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Lecis D, Prandi FR, Barone L, Belli M, Sergi D, Longo S, Muscoli S, Romeo F, Federici M, Lerakis S, Barillà F. Beyond the Cardiovascular Effects of Glucagon-like Peptide-1 Receptor Agonists: Body Slimming and Plaque Stabilization. Are New Statins Born? Biomolecules 2023; 13:1695. [PMID: 38136567 PMCID: PMC10741698 DOI: 10.3390/biom13121695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/19/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Atherosclerosis is a chronic inflammatory disease characterized by lipid and inflammatory cell deposits in the inner layer of large- and medium-sized elastic and muscular arteries. Diabetes mellitus (DM) significantly increases the risk of cardiovascular diseases and the overall and cardiovascular mortality, and it is a pro-atherogenic factor that induces atherosclerosis development and/or accelerates its progression through a multifactorial process. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) are a new class of drugs, belonging to the armamentarium to fight type 2 DM, that have shown robust reductions in atherosclerotic events and all-cause mortality in all studies. Preclinical studies have shown that GLP-1RAs play a role in the immunomodulation of atherosclerosis, affecting multiple pathways involved in plaque development and progression. In this review, we wanted to explore the translational power of such preclinical studies by analyzing the most recent clinical trials investigating the atheroprotective effect of GLP-1RAs.
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Affiliation(s)
- Dalgisio Lecis
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
| | - Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA;
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Domenico Sergi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
| | - Susanna Longo
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (S.L.); (M.F.)
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
| | - Francesco Romeo
- Faculty of Medicine, UniCamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy;
| | - Massimo Federici
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (S.L.); (M.F.)
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA;
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (F.R.P.); (L.B.); (M.B.); (D.S.); (S.M.); (F.B.)
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Belli M, Barone L, Longo S, Prandi FR, Lecis D, Mollace R, Margonato D, Muscoli S, Sergi D, Federici M, Barillà F. Gut Microbiota Composition and Cardiovascular Disease: A Potential New Therapeutic Target? Int J Mol Sci 2023; 24:11971. [PMID: 37569352 PMCID: PMC10418329 DOI: 10.3390/ijms241511971] [Citation(s) in RCA: 1] [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] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/13/2023] [Accepted: 07/24/2023] [Indexed: 08/13/2023] Open
Abstract
A great deal of evidence has revealed an important link between gut microbiota and the heart. In particular, the gut microbiota plays a key role in the onset of cardiovascular (CV) disease, including heart failure (HF). In HF, splanchnic hypoperfusion causes intestinal ischemia resulting in the translocation of bacteria and their metabolites into the blood circulation. Among these metabolites, the most important is Trimethylamine N-Oxide (TMAO), which is responsible, through various mechanisms, for pathological processes in different organs and tissues. In this review, we summarise the complex interaction between gut microbiota and CV disease, particularly with respect to HF, and the possible strategies for influencing its composition and function. Finally, we highlight the potential role of TMAO as a novel prognostic marker and a new therapeutic target for HF.
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Affiliation(s)
- Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
| | - Susanna Longo
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy (R.M.)
| | - Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Dalgisio Lecis
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
| | - Rocco Mollace
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy (R.M.)
- Cardiovascular Department, Humanitas Gavazzeni, 24125 Bergamo, Italy
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
| | - Domenico Sergi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
| | - Massimo Federici
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy (R.M.)
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy; (M.B.)
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Lecis D, Massaro G, Benedetto D, Di Luozzo M, Russo G, Mauriello A, Federici M, Sangiorgi GM. Immunomodulation Therapies for Atherosclerosis: The Past, the Present, and the Future. Int J Mol Sci 2023; 24:10979. [PMID: 37446157 PMCID: PMC10342012 DOI: 10.3390/ijms241310979] [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: 05/28/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
Atherosclerotic cardiovascular disease is the most common cause of morbidity and death worldwide. Recent studies have demonstrated that this chronic inflammatory disease of the arterial wall can be controlled through the modulation of immune system activity. Many patients with cardiovascular disease remain at elevated risk of recurrent events despite receiving current, state-of-the-art preventive medical treatment. Much of this residual risk is attributed to inflammation. Therefore, finding new treatment strategies for this category of patients became of common interest. This review will discuss the experimental and clinical data supporting the possibility of developing immune-based therapies for lowering cardiovascular risk, explicitly focusing on vaccination strategies.
