27 mg. CONCLUSIONS/INTERPRETATION A metabolic response was observed with otelixizumab 9 mg, while doses higher than 18 mg increased the risk of unwanted clinical EBV reactivation. Although otelixizumab can temporarily compromise immunocompetence, allowing EBV to reactivate, the effect is dose dependent and transient, as evidenced by a rapid emergence of EBV-specific T cells preceding long-term control over EBV reactivation. TRIAL REGISTRATION ClinicalTrials.gov NCT02000817. FUNDING The study was funded by GlaxoSmithKline. Graphical abstract.
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Affiliation(s)
- Bart Keymeulen
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium.
- Belgian Diabetes Registry, Brussels, Belgium.
| | | | - Dave Inman
- GlaxoSmithKline Medicines Research Centre, Stevenage, UK
| | - João Oliveira
- GlaxoSmithKline, Global Clinical Operations, Cambridge, UK
| | - Rene McLaughlin
- Department of Immunology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Bart O Roep
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
- Department of Diabetes Immunology, Diabetes & Metabolism Research Institute, Beckman Research Institute at the City of Hope, Duarte, CA, USA
| | - Pieter Gillard
- Department of Endocrinology, University Hospitals Leuven-KUL, Leuven, Belgium
| | - Robert Hilbrands
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
| | - Frans Gorus
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
| | - Chantal Mathieu
- Department of Endocrinology, University Hospitals Leuven-KUL, Leuven, Belgium
| | - Ursule Van de Velde
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
- Belgian Diabetes Registry, Brussels, Belgium
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Longo D, Bottino F, Lucignani G, Scarciolla L, Pasquini L, Rossi Espagnet MC, Polito C, Figà-Talamanca L, Calbi G, Savarese I, Giliberti P, Napolitano A. DTI parameters in neonates with hypoxic-ischemic encephalopathy after total body hypothermia. J Matern Fetal Neonatal Med 2020; 35:4035-4042. [PMID: 33203279 DOI: 10.1080/14767058.2020.1846180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND PURPOSE MR imaging provides means for discriminating different patterns of Hypoxic-ischemic encephalopathy (HIE) and may distinguish most severe cases from less severe but is unable to predict long-term outcome. Diffusion tensor imaging (DTI) offers information for a more complete characterization of HIE. The purpose of this study is to compare the modifications of DTI parameters in newborns one week and six months following total-body cooling to healthy controls. METHODS Forty-seven cooled newborns were studied with MRI, 20 underwent follow-up at 6 months. 12 healthy newborns and nine children at 6 months were enrolled as control groups (HC). Inferior Longitudinal Fasciculus (ILF), Corpus Callosum Fasciculus (CCF), Corticospinal Tract (CST), Optical Tract (OT), Optic Radiation (OR) were generated in all subjects. DTI parameters were evaluated in basal ganglia (BG), thalamus (TH) and tracks. Statistical analysis was performed with MANOVA. RESULTS In newborns HIE versus HC, there were significantly lower fractional anisotropy (FA) on OR and CST and higher axial diffusivity (AD), apparent diffusion coefficient (ADC) and radial diffusivity (RD) values on CST, BG and TH in HIE-N. At 6 months there were no significant grouping effects. The analysis showed a significant increase of FA, decrease of ADC, AD, RD after 6 months for HIE and HC. CONCLUSIONS We observed modifications of parameter values in HIE newborns vs HC; however normalization of values at 6 months suggests that changes of parameters cannot be considered early biomarkers for evaluation of therapeutic hypothermia in newborns with moderate HIE and normal conventional MRI.
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Affiliation(s)
- D Longo
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - F Bottino
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - G Lucignani
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Scarciolla
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Pasquini
- NESMOS, Neuroradiology Department, Sapienza University, Rome, Italy
| | - M C Rossi Espagnet
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.,NESMOS, Neuroradiology Department, Sapienza University, Rome, Italy
| | - C Polito
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Figà-Talamanca
- Imaging Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - G Calbi
- Anesthesiology Unit, DEA-ARCO, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - I Savarese
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - P Giliberti
- Neonatal Intensive Care Unit, Department of Medical and Surgical Neonatology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - A Napolitano
- Medical Physics Department, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
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Genazzani AD, Prati A, Marchini F, Petrillo T, Napolitano A, Simoncini T. Differential insulin response to oral glucose tolerance test (OGTT) in overweight/obese polycystic ovary syndrome patients undergoing to myo-inositol (MYO), alpha lipoic acid (ALA), or combination of both. Gynecol Endocrinol 2019; 35:1088-1093. [PMID: 31304823 DOI: 10.1080/09513590.2019.1640200] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Polycystic ovary syndrome is characterized by several endocrine impairments, insulin resistance and hyperinsulinemia. We aimed to evaluate the effects of myo-inositol (MYO), alpha-lipoic acid (ALA) and a combination of both. Setting: retrospective study. Ninety overweight/obese patients were considered. Presence or absence of first grade diabetic relatives was checked. Patients were administered MYO (1 g/die per os), ALA (400 mg/die per os), MYO (1 gr/die) + ALA (400 mg/die) per os. Only 76 out of 90 patients completed the 12 weeks of treatment. Patients were evaluated before and after the treatment interval for LH, FSH, E2 (estradiol), A (androstenedione), T (testosterone) plasma levels, oral glucose tolerance test (OGTT). All treatments demonstrated specific positive effects: MYO modulated more hormonal profiles and OGTT in polycystic ovary syndrome (PCOS) with no familial diabetes, ALA improved insulin response to OGTT and metabolic parameters in all patients with no effects on reproductive hormones, MYO + ALA improved hormonal and metabolic aspects and insulin response to OGTT in all patients. Presence of familial diabetes is a relevant clinical aspect. MYO is less effective when familial diabetes is present, ALA improved only metabolic aspects while MYO + ALA was effective on all PCOS patients independently from familial diabetes.
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Affiliation(s)
- Alessandro D Genazzani
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessia Prati
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Federico Marchini
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Tabatha Petrillo
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonella Napolitano
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Modena, Italy
| | - Tommaso Simoncini
- Department of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
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Giannini A, Genazzani AD, Napolitano A, Caretto M, Stomati M, Simoncini T, Genazzani AR. Oral dehydroepiandrosterone restores ß-endorphin response to OGTT in early and late postmenopause. Gynecol Endocrinol 2019; 35:767-771. [PMID: 30935252 DOI: 10.1080/09513590.2019.1590548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
ß-endorphin is a neuropeptide involved in several brain functions: its plasma levels are higher in obese women and its release increases after oral glucose tolerance test (OGTT) in normal or obese women. The study included 46 healthy women and evaluated the effect of oral dehydroepiandrosterone [DHEA] (50 mg/day) in early postmenopausal women (50-55 years) both of normal weight (group A, n = 12, BMI = 22.1 ± 0.5) and overweight (group B, n = 12, BMI = 28.2 ± 0.5), and late postmenopausal women (60-65 years) both normal weight (group C, n = 11, BMI = 22.5 ± 0.6) and overweight (group D, n = 11, BMI = 27.9 ± 0.4) undergone OGTT, in order to investigate if DHEA could restore/modify the control of insulin and glucose secretion and ß-endorphin release in response to glucose load. The area under the curve (AUC) of OGTT evaluated plasma levels of different molecules. DHEA, DHEAS, and ß-endorphin plasma levels were lower in baseline conditions in older women than younger women. Considering the AUC of ß-endorphin response to OGTT, all groups showed a progressive significant increase after 3 and also after 6 months of treatment in comparison to baseline and 3 months of treatment.