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Affiliation(s)
- Dalgisio Lecis
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
| | - Gianluca Massaro
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
| | - Daniela Benedetto
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
| | - Marco Di Luozzo
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
| | - Giulio Russo
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
| | - Alessandro Mauriello
- Department of Experimental Medicine, University “Tor Vergata”, 00133 Rome, Italy;
| | - Massimo Federici
- Department of Systemic Medicine, University “Tor Vergata”, 00133 Rome, Italy;
| | - Giuseppe Massimo Sangiorgi
- Division of Cardiology, “Tor Vergata” University Hospital, Viale Oxford 81, 00133 Rome, Italy; (G.M.); (D.B.); (M.D.L.); (G.R.)
- Department of Biomedicine and Prevention, “Tor Vergata” University of Rome, 00133 Rome, Italy
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Russo M, Marchei M, Idone G, Lecis D, Di Landro A, Macrini M, Di Luozzo M, Sanseviero A, Romeo F, Muscoli S, Barilla´ F, De Vico P. 989 ANAESTHESIOLOGICAL MANAGEMENT IN PATIENTS UNDERGOING TEER: A NEW APPROACH IMPROVES CV OUTCOMES. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Transcatheter edge-to-edge repair (TEER) with the MitraClip system is an alternative procedure for the treatment of severe mitral regurgitation (MR) in high-risk patients who are not suitable for conventional surgery and is usually performed under general anaesthesia (GA). GA may be associated with potential haemodynamic complications. A new alternative approach is deep sedation (DS) with spontaneous breathing using a target-controlled infusion (TCI). The aim of this study is to compare TCI during DS with manual administration of total intravenous anaesthesia (TIVA) during GA in patients undergoing TEER evaluating the impact of these approaches on anaesthesia time, remifentanil dose administered, haemodynamic profile, vasopressor requirements, adverse events and postoperative hospital stay.
Methods
The study population included 90 consecutive patients treated with MitraClip (mean age 73.5 ± 9.54 years). 65 patients (72%) suffered from functional MR. Mean LVEF was 35 ± 13% and logistic EuroSCORE was 23 ± 19%. 24 patients received GA and TIVA; 66 patients underwent DS and TCI, consisting of administration of midazolam and fentanyl citrate as induction of anaesthesia followed by continuous infusion of remifentanil hydrochloride.
Results
Acute procedural success was 100%, with no major complications during the procedure. No statistical differences were found between the GA-TIVA and the DS-TCI group in terms of demographics and surgical risk profile. Anaesthesia time was significantly shorter in the DS-TCI group (71 ± 30 vs. 118 ± 35 minutes; p < 0.0001), as was procedure duration (54 ± 29 vs. 99 ± 74 minutes; p = 0.00007). In addition, there was a significant reduction in the remifentanil dose administered (249 µg vs. 2865 µg, p < 0.01), the incidence of hypotension (p = 0.08) and the need for vasopressors (29.6% vs. 63%, p = 0.03) in the DS-TCI group. There were no differences in days of hospital stay after the procedure (5.4 days vs. 5.8 days, p = 0.4).
Conclusions
DS with spontaneous breathing using TCI could be a valid alternative during TEER which can ensure stable anaesthetic conditions, less drug administration, higher haemodynamic stability and fewer side effects, with particular advantages in patients at high risk for general anaesthesia.