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Affiliation(s)
- A Giannini
- a Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
| | - A D Genazzani
- b Gynecological Endocrinology Center, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia , Modena , Italy
| | - A Napolitano
- b Gynecological Endocrinology Center, Department of Obstetrics and Gynecology, University of Modena and Reggio Emilia , Modena , Italy
| | - M Caretto
- a Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
| | - M Stomati
- c Unit of Obstetrics and Gynecology, Francavilla Fontana Hospital , Francavilla Fontana , Italy
| | - T Simoncini
- a Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
| | - A R Genazzani
- a Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa , Pisa , Italy
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Vlasakakis G, Napolitano A, Barnard R, Brown K, Bullman J, Inman D, Keymeulen B, Lanham D, Leirens Q, MacDonald A, Mezzalana E, Page K, Patel M, Savage CO, Zamuner S, van Maurik A. Target engagement and cellular fate of otelixizumab: a repeat dose escalation study of an anti-CD3ε mAb in new-onset type 1 diabetes mellitus patients. Br J Clin Pharmacol 2019; 85:704-714. [PMID: 30566758 DOI: 10.1111/bcp.13842] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 10/03/2018] [Accepted: 12/12/2018] [Indexed: 12/15/2022] Open
Abstract
AIMS This paper describes the pharmacological findings from a study where otelixizumab, an anti-CD3ɛ mAb, was dosed in new onset Type 1 diabetes mellitus (NOT1DM) patients. This is the first time that the full dose-response of an anti-CD3ɛ mAb has been investigated in the clinic. The data have been validated using a previously developed pharmacokinetic/pharmacodynamic (PK/PD) model of otelixizumab to simulate the interplay between drug administration, CD3ɛ target engagement and downmodulation. METHODS Patients were randomized to control or active treatment with otelixizumab (1:4), administered via infusion over 6 days, in a dose-ascending study consisted of three cohorts (n = 10 per cohort) at doses of 9, 18 or 27 mg respectively. The study allowed quantification of otelixizumab PK, CD3ɛ target engagement and its pharmacodynamic effect (CD3ε/TCR modulation on circulating T lymphocytes). RESULTS Otelixizumab concentrations increased and averaged to 364.09 (54.3), 1625.55 (72.5) and 2781.35 (28.0) ng ml-1 (Geom.mean, %CV) at the 9, 18 and 27 mg dose respectively. CD3ɛ target engagement was found to be rapid (within the first 30 min), leading to a receptor occupancy of ~60% within 6 h of dosing in all three doses. A dose-response relationship was observed with the two highest doses achieving a ~90% target engagement and consequential CD3ɛ/TCR downmodulation by Day 6. CONCLUSIONS Data from this study revealed maximum target engagement and CD3ɛ/TCR modulation is achieved at doses of 18, 27 mg of otelixizumab. These findings can be useful in guiding dose selection in clinical trials with anti-CD3ɛ mAbs.
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Affiliation(s)
| | | | - Ruth Barnard
- Research and Development, GlaxoSmithKline, London, UK
| | - Kim Brown
- Project Management, GlaxoSmithKline, London, UK
| | | | - David Inman
- Research and Development, GlaxoSmithKline, London, UK
| | - Bart Keymeulen
- Academic Hospital and Diabetes Research Center, Vrije Universiteit Brussel, Brussels, Belgium
| | | | - Quentin Leirens
- SGS Exprimo NV, Generaal de Wittelaan 19A b5, B-2800, Mechelen, Belgium
| | - Alexander MacDonald
- Oncology Quantitative Clinical Pharmacology, Early Clinical Development, IMED Biotech Unit, Astrazeneca, Cambridge, UK
| | - Enrica Mezzalana
- SGS Exprimo NV, Generaal de Wittelaan 19A b5, B-2800, Mechelen, Belgium
| | - Kevin Page
- Research and Development, GlaxoSmithKline, London, UK
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Grandi G, Barra F, Ferrero S, Sileo FG, Bertucci E, Napolitano A, Facchinetti F. Hormonal contraception in women with endometriosis: a systematic review. EUR J CONTRACEP REPR 2019; 24:61-70. [PMID: 30664383 DOI: 10.1080/13625187.2018.1550576] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE A systematic review was carried out of studies of women with endometriosis, to examine the evidence for efficacy of the use of hormonal contraception to improve disease-related pain and decrease postoperative risk of disease recurrence. METHODS A search of the Medline/PubMed and Embase databases was performed to identify all published English language studies on hormonal contraceptive therapies (combined hormonal contraceptives [CHCs], combined oral contraceptives [COCs], progestin-only pills [POPs] and progestin-only contraceptives [POCs]) in women with a validated endometriosis diagnosis, in comparison with placebo, comparator therapies or other hormonal therapies. Main outcome measures were endometriosis-related pain (dysmenorrhoea, pelvic pain and dyspareunia), quality of life (QoL) and postoperative rate of disease recurrence during treatment. RESULTS CHC and POC treatments were associated with clinically significant reductions in dysmenorrhoea, often accompanied by reductions in non-cyclical pelvic pain and dyspareunia and an improvement in QoL. Only two COC preparations (ethinylestradiol [EE]/norethisterone acetate [NETA] and a flexible EE/drospirenone regimen) demonstrated significantly increased efficacy compared with placebo. Only three studies found that the postoperative use of COCs (EE/NETA, EE/desogestrel and EE/gestodene) reduced the risk of disease recurrence. There was no evidence that POCs reduced the risk of disease recurrence. CONCLUSIONS CHCs and POCs are effective for the relief of endometriosis-related dysmenorrhoea, pelvic pain and dyspareunia, and improve QoL. Some COCs decreased the risk of disease recurrence after conservative surgery, but POCs did not. There is insufficient evidence, however, to reach definitive conclusions about the overall superiority of any particular hormonal contraceptive.
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Affiliation(s)
- Giovanni Grandi
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Fabio Barra
- b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI) , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Simone Ferrero
- b Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, and Maternal and Child Health (DINOGMI) , University of Genoa, IRCCS Ospedale Policlinico San Martino , Genoa , Italy
| | - Filomena Giulia Sileo
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Emma Bertucci
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Antonella Napolitano
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
| | - Fabio Facchinetti
- a Department of Medical and Surgical Sciences for Mothers, Children and Adults , University of Modena and Reggio Emilia, Azienda Ospedaliero Universitaria Policlinico , Modena , Italy
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Genazzani AD, Shefer K, Della Casa D, Prati A, Napolitano A, Manzo A, Despini G, Simoncini T. Modulatory effects of alpha-lipoic acid (ALA) administration on insulin sensitivity in obese PCOS patients. J Endocrinol Invest 2018; 41:583-590. [PMID: 29090431 DOI: 10.1007/s40618-017-0782-z] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 10/22/2017] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the efficacy of alpha-lipoic acid (ALA) administration on hormonal and metabolic parameters of obese PCOS patients. METHODS A group of 32 obese PCOS patients were selected after informed consent. 20 patients referred to have first grade relatives with diabetes type I or II. Hormonal and metabolic parameters as well as OGTT were evaluated before and after 12 weeks of ALA integrative administration (400 mg per os every day). RESULTS ALA administration significantly decreased insulin, glucose, BMI and HOMA index. Hyperinsulinemia and insulin response to OGTT decreased both as maximal response (Δmax) and as AUC. PCOS with diabetes relatives showed the decrease also of triglyceride and GOT. Interestingly in all PCOS no changes occurred on all hormonal parameters involved in reproduction such as LH, FSH, and androstenedione. CONCLUSIONS ALA integrative administration at a low dosage as 400 mg daily improved the metabolic impairment of all PCOS patients especially in those PCOS with familiar diabetes who have a higher grade of risk of NAFLD and predisposition to diabetes.
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Affiliation(s)
- A D Genazzani
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy.
| | - K Shefer
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - D Della Casa
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - A Prati
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - A Napolitano
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - A Manzo
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - G Despini
- Department of Obstetrics and Gynecology, Gynecological Endocrinology Center, University of Modena and Reggio Emilia, Via del Pozzo 71, 41100, Modena, Italy
| | - T Simoncini
- Department of Obstetrics and Gynecology, University of Pisa, Pisa, Italy
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Cagnacci A, Palma F, Napolitano A, Xholli A. Association between pelvic organ prolapse and climacteric symptoms in postmenopausal women. Maturitas 2017; 99:73-78. [DOI: 10.1016/j.maturitas.2017.02.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 02/04/2017] [Accepted: 02/10/2017] [Indexed: 12/22/2022]
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Mattei E, Censi F, Calcagnini G, Falsaperla R, Genovese E, Napolitano A, Cannatà V. Pacemaker and ICD oversensing induced by movements near the MRI scanner bore. Med Phys 2016; 43:6621. [DOI: 10.1118/1.4967856] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Schooneman MG, Napolitano A, Houten SM, Ambler GK, Murgatroyd PR, Miller SR, Hollak CEM, Tan CY, Virtue S, Vidal-Puig A, Nunez DJ, Soeters MR. Assessment of plasma acylcarnitines before and after weight loss in obese subjects. Arch Biochem Biophys 2016; 606:73-80. [PMID: 27444119 DOI: 10.1016/j.abb.2016.07.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/14/2016] [Accepted: 07/17/2016] [Indexed: 12/22/2022]
Abstract
Acylcarnitines, fatty acid oxidation (FAO) intermediates, have been implicated in diet-induced insulin resistance and type 2 diabetes mellitus, as increased levels are found in obese insulin resistant humans. Moreover plasma acylcarnitines have been associated with clinical parameters related to glucose metabolism, such as fasting glucose levels and HbA1c. We hypothesized that plasma acylcarnitines would correlate with energy expenditure, insulin sensitivity and other clinical parameters before and during a weight loss intervention. We measured plasma acylcarnitines in 60 obese subjects before and after a 12 week weight loss intervention. These samples originated from three different interventions (diet alone (n = 20); diet and exercise (n = 21); diet and drug treatment (n = 19)). Acylcarnitine profiles were analysed in relation to clinical parameters of glucose metabolism, insulin sensitivity and energy expenditure. Conclusions were drawn from all 60 subjects together. Despite amelioration of HOMA-IR, plasma acylcarnitines levels increased during weight loss. HOMA-IR, energy expenditure and respiratory exchange ratio were not related to plasma acylcarnitines. However non-esterified fatty acids correlated strongly with several acylcarnitines at baseline and during the weight loss intervention (p < 0.001). Acylcarnitines did not correlate with clinical parameters of glucose metabolism during weight loss, questioning their role in insulin resistance and type 2 diabetes mellitus.
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Affiliation(s)
- Marieke G Schooneman
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Department of Clinical Chemistry, Laboratory Genetic Metabolic Diseases, Academic Medical Center, University of Amsterdam, The Netherlands.
| | - Antonella Napolitano
- GlaxoSmithKline Research and Development, Research Triangle Park, NC, 27709, USA
| | - Sander M Houten
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, NY, USA
| | - Graeme K Ambler
- Institute of Metabolic Science, Metabolic Research Laboratories, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Peter R Murgatroyd
- NIHR Wellcome Trust Clinical Research Facility, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Sam R Miller
- GlaxoSmithKline Research and Development, Research Triangle Park, NC, 27709, USA
| | - Carla E M Hollak
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Chong Y Tan
- Institute of Metabolic Science, Metabolic Research Laboratories, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Samuel Virtue
- Institute of Metabolic Science, Metabolic Research Laboratories, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Antonio Vidal-Puig
- Institute of Metabolic Science, Metabolic Research Laboratories, Cambridge University Hospital NHS Trust, Cambridge, UK
| | - Derek J Nunez
- GlaxoSmithKline Research and Development, Research Triangle Park, NC, 27709, USA
| | - Maarten R Soeters
- Department of Endocrinology and Metabolism, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Institute of Metabolic Science, Metabolic Research Laboratories, Cambridge University Hospital NHS Trust, Cambridge, UK. http://www.metabolism.maartensoeters.nl/
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Affiliation(s)
- Giovanni Grandi
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Modena, Italy
| | - Antonella Napolitano
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Modena, Italy
| | - Angelo Cagnacci
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Ospedaliero Universitaria Policlinico of Modena, Modena, Italy
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Genovese E, Napolitano A, Donatiello S, Orlandi C, Toma' P, Campanella F, Calcagnini G, Censi F. Safety for MRI patients with implanted medical devices. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Genovese E, Napolitano A, Donatiello S, Orlandi C, Toma' P, Cannata' V. MRI ferromagnetic detector system for patients' and operators' safety: Experience in opbg. Phys Med 2016. [DOI: 10.1016/j.ejmp.2016.01.442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Grandi G, Napolitano A, Xholli A, Tirelli A, Di Carlo C, Cagnacci A. Effect of oral contraceptives containing estradiol and nomegestrol acetate or ethinyl-estradiol and chlormadinone acetate on primary dysmenorrhea. Gynecol Endocrinol 2015; 31:774-8. [PMID: 26291811 DOI: 10.3109/09513590.2015.1063118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To study the three cycles effect on primary dysmenorrhea of the monophasic 24/4 estradiol/nomegestrol acetate (E2/NOMAC) and of the 21/7 ethinyl-estradiol/chlormadinone acetate (EE/CMA) oral contraceptive. The tolerability and the effect of both preparations on metabolism and health-related quality of life were also evaluated. DESIGN Prospective observational cohort study. SETTING Tertiary gynecologic center for pelvic pain. PATIENTS Subjects with primary dysmenorrhea requiring an oral contraceptive, who spontaneously selected either E2/NOMAC (n = 20) or EE/CMA (n = 20). MAIN OUTCOME MEASURES Visual Analogue Scale (VAS) score for dysmenorrhea, Short Form-36 questionnaire for health-related quality of life, lipoproteins and days of menstrual bleeding (withdrawal bleeding during oral contraceptive). RESULTS Mean age and body mass index (BMI) were similar between the two groups. The final analysis was performed on 34 women, 15 in E2/NOMAC and 19 in EE/CMA group. Compliance with treatment was significantly higher with EE/CMA (100%) than E2/NOMAC (75%) (p = 0.02). Both treatments significantly (p < 0.0001) reduced VAS of primary dysmenorrhea, similarly (E2/NOMAC by a mean of 74.7%, EE/CMA by a mean of 78.4%; p = 0.973). Only E2/NOMAC significantly increased SF-36 score (p = 0.001), both in physical (p = 0.001) and mental domains (p = 0.004). The mean number of days of menstrual bleeding was significantly reduced in E2/NOMAC group (from 4.86 ± 1.20 d to 2.64 ± 1.59 d, p = 0.0005 versus baseline, p = 0.007 versus EE/CMA group). BMI did not vary in either group. E2/NOMAC did not change lipoproteins and apoproteins while EE/CMA increased total cholesterol (p = 0.0114), HDL-cholesterol (p = 0.0008), triglycerides (p = 0.002), apoprotein-A1 (Apo-A1; p = 0.0006) and apopoprotein-B (Apo-B; p = 0.008), decreasing LDL/HDL ratio (p = 0.024). CONCLUSIONS Both oral contraceptives reduced similarly primary dysmenorrhea, with E2/NOMAC also reducing withdrawal bleedings and being neutral on lipid metabolism.
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Affiliation(s)
- Giovanni Grandi
- a Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit , Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Antonella Napolitano
- a Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit , Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Anjeza Xholli
- a Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit , Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Alessandra Tirelli
- a Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit , Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
| | - Costantino Di Carlo
- b Department of Neurosciences and Reproductive Sciences , University of Naples Federico II , Naples , Italy
| | - Angelo Cagnacci
- a Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit , Azienda Ospedaliero Universitaria Policlinico of Modena , Modena , Italy and
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Napolitano A, Zanin R, Palma F, Romani C, Grandi G, Di Carlo C, Cagnacci A. Body composition and resting metabolic rate of perimenopausal women using continuous progestogen contraception. EUR J CONTRACEP REPR 2015; 21:168-75. [PMID: 26305596 DOI: 10.3109/13625187.2015.1079610] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The effect on body composition and in particular on fat mass (FM) of 12 months' use of a desogestrel (DSG)-only contraceptive pill or the levonorgestrel-releasing intrauterine system (LNG-IUS) was evaluated in women in the perimenopause. METHODS An observational study comprised 102 perimenopausal women: 42 received a 75 μg DSG pill, 34 received the 52 mg LNG-IUS, and 26 received no treatment. Body composition, body weight and resting metabolic rate (RMR) were evaluated at baseline and again after 12 months. RESULTS FM did not change in the control group (- 0.5 ± 1.6%) but significantly increased in the LNG-IUS group (+ 1.1 ± 2.9%; p = 0.02 vs. controls) and in the DSG group (+ 2.8 ± 3.5%; p = 0.0001 vs. controls; p = 0.02 vs. LNG-IUS). Women treated with DSG or the LNG-IUS showed a non-significant increase in body weight, body mass index and waist circumference. RMR did not significantly vary in the control group (- 3.8 ± 292.9 kJ/ 24 h) and tended to decrease but not significantly in the LNG-IUS (115.5 ± 531.8 kJ/ 24 h) and DSG groups (305.9 ± 556.9 kJ/24 h). CONCLUSIONS The results of this preliminary study seem to indicate that in perimenopausal women continuous use of the DSG-only pill and to a lesser extent the LNG-IUS may favour FM accumulation.