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Lecis D, Minasi V, Galluccio C, Idone G, Marchei M, Di Landro A, Macrini M, Oro P, Manni G, Illuminato F, Marsili G, Muscoli S, Barillà F. 1109 PULMONARY PRESSUR TREND ANALYSIS IN PATIENTS UNDERGOING MITRACLIP. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Mitral regurgitation (MR) is the second most frequent valve heart disease in Europe and its underlying mechanism primary-organic (due to disease of the mitral leaflets), or secondary-functional (where valve leaflets and chordae are structurally normal and MR results from alterations in left ventricle and left atrium geometry), determines the therapeutic approach. Transcatheter Edge-to-Edge Repair (TEER) with MitraClip implantation is a minimal-invasive treatment that according to 2021 ESC Guidelines should be considered (class of recomandation IIa) in selected symptomatic patients with severe MR despite optimal medical therapy, not eligible for surgery and fulfilling COAPT trial inclusion criteria, suggesting an increased chance of responding to treatment. Optimal valve morphology features for TEER are central pathology (second scallop), no leaflet calcifications, mitral valve area >4cm2, mobile length of posterior leaftel >10 mm, coaptation depth <11mm, normal leaflet strength and mobility, flail width <15 mm, flail gap <10 mm. TEER may be considered (class IIb) only in selected cases when the COAPT criteria are not fulfilled with the aim of improving symptoms and quality of life. MR occurs during systole, that at normal heart rates represents 30-50% of the cardiac cycle. As such, marked left atrial (LA) pressure elevation is present only transiently, representing less of a drive to development of secondary pulmonary hypertension compared to chronic LA pressure elevation seen in severe mitral stenosis. Anyway, in patients with severe MR echocardiography often reveals elevated systolic pulmonary artery pressure (PAPs) and MitraClip implantation usually is associated with a slight increase of the trans-mitral gradient with possible repercussions on pulmonary pressures. To better describe the effect of MitraClip implantation on pulmonary pressures and clinical outcomes we did a retrospective study enrolling in the period 2012-2022 thirty-six patients with severe mitral regurgitation treated with TEER. Compared to the last year presentation, we add eleven patients. The target was still to evaluate the clinical outcomes (symptoms, signs of heart failure, NYHA functional class) and the pulmonary pressures assessed by an echocardiographic examination before and after the intervention. At 6-month follow-up we observed in all patients with repaired mitral regurgitation an improvement in the NYHA class (from IV to II) without re-hospitalization. In addition we notice a more pronounced trend in the reduction of the mean sistolic pulmonary arterial pressure, estimated at around 2.86 mmHg ± 14 mmHg (p 0.24, 95% C.I. -7.69 to 1.94) with an unchanged left ventricle ejection fraction. Moreover, the echocardiographic exam showed a normalization of the S and D waves pattern in the pulmonary veins at the PW Doppler evaluation. These new data reinforced the idea that the clinical improvement and the reduction of dyspnea in these patients underwent TEER is related to a reduction of pressures in the pulmonary circulation regardless of the ejection fraction. This finding could be used as a tool that the cardiologist has to evaluate in the echocardiography lab to reveal a new mitral valve disfunction. Despite the addition of the new patients, the sample is still relatively small. However, considering the improvement of the results with the enlargement of the sample, the goal is to enroll additional patients to make the study even more meaningful.
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Affiliation(s)
| | | | | | | | | | | | | | - Pietro Oro
- U.O.C. Cardiologia Policlinico Tor Vergata , Roma
| | - Giulia Manni
- U.O.C. Cardiologia Policlinico Tor Vergata , Roma
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Manni G, Macrini M, Idone G, Lecis D, Marchei M, Di Landro A, Marsili G, Illuminato F, Galluccio C, Oro P, Minasi V, Muscoli S, Barillà F. 931 EVALUATION OF IATROGENIC ATRIAL SEPTAL DEFECT CLOSURE AFTER TEER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Iatrogenic atrial septal defect (iASD) represents one of the main access-related cardiac complications after trancatheter edge to edge (TEER) mitral valve repair with Mitraclip system. Transesophageal echocardiography (TEE) guiding supports a controlled and safe transseptal puncture. The rate of persistent iASD is 57, 50, and 25% after 1, 6, and 12 months post procedure. An elevated left atrial pressure after clip positioning correlates with iASD persistence. Its clinical impact is controversially discussed: Post-TEER iASD has been associated with right heart volume overload, as well as increased rates of heart failure (HF) hospitalization and death in some studies.