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Affiliation(s)
- Antonella Napolitano
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
| | - Renata Zanin
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
| | - Federica Palma
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
| | - Cecilia Romani
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
| | - Giovanni Grandi
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
| | - Costantino Di Carlo
- b Department of Neurosciences and Reproductive Sciences , University of Naples Federico II , Naples , Italy
| | - Angelo Cagnacci
- a * Department of Obstetrics , Gynecology and Pediatrics, Obstetrics and Gynecology Unit, University of Modena , Modena , Italy
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Napolitano A, Pellegrini L, Dey A, Larson D, Tanji M, Flores EG, Kendrick B, Lapid D, Powers A, Kanodia S, Pastorino S, Pass HI, Dixit V, Yang H, Carbone M. Abstract LB-220: Minimal asbestos exposure in germline BAP1 heterozygous mice is associated with deregulated inflammatory response and increased risk of mesothelioma. Cancer Res 2015. [DOI: 10.1158/1538-7445.am2015-lb-220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Germline BAP1 mutations predispose to several cancers, in particular malignant mesothelioma (MM). MM pathogenesis is generally associated to professional exposure to asbestos. However, to date we found that none of the mesothelioma patients carrying germline BAP1 mutations were professionally exposed to asbestos. We hypothesized that germline BAP1 mutations might influence the asbestos-induced inflammatory response that is linked to asbestos carcinogenesis, thereby increasing the risk of developing mesothelioma after even minimal exposure.
In a set of short-term experiments, we intraperitoneally injected BAP1+/- and wild-type littermates with low doses of asbestos fibers and analyzed the inflammatory response both at a cellular and humoral level. In a long-term experiment following a similar protocol, we assessed the incidence of MM in mice with and without germline BAP1 mutations and their survival.
We found that, compared to their wild type littermates, BAP1+/- mice exposed to low doses of asbestos fibers showed significant alterations of the peritoneal inflammatory response. In particular, we observed significantly higher levels of pro-tumorigenic alternatively polarized M2 macrophages, and lower levels of several chemokines and cytokines. Consistent with these data, BAP1+/- mice had a significantly higher incidence of mesothelioma after exposure to very low doses of asbestos, and shorter survival.
Our findings suggest that minimal exposure to carcinogenic fibers may significantly increase the risk of malignant mesothelioma in genetically predisposed individuals carrying germline BAP1 mutations, possibly via alterations of the inflammatory response.
Citation Format: A. Napolitano, L. Pellegrini, A. Dey, D. Larson, M. Tanji, E. G. Flores, B. Kendrick, D. Lapid, A. Powers, S. Kanodia, S. Pastorino, H. I. Pass, V Dixit, H. Yang, M. Carbone. Minimal asbestos exposure in germline BAP1 heterozygous mice is associated with deregulated inflammatory response and increased risk of mesothelioma. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr LB-220. doi:10.1158/1538-7445.AM2015-LB-220
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Affiliation(s)
| | | | - A. Dey
- 2Genentech, South San Francisco, CA
| | - D. Larson
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - M. Tanji
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - E. G. Flores
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - B. Kendrick
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - D. Lapid
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - A. Powers
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - S. Kanodia
- 3Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA
| | - S. Pastorino
- 1University of Hawaii Cancer Center, Honolulu, HI
| | | | - V Dixit
- 2Genentech, South San Francisco, CA
| | - H. Yang
- 1University of Hawaii Cancer Center, Honolulu, HI
| | - M. Carbone
- 1University of Hawaii Cancer Center, Honolulu, HI
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Napolitano A, Pellegrini L, Dey A, Larson D, Tanji M, Flores EG, Kendrick B, Lapid D, Powers A, Kanodia S, Pastorino S, Pass HI, Dixit V, Yang H, Carbone M. Minimal asbestos exposure in germline BAP1 heterozygous mice is associated with deregulated inflammatory response and increased risk of mesothelioma. Oncogene 2015; 35:1996-2002. [PMID: 26119930 DOI: 10.1038/onc.2015.243] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 03/16/2015] [Accepted: 04/20/2015] [Indexed: 01/04/2023]
Abstract
Germline BAP1 mutations predispose to several cancers, in particular malignant mesothelioma. Mesothelioma is an aggressive malignancy generally associated with professional exposure to asbestos. However, to date, we found that none of the mesothelioma patients carrying germline BAP1 mutations were professionally exposed to asbestos. We hypothesized that germline BAP1 mutations might influence the asbestos-induced inflammatory response that is linked to asbestos carcinogenesis, thereby increasing the risk of developing mesothelioma after minimal exposure. Using a BAP1(+/-) mouse model, we found that, compared with their wild-type littermates, BAP1(+/-) mice exposed to low-dose asbestos fibers showed significant alterations of the peritoneal inflammatory response, including significantly higher levels of pro-tumorigenic alternatively polarized M2 macrophages, and lower levels of several chemokines and cytokines. Consistent with these data, BAP1(+/-) mice had a significantly higher incidence of mesothelioma after exposure to very low doses of asbestos, doses that rarely induced mesothelioma in wild-type mice. Our findings suggest that minimal exposure to carcinogenic fibers may significantly increase the risk of malignant mesothelioma in genetically predisposed individuals carrying germline BAP1 mutations, possibly via alterations of the inflammatory response.
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Affiliation(s)
- A Napolitano
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA.,Department of Molecular Biosciences and Bioengineering, University of Hawaii at Manoa, Honolulu, HI, USA
| | - L Pellegrini
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - A Dey
- Department of Discovery Oncology, Genentech, South San Francisco, CA, USA
| | - D Larson
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - M Tanji
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - E G Flores
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - B Kendrick
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - D Lapid
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - A Powers
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - S Kanodia
- Department of Biomedical Sciences and Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - S Pastorino
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - H I Pass
- Department of Cardiothoracic Surgery, New York University, New York, NY, USA
| | - V Dixit
- Department of Discovery Oncology, Genentech, South San Francisco, CA, USA
| | - H Yang
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - M Carbone
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
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Dobbins R, Byerly R, Gaddy R, Gao F, Mahar K, Napolitano A, Ambery P, Le Monnier de Gouville AC. GSK256073 acutely regulates NEFA levels via HCA2 agonism but does not achieve durable glycaemic control in type 2 diabetes. A randomised trial. Eur J Pharmacol 2015; 755:95-101. [DOI: 10.1016/j.ejphar.2015.03.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/24/2015] [Accepted: 03/03/2015] [Indexed: 11/26/2022]
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Grandi G, Xholli A, Napolitano A, Palma F, Cagnacci A. Pelvic pain and quality of life of women with endometriosis during quadriphasic estradiol valerate/dienogest oral contraceptive: a patient-preference prospective 24-week pilot study. Reprod Sci 2014; 22:626-32. [PMID: 25394646 DOI: 10.1177/1933719114556488] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The progestin dienogest (DNG) given alone effectively reduces pelvic pain of women with endometriosis. It is not clear whether the same occurs when DNG is associated with estradiol (E2). DESIGN Patient preference prospective observational study. SETTING Outpatient centre of university hospital. PATIENTS 40 patients with endometriosis and menstrual pain. INTERVENTIONS 24-week treatment with a quadriphasic association of E2 valerate (E2V) and DNG or a nonsteroidal anti-inflammatory drug (NSAID) to be used only in case of pain (ketoprofene 200-mg tablets). MAIN OUTCOME MEASURES Menstrual pain and, when present, intermenstrual pain, and dyspareunia were investigated by means of a 10-cm visual analogue scale (VAS). Quality of life was investigated by the short form 36 (SF-36) of the health-related quality of life questionnaire. RESULTS Final study group consists of 34 patients, 19 in the E2V/DNG group and 15 in the NSAID group. After 24 weeks, no significant modification of menstrual pain, intermenstrual pain, dyspareunia, or SF-36 score was observed in the NSAID group. Treatment with E2V/DNG reduced the VAS score of menstrual pain by 61% (P < .0001). In the subgroups of women with intermenstrual pain or dyspareunia, E2V/DNG reduced these complaints by 65% (P = .013) and 52% (P = .016), respectively. The reduction in menstrual (P = .0001) and intermenstrual pain (p = 0.03) was significantly greater during E2V/DNG than NSAID. Quality of life improved during E2V/DNG (P = .0002), both in physical (P = .0003) and mental domains (P = .0065). Only a few minor adverse effects were described during E2V/DNG, and none caused withdrawal from treatment. CONCLUSION In patients with endometriosis and pelvic pain, the 24-week administration of the quadriphasic association of E2V/DNG decreases pelvic pain and improves quality of life.
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Affiliation(s)
- Giovanni Grandi
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Policlinico of Modena, Italy
| | - Anjeza Xholli
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Policlinico of Modena, Italy
| | - Antonella Napolitano
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Policlinico of Modena, Italy
| | - Federica Palma
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Policlinico of Modena, Italy
| | - Angelo Cagnacci
- Department of Obstetrics Gynecology and Pediatrics, Obstetrics and Gynecology Unit, Azienda Policlinico of Modena, Italy
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Grandi G, Xholli A, Napolitano A, Piacenti I, Bellafronte M, Cagnacci A. Prospective measurement of blood pressure and heart rate over 24 h in women using combined oral contraceptives with estradiol. Contraception 2014; 90:529-34. [DOI: 10.1016/j.contraception.2014.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 05/12/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
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Napolitano A, Miller S, Nicholls AW, Baker D, Van Horn S, Thomas E, Rajpal D, Spivak A, Brown JR, Nunez DJ. Novel gut-based pharmacology of metformin in patients with type 2 diabetes mellitus. PLoS One 2014; 9:e100778. [PMID: 24988476 PMCID: PMC4079657 DOI: 10.1371/journal.pone.0100778] [Citation(s) in RCA: 191] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/23/2014] [Indexed: 12/20/2022] Open
Abstract
UNLABELLED Metformin, a biguanide derivate, has pleiotropic effects beyond glucose reduction, including improvement of lipid profiles and lowering microvascular and macrovascular complications associated with type 2 diabetes mellitus (T2DM). These effects have been ascribed to adenosine monophosphate-activated protein kinase (AMPK) activation in the liver and skeletal muscle. However, metformin effects are not attenuated when AMPK is knocked out and intravenous metformin is less effective than oral medication, raising the possibility of important gut pharmacology. We hypothesized that the pharmacology of metformin includes alteration of bile acid recirculation and gut microbiota resulting in enhanced enteroendocrine hormone secretion. In this study we evaluated T2DM subjects on and off metformin monotherapy to characterize the gut-based mechanisms of metformin. Subjects were studied at 4 time points: (i) at baseline on metformin, (ii) 7 days after stopping metformin, (iii) when fasting blood glucose (FBG) had risen by 25% after stopping metformin, and (iv) when FBG returned to baseline levels after restarting the metformin. At these timepoints we profiled glucose, insulin, gut hormones (glucagon-like peptide-1 (GLP-1), peptide tyrosine-tyrosine (PYY) and glucose-dependent insulinotropic peptide (GIP) and bile acids in blood, as well as duodenal and faecal bile acids and gut microbiota. We found that metformin withdrawal was associated with a reduction of active and total GLP-1 and elevation of serum bile acids, especially cholic acid and its conjugates. These effects reversed when metformin was restarted. Effects on circulating PYY were more modest, while GIP changes were negligible. Microbiota abundance of the phylum Firmicutes was positively correlated with changes in cholic acid and conjugates, while Bacteroidetes abundance was negatively correlated. Firmicutes and Bacteroidetes representation were also correlated with levels of serum PYY. Our study suggests that metformin has complex effects due to gut-based pharmacology which might provide insights into novel therapeutic approaches to treat T2DM and associated metabolic diseases. TRIAL REGISTRATION www.ClinicalTrials.gov NCT01357876.
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Affiliation(s)
| | - Sam Miller
- Quantitative Sciences, GSK R&D, Stevenage, Herts, United Kingdom
| | | | - David Baker
- Safety Assessment, GSK R&D, Ware, Herts, United Kingdom
| | - Stephanie Van Horn
- Target and Pathways Validation, GSK R&D, Upper Providence, Pennsylvania, United States of America
| | - Elizabeth Thomas
- Target and Pathways Validation, GSK R&D, Upper Providence, Pennsylvania, United States of America
| | - Deepak Rajpal
- Computational Biology, GSK R&D, Upper Providence, Pennsylvania, United States of America
| | - Aaron Spivak
- Computational Biology, GSK R&D, Upper Providence, Pennsylvania, United States of America
| | - James R. Brown
- Computational Biology, GSK R&D, Upper Providence, Pennsylvania, United States of America
| | - Derek J. Nunez
- Enteroendocrine Discovery Unit, GlaxoSmithKline R&D, GSK R&D, Research Triangle Park, North Carolina, United States of America
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Isella V, Mapelli C, Morielli N, De Gaspari D, Siri C, Pezzoli G, Antonini A, Poletti M, Bonuccelli U, Picchi L, Napolitano A, Vista M, Veglia M, Piamarta F, Grassi F, Appollonio IM. Psychometric properties of the Italian version of the Scales for Outcomes in Parkinson's disease- Cognition (SCOPA-Cog). Funct Neurol 2014; 28:121-5. [PMID: 24125562 DOI: 10.11138/fneur/2013.28.2.121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog) has been shown to be a clinimetrically rigorous and valid instrument for a disease-oriented neuropsychological assessment of Parkinson's disease (PD) patients. In the present study we evaluated the psychometric properties of the Italian version of the SCOPA-Cog in 121 PD patients. The scale explores memory, attention, and executive and visuospatial functions and takes approximately 20 minutes to administer. Data distribution (skewness= -0.23) and internal consistency (Cronbach's alpha= 0.78) were satisfactory. Standard error of measurement was 3.42. The outcome was significantly worse in patients with an abnormal Psychometric properties of the Italian version of the Scales for Outcomes in Parkinson's disease-Cognition (SCOPA-Cog) score on the Dementia Rating Scale (DRS) (SCOPACog mean score 14.6 ± 5.1 out of a total of 43) with respect to cognitively intact subjects (24.2 ± 4.3) (p<0.0001). The DRS showed good convergent validity (Spearman rho= 0.77, p<0.0001), and a high coefficient of variation (= 0.34). These findings support the goodness of the Italian SCOPA-Cog in terms of metrics and validity.
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Ferrari S, Piacenti I, Napolitano A, Cagnacci A. [Pharmacological, metabolic and clinical aspects of new oral contraceptive associations containing natural estrogens]. Minerva Ginecol 2014; 66:91-102. [PMID: 24569408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Introduction of new compounds containing natural estrogens represented a major development in the field of hormonal contraception. Micronized estradiol (E2) and its estere valerate (EV), is more easily metabolized by the liver than ethynylestradiol (EE). This causes minimal metabolic impact, but the weak estrogenic activity needs not be antagonized by androgenic progestin and requires progestin capable to stabilize the endometrium. Dienogest (DNG), an antiandrogenic progestin with a short half-life, is associated with estradiol valerate (EV) in a quadriphasic fashion. In comparison to EE/levonorgestrel (LNG), EV/DNG is more neutral on metabolism and coagulation. Furthermore, it does not seem to negatively affect the cardiovascular system and breast. Cycle control is optimal with a higher prevalence of amenorrhea and reduction of menstrual flow. For this reason EV/DNG can be tehrapeutic for heavy menstrual bleedings. Nomegestrol acetate (NOMAc), an anti-andogen progestin with a long half-life is combined in monophasic regimen with micronized E2. E2/NOMAc is more neutral than EE/LNG on metabolism and more neutral than EE/DRSP on coagulation. NOMAc reduces peripheral tissue estrogen formation, and this may be beneficial for the breast. The two formulations exert a high contraceptive efficacy similar to the ones containing EE, but with less estrogen-related side-effects. The additional benefits due to DNG and NOMAc need to be further explored.
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MESH Headings
- Animals
- Contraceptive Agents, Female/administration & dosage
- Contraceptive Agents, Female/pharmacokinetics
- Contraceptive Agents, Female/pharmacology
- Contraceptives, Oral/administration & dosage
- Contraceptives, Oral/pharmacokinetics
- Contraceptives, Oral/pharmacology
- Contraceptives, Oral, Combined/administration & dosage
- Contraceptives, Oral, Combined/pharmacokinetics
- Contraceptives, Oral, Combined/pharmacology
- Drug Design
- Estrogens/administration & dosage
- Estrogens/pharmacokinetics
- Estrogens/pharmacology
- Female
- Humans
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Affiliation(s)
- S Ferrari
- Unità Ginecologia e Ostetricia, Dipartimento di Scienze Mediche e Chirurgiche dell'Adulto e del Bambino, Azienda Ospedaliero Universitaria di Modena, Modena, Italia
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Patel AX, Miller SR, Nathan PJ, Kanakaraj P, Napolitano A, Lawrence P, Koch A, Bullmore ET. Neuroendocrine and sympathetic responses to an orexin receptor antagonist, SB-649868, and alprazolam following insulin-induced hypoglycemia in humans. Psychopharmacology (Berl) 2014; 231:3817-28. [PMID: 24770625 PMCID: PMC4159598 DOI: 10.1007/s00213-014-3520-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 02/24/2014] [Indexed: 02/02/2023]
Abstract
RATIONALE The orexin-hypocretin system is important for translating peripheral metabolic signals and central neuronal inputs to a diverse range of behaviors, from feeding, motivation and arousal, to sleep and wakefulness. Orexin signaling is thus an exciting potential therapeutic target for disorders of sleep, feeding, addiction, and stress. OBJECTIVES/METHODS Here, we investigated the low dose pharmacology of orexin receptor antagonist, SB-649868, on neuroendocrine, sympathetic nervous system, and behavioral responses to insulin-induced hypoglycemic stress, in 24 healthy male subjects (aged 18-45 years; BMI 19.0-25.9 kg/m(2)), using a randomized, double-blind, placebo-controlled, within-subject crossover design. Alprazolam, a licensed benzodiazepine anxiolytic, was used as a positive comparator, as it has previously been validated using the insulin tolerance test (ITT) model in humans. RESULTS Of the primary endpoints, ITT induced defined increases in pulse rate, plasma cortisol, and adrenocorticotropic hormone in the placebo condition, but these responses were not significantly impacted by alprazolam or SB-649868 pre-treatment. Of the secondary endpoints, ITT induced a defined increase in plasma concentrations of adrenaline, noradrenaline, growth hormone (GH), and prolactin in the placebo condition. Alprazolam pre-treatment significantly reduced the GH response to ITT (p < 0.003), the peak electromyography (p < 0.0001) and galvanic skin response (GSR, p = 0.04) to acoustic startle, the resting GSR (p = 0.01), and increased appetite following ITT (p < 0.0005). SB-649868 pre-treatment produced no significant results. CONCLUSION We concluded that the ITT model may be informative for assessing the effects of drugs directly acting on the neuroendocrine or sympathetic nervous systems, but could not be validated for studying low dose orexin antagonist activity.
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Affiliation(s)
- Ameera X. Patel
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK
| | - Sam R. Miller
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Pradeep J. Nathan
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK ,Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK ,School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Ponmani Kanakaraj
- Quantitative Sciences India, GlaxoSmithKline Pharmaceuticals Ltd, Bangalore, India
| | - Antonella Napolitano
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Philip Lawrence
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Annelize Koch
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
| | - Edward T. Bullmore
- Brain Mapping Unit, Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB UK ,Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, UK
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Napolitano A, Miller S, Murgatroyd PR, Hussey E, Dobbins RL, Bullmore ET, Nunez DJR. Exploring glycosuria as a mechanism for weight and fat mass reduction. A pilot study with remogliflozin etabonate and sergliflozin etabonate in healthy obese subjects. J Clin Transl Endocrinol 2013; 1:e3-e8. [PMID: 29235586 PMCID: PMC5685025 DOI: 10.1016/j.jcte.2013.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 11/26/2013] [Accepted: 12/05/2013] [Indexed: 11/08/2022]
Abstract
Inhibitors of sodium-dependent glucose co-transporter 2 (SGLT2) increase glucose excretion in the urine and improve blood glucose in Type 2 diabetes mellitus. Glycosuria provides an energy and osmotic drain that could alter body composition. We therefore conducted a pilot study comparing the effects on body composition of two SGLT2 inhibitors, remogliflozin etabonate (RE) 250 mg TID (n = 9) and sergliflozin etabonate (SE) (1000 mg TID) (n = 9), with placebo (n = 12) in obese non-diabetic subjects. Both drugs were well tolerated during 8 weeks of dosing, and the most common adverse event was headache. No urinary tract infections were observed, but there was one case of vaginal candidiasis in the RE group. As expected, RE and SE increased urine glucose excretion, with no change in the placebo group. All the subjects lost weight over 8 weeks, irrespective of treatment assignment. There was a reduction in TBW measured by D2O dilution in the RE group that was significantly greater than placebo (1.4 kg, p = 0.029). This was corroborated by calculation of fat-free mass using a quantitative magnetic resonance technique. All but one subject had a measurable decrease in fat mass. There was significant between-subject variability of weight and fat loss, and no statistically significant differences were observed between groups. Despite a lack of a difference in weight and fat mass loss, the leptin/adiponectin ratio, a measure of insulin resistance, was significantly decreased in the RE group when compared to placebo and SE, suggesting that this SGTL-2 inhibitor may improve metabolic health independent of a change in fat mass.
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Affiliation(s)
- Antonella Napolitano
- Clinical Unit in Cambridge, GlaxoSmithKline, Addenbrookes Hospital, Cambridge, UK
| | - Sam Miller
- Clinical Unit in Cambridge, GlaxoSmithKline, Addenbrookes Hospital, Cambridge, UK
| | - Peter R Murgatroyd
- Wellcome Trust Clinical Research Facility, Cambridge University Hospital NHS Trust, UK
| | - Elizabeth Hussey
- Metabolic Pathways and Cardiovascular Unit, GlaxoSmithKline, NC, USA
| | - Robert L Dobbins
- Metabolic Pathways and Cardiovascular Unit, GlaxoSmithKline, NC, USA
| | - Edward T Bullmore
- Clinical Unit in Cambridge, GlaxoSmithKline, Addenbrookes Hospital, Cambridge, UK
| | - Derek J R Nunez
- Metabolic Pathways and Cardiovascular Unit, GlaxoSmithKline, NC, USA
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Isella V, Mapelli C, Morielli N, Siri C, De Gaspari D, Pezzoli G, Antonini A, Poletti M, Bonuccelli U, Picchi L, Napolitano A, Vista M, Appollonio I. Diagnosis of possible Mild Cognitive Impairment in Parkinson's disease: Validity of the SCOPA-Cog. Parkinsonism Relat Disord 2013; 19:1160-3. [DOI: 10.1016/j.parkreldis.2013.08.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Revised: 08/05/2013] [Accepted: 08/14/2013] [Indexed: 11/29/2022]
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Dobbins RL, Shearn SP, Byerly RL, Gao FF, Mahar KM, Napolitano A, Nachbaur GJ, Le Monnier de Gouville AC. GSK256073, a selective agonist of G-protein coupled receptor 109A (GPR109A) reduces serum glucose in subjects with type 2 diabetes mellitus. Diabetes Obes Metab 2013; 15:1013-21. [PMID: 23701262 DOI: 10.1111/dom.12132] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 01/26/2013] [Accepted: 05/06/2013] [Indexed: 11/30/2022]
Abstract
AIMS This clinical trial assessed whether a potent, selective GPR109A agonist, GSK256073, could, through inhibition of lipolysis, acutely improve glucose homeostasis in subjects with type 2 diabetes mellitus. METHODS Thirty-nine diabetic subjects were enrolled in the randomized, single-blind, placebo-controlled, three-period crossover trial. Each subject received placebo and two of four regimens of GSK256073 for 2 days. GSK256073 was dosed 5 mg every 12 h before breakfast and supper (BID), 10 mg every 24 h before breakfast (QD), 25 mg BID and 50 mg QD. RESULTS The change from baseline weighted mean glucose concentration for an interval from 24 to 48 h after the initial drug dose was significantly reduced for all GSK256073 regimens, reaching a maximum of -0.87 mmol/l (-1.20, -0.52) with the 25 mg BID dose. Sustained suppression of non-esterified fatty acid (NEFA) and glycerol concentrations was observed with all GSK256073 doses throughout the 48-h dosing period. Serum insulin and C-peptide concentrations fell in concert with glucose concentrations and calculated HOMA-IR scores decreased 27-47%, consistent with insulin sensitization. No marked differences were evident between either 10 and 50 mg total daily doses or QD versus BID dosing. CONCLUSIONS Administration of a GPR109A agonist for 2 days significantly decreased serum NEFA and glucose concentrations in diabetic subjects. Glucose improvements were associated with decreased insulin concentrations and measures of enhanced insulin sensitivity. Improved glucose control occurred with GSK256073 doses that were generally safe and not associated with events of flushing or gastrointestinal disturbances.
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MESH Headings
- C-Peptide/blood
- Cross-Over Studies
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/drug therapy
- Diabetes Mellitus, Type 2/metabolism
- Dose-Response Relationship, Drug
- Drug Administration Schedule
- Drugs, Investigational/administration & dosage
- Drugs, Investigational/analysis
- Drugs, Investigational/pharmacokinetics
- Drugs, Investigational/therapeutic use
- Fatty Acids, Nonesterified/blood
- Female
- Follow-Up Studies
- Glycerol/blood
- Humans
- Hyperglycemia/prevention & control
- Hyperinsulinism/prevention & control
- Hypoglycemic Agents/administration & dosage
- Hypoglycemic Agents/blood
- Hypoglycemic Agents/pharmacokinetics
- Hypoglycemic Agents/therapeutic use
- Hypolipidemic Agents/administration & dosage
- Hypolipidemic Agents/blood
- Hypolipidemic Agents/pharmacokinetics
- Hypolipidemic Agents/therapeutic use
- Insulin Resistance
- Male
- Middle Aged
- Receptors, G-Protein-Coupled/agonists
- Receptors, G-Protein-Coupled/metabolism
- Receptors, Nicotinic/metabolism
- Single-Blind Method
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Affiliation(s)
- R L Dobbins
- GlaxoSmithKline, Drug Discovery, Research Triangle Park, NC, USA
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Cagnacci A, Ferrari S, Napolitano A, Piacenti I, Arangino S, Volpe A. Combined oral contraceptive containing drospirenone does not modify 24-h ambulatory blood pressure but increases heart rate in healthy young women: prospective study. Contraception 2013; 88:413-7. [DOI: 10.1016/j.contraception.2012.12.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/29/2012] [Accepted: 12/01/2012] [Indexed: 11/27/2022]
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Cambridge VC, Ziauddeen H, Nathan PJ, Subramaniam N, Dodds C, Chamberlain SR, Koch A, Maltby K, Skeggs AL, Napolitano A, Farooqi IS, Bullmore ET, Fletcher PC. Neural and behavioral effects of a novel mu opioid receptor antagonist in binge-eating obese people. Biol Psychiatry 2013; 73:887-94. [PMID: 23245760 PMCID: PMC3898083 DOI: 10.1016/j.biopsych.2012.10.022] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 10/10/2012] [Accepted: 10/12/2012] [Indexed: 11/26/2022]
Abstract
BACKGROUND Binge eating is associated with obesity and has been conceptualized as "food addiction." However, this view has received only inconsistent support in humans, and limited evidence relates key neurocircuitry to the disorder. Moreover, relatively few studies have used pharmacologic functional magnetic resonance imaging to probe the underlying basis of altered eating behaviors. METHODS In a double-blind, placebo-controlled, parallel group study, we explored the effects of a potent mu-opioid receptor antagonist, GSK1521498, in obese individuals with moderate binge eating. Subjects were tested during a baseline placebo run-in period and retested after 28-days of drug (n = 21) or placebo (n = 21) treatment. Using functional magnetic resonance imaging and behavioral measures, we determined the drug's effects on brain responses to food images and, separately, on motivation to expend energy to view comparable images. RESULTS Compared with placebo, GSK1521498 was associated with a significant reduction in pallidum/putamen responses to pictures of high-calorie food and a reduction in motivation to view images of high-calorie food. Intriguingly, although motivational responding was reduced, subjective liking for the same images actually increased following drug treatment. CONCLUSIONS Stimulus-specific putamen/pallidal responses in obese people with binge eating are sensitive to altered mu-opioid function. This neuromodulation was accompanied by reductions in motivational responding, as measured by grip force, although subjective liking responses to the same stimuli actually increased. As well as providing evidence for a link between the opioid system and food-related behavior in binge-eating obese individuals, these results support a dissociation across measures of motivation and liking associated with food-related stimuli in these individuals.
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Affiliation(s)
- Victoria C. Cambridge
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom
| | - Hisham Ziauddeen
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom,Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom,Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom,Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Pradeep J. Nathan
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom,Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - Naresh Subramaniam
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom
| | - Chris Dodds
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom,Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom,Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Annelize Koch
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - Kay Maltby
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - Andrew L. Skeggs
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - Antonella Napolitano
- Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom
| | - I. Sadaf Farooqi
- Metabolic Research Laboratories, Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Edward T. Bullmore
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom,Medicines Discovery and Development, GlaxoSmithKline, Clinical Unit Cambridge, Addenbrooke’s Centre for Clinical Investigations, Cambridge, United Kingdom,Academic Discovery Performance Unit, GlaxoSmithKline, Addenbrooke’s Centre for Clinical Investigation, Cambridge, United Kingdom,Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Paul C. Fletcher
- Department of Psychiatry, Behavioural & Clinical Neuroscience Institute, Cambridge Biomedical Campus, University of Cambridge, United Kingdom,Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom,Address correspondence to Paul C. Fletcher, M.B., B.S., M.R.C.Psych., Ph.D., Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke’s Hospital, Forvie Site, Robinson Way, Cambridge, UK, CB2 0SZ
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Nathan PJ, Bush MA, Tao WX, Koch A, Davies KM, Maltby K, O'Neill BV, Napolitano A, Skeggs AL, Brooke AC, Richards DB, Williams PM, Bullmore ET. Multiple-Dose Safety, Pharmacokinetics, and Pharmacodynamics of the μ-Opioid Receptor Inverse Agonist GSK1521498. J Clin Pharmacol 2013; 52:1456-67. [DOI: 10.1177/0091270011421785] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Balbi G, Di Martino L, Pitruzzella G, Pitruzzella D, Grauso F, Napolitano A, Seguino E, Gioia F, Orabona P. Undifferentiated pleomorphic sarcoma with osteoclast-like giant cells of the female breast. World J Surg Oncol 2013; 11:21. [PMID: 23351285 PMCID: PMC3579744 DOI: 10.1186/1477-7819-11-21] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 01/06/2013] [Indexed: 11/25/2022] Open
Abstract
The authors describe a case of undifferentiated pleomorphic sarcoma of the breast occurring in a 50-year-old woman who presented with a palpable mass in her right breast. She first noticed the mass one month previously. Core needle biopsy showed connective tissue including epithelioid and spindle cells. The patient underwent total mastectomy without axillary lymph node dissection. Based on examination of the excised tumor, the initial pathologic diagnosis was atypical spindle-shaped and ovoid cells with uncertain malignant potential. Histological findings with immunomarkers led to the final diagnosis of undifferentiated pleomorphic sarcoma. This case highlights a rare and interesting variant of primary breast sarcoma and the important role of immunohistochemistry in defining histological type and differential diagnosis. Hence, undifferentiated pleomorphic sarcoma has been a diagnosis of exclusion performed through sampling and critical use of ancillary diagnostic techniques.
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Affiliation(s)
- Giancarlo Balbi
- U.O. Ginecologia ed Ostetricia, Seconda Università degli Studi di Napoli, c/o S. Anna e S. Sebastiano Hospital, Caserta, Italy.
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Chamberlain SR, Mogg K, Bradley BP, Koch A, Dodds CM, Tao WX, Maltby K, Sarai B, Napolitano A, Richards DB, Bullmore ET, Nathan PJ. Effects of mu opioid receptor antagonism on cognition in obese binge-eating individuals. Psychopharmacology (Berl) 2012; 224:501-9. [PMID: 22752384 DOI: 10.1007/s00213-012-2778-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 06/11/2012] [Indexed: 11/28/2022]
Abstract
RATIONALE Translational research implicates the mu opioid neurochemical system in hedonic processing, but its role in dissociable high-level cognitive functions is not well understood. Binge-eating represents a useful model of 'behavioural addiction' for exploring this issue. OBJECTIVE The aim of this study was to objectively assess the cognitive effects of a mu opioid receptor antagonist in obese individuals with binge-eating symptoms. METHODS Adults with moderate to severe binge-eating and body mass index ≥30 kg/m² received 4 weeks of treatment with a mu opioid receptor antagonist (GSK1521498) 2 or 5 mg per day, or placebo, in a double-blind randomised parallel design. Neuropsychological assessment was undertaken at baseline and endpoint to quantify processing bias for food stimuli (visual dot probe with 500- and 2,000-ms stimulus presentations and food Stroop tasks) and other distinct cognitive functions (N-back working memory, sustained attention, and power of attention tasks). RESULTS GSK1521498 5 mg/day significantly reduced attentional bias for food cues on the visual dot probe task versus placebo (p = 0.042), with no effects detected on other cognitive tasks (all p > 0.10). The effect on attentional bias was limited to the longer stimulus duration condition in the higher dose cohort alone. CONCLUSIONS These findings support a central role for mu opioid receptors in aspects of attentional processing of food cues but militate against the notion of major modulatory influences of mu opioid receptors in working memory and sustained attention. The findings have implications for novel therapeutic directions and suggest that the role of different opioid receptors in cognition merits further research.
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Affiliation(s)
- Samuel R Chamberlain
- Clinical Unit Cambridge, GlaxoSmithKline, Addenbrooke's Hospital, Cambridge CB0 0QQ, UK.
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Sgambato A, Casaluce F, Maione P, Rossi A, Rossi E, Napolitano A, Palazzolo G, Bareschino MA, Schettino C, Sacco PC, Ciadiello F, Gridelli C. The role of EGFR tyrosine kinase inhibitors in the first-line treatment of advanced non small cell lung cancer patients harboring EGFR mutation. Curr Med Chem 2012; 19:3337-52. [PMID: 22664249 DOI: 10.2174/092986712801215973] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 03/06/2012] [Accepted: 03/08/2012] [Indexed: 11/22/2022]
Abstract
Lung cancer continues to be the leading cause of cancer death worldwide. Among lung cancers, 80% are classified as nonsmall- cell lung cancer (NSCLC) and are mostly diagnosed at an advanced stage (either locally advanced or metastatic disease). In the last years, the discovery of the pivotal role in tumorigenesis of the Epidermal Growth Factor Receptor (EGFR) has provided a new class of targeted therapeutic agents: the EGFR tyrosine kinase inhibitors (EGFR-TKIs). Since the first reports of an association between somatic mutations in EGFR exons 19 and 21 and response to EGFR-TKIs, treatment of advanced NSCLC has changed dramatically. Histologic profile, clinical characteristics, and mutational profile of lung carcinoma have all been reported as predictive factors of response to EGFR-TKIs and other targeted therapies. In advanced NSCLC patients harboring EGFR mutations, the use of EGFR TKIs in first-line treatment has provided an unusually large progression-free survival (PFS) benefit with a negligible toxicity when compared with cytotoxic chemotherapy in phase III randomized trials. Considering the findings regarding the excellent benefit and better safety profile of EGFR TKIs in EGFR mutation positive patients, these targeted therapeutic agents can be now considered as first-line treatment in this setting of patients. This review will discuss the new evidences in the role of EGFR-TKIs in the first-line treatment of advanced NSCLC and their implication in the current clinical decision-making.
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Affiliation(s)
- A Sgambato
- Department of Clinical and Experimental Medicine, Second University of Naples, Naples Italy
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Mari A, Napolitano A, Perrone A, Pizza C, Piacente S. An analytical approach to profile steroidal saponins in food supplements: The case of Ruscus aculeatus. Food Chem 2012. [DOI: 10.1016/j.foodchem.2012.02.099] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Placidi E, Marciani L, Hoad CL, Napolitano A, Garsed KC, Pritchard SE, Cox EF, Costigan C, Spiller RC, Gowland PA. The effects of loperamide, or loperamide plus simethicone, on the distribution of gut water as assessed by MRI in a mannitol model of secretory diarrhoea. Aliment Pharmacol Ther 2012; 36:64-73. [PMID: 22582872 DOI: 10.1111/j.1365-2036.2012.05127.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 01/17/2012] [Accepted: 04/20/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Loperamide (LOP) is an anti-diarrhoeal agent which is thought to act largely by slowing transit with an uncertain effect on the fluid content of the small and large bowel in humans. Adding simethicone (SIM) to LOP improves its efficacy, but the mechanism of interaction is unclear. Novel MRI techniques to assess small bowel water content (SBWC) have shown that mannitol solutions markedly increase SBWC and can be used as a model of diarrhoea. AIM We aimed to use quantitative MRI techniques to compare the actions in the gut of LOP and LOP + SIM in a model of secretory diarrhoea using mannitol. METHODS A total of 18 healthy volunteers ingested capsules containing placebo (PLA) or 12 mg LOP or 12 mg LOP + 125 mg SIM. After 100 min they were given a drink containing 5% mannitol in 350 mL of water. They underwent baseline fasting and postprandial serial MRI scans at 45 min intervals for 4.5 h after ingesting the drink. A range of MRI sequences was acquired to image the gut. RESULTS LOP and LOP + SIM significantly accelerated gastric emptying (P < 0.03) and reduced SBWC during the late phase (135-270 min after mannitol ingestion), P < 0.009, while delaying arrival of fluid in the ascending colon (AC). The relaxation time T2 of the contents of the AC was reduced by both drugs (P < 0.0001). CONCLUSIONS LOP and LOP + SIM accelerate gastric emptying, but reduce small bowel water content which may contribute to the delay in oral-caecal transit and overall anti-diarrhoeal effect.
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Affiliation(s)
- E Placidi
- Sir Peter Mansfield Magnetic Resonance Centre, University of Nottingham, UK
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Napolitano A, Miller SR, Murgatroyd PR, Delafont B, Brooke A, Elkhawad M, Tan CY, Virtue S, Vidal-Puig A, Nunez DJ. Prediction of weight loss and regain following dietary, lifestyle, and pharmacologic intervention. Clin Pharmacol Ther 2012; 91:1027-34. [PMID: 22336590 DOI: 10.1038/clpt.2011.333] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To develop statistical models for predicting weight loss and regain, we analyzed the phenotypic responses in an outpatient study of 60 obese subjects randomized to one of three 12-week interventions, diet (-600 kcal) alone, diet with exercise, and diet with sibutramine. This was followed by 12 weeks of observation. The best of the "baseline covariates" models was one that incorporated intervention group and baseline homeostasis model assessment-estimated insulin resistance (HOMA(IR)). It predicted week 12 weight change with R(2) of 0.38 and root mean square error (√MSE) of 2.92 kg. An alternative model incorporating baseline fat mass plus change in weight and HOMA(IR) at week 4 improved the prediction (R(2), 0.67, √MSE, 2.19 kg). We could not identify a satisfactory model to predict weight regain. We conclude that prediction of weight loss over 12 weeks is significantly improved when short-term weight change is incorporated into the model. This information could be utilized to forecast the success of a weight-loss program and to motivate and contribute to innovative designing of obesity trials.
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Affiliation(s)
- A Napolitano
- Clinical Unit in Cambridge, GlaxoSmithKline, Cambridge University Hospital NHS Trust, Cambridge, UK
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