In contrast, other studies have shown an association between post-TEER iASD and improved hemodynamics. In theory, creation of an iASD can decompress an overloaded left atrium, mitigating heart failure. Some studies have demonstrated that iASD closure can reduce significantly both right and left heart failure symptoms. We did a retrospective study enrolling in the period 2012-2022 twenty-one patients with severe mitral regurgitation treated with TEER. Our aim was to evaluate the clinical outcomes (symptoms, signs of heart failure, NYHA functional class) and echocardiographic parameters (PAPs, TAPSE, Right Atrium Area) in two group of patients: Group A underwent iASD closure during the TEER and Group B after one month following the TEER. At 1-month follow-up all patients with repaired mitral regurgitation showed an improvement in the NYHA class (from IV-III to II-I) and no need for re-hospitalization with no significant differences between two groups. In the Group A there were two adverse events during the recovery (2 major bleeding); while there were no adverse events in patients undergoing iASD closure after wise. There was 1 death in the first month after the procedure in group A, while there wasn't any in group B.
Statistical analysis showed no significant differences in terms of NYHA class improvement in the two groups (p=0.91). We observed a greater reduction in PAPs in patients going to encounter intraprocedural DIA closure which was found to be statistically significant (p=0.01). Regarding TAPSE, there was a difference in terms of improvement which was found to be greater in the group A. However, this finding was not found to be statistically significant. We also assessed the right atrium area: in group A, we registered a mean preprocedural value of 28 cmq and a postprocedural value of 34 cmq; in group B the values were 20 cmq and 24 cmq, respectively, with a nonstatistically significant difference in terms of atrial enlargement post device placement.
In conclusion, we can assume that the improvements in symptomatology are not closely related to iASD closure. However, it must considered that patients in group A had more unfavorable echocardiographic values before the procedure than those in group B, and probably, if we had not closed the iASD immediately during the procedure, these patients would have had worse symptomatology. Therefore, targeted patient selection is essential.
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Affiliation(s)
- Giulia Manni
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Massimiliano Macrini
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Gaetano Idone
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Dalgisio Lecis
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Massimo Marchei
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Alessio Di Landro
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Giorgia Marsili
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Federica Illuminato
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Chiara Galluccio
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Pietro Oro
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Vincenzo Minasi
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Saverio Muscoli
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
| | - Francesco Barillà
- UOC Di Cardiologia, Dipartimento Di Medicina Dei Sistemi-Università Degli Studi Di Roma Tor Vergata
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Belli M, Barone L, Bellia A, Sergi D, Lecis D, Prandi FR, Milite M, Galluccio C, Muscoli S, Romeo F, Barillà F. Treatment of HFpEF beyond the SGLT2-Is: Does the Addition of GLP-1 RA Improve Cardiometabolic Risk and Outcomes in Diabetic Patients? Int J Mol Sci 2022; 23:ijms232314598. [PMID: 36498924 PMCID: PMC9737325 DOI: 10.3390/ijms232314598] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/19/2022] [Accepted: 11/20/2022] [Indexed: 11/24/2022] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is a common clinical syndrome frequently seen in elderly patients, the incidence of which is steadily increasing due to an ageing population and the increasing incidence of diseases, such as diabetes, hypertension, obesity, chronic renal failure, and so on. It is a multifactorial disease with different phenotypic aspects that share left ventricular diastolic dysfunction, and is the cause of about 50% of hospitalizations for heart failure in the Western world. Due to the complexity of the disease, no specific therapies have been identified for a long time. Sodium-Glucose Co-Transporter 2 Inhibitors (SGLT2-Is) and Glucagon-Like Peptide Receptor Agonists (GLP-1 RAs) are antidiabetic drugs that have been shown to positively affect heart and kidney diseases. For SGLT2-Is, there are precise data on their potential benefits in heart failure with reduced ejection fraction (HFrEF) as well as in HFpEF; however, insufficient evidence is available for GLP-1 RAs. This review addresses the current knowledge on the cardiac effects and potential benefits of combined therapy with SGLT2-Is and GLP-1RAs in patients with HFpEF.
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Affiliation(s)
- Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Alfonso Bellia
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Domenico Sergi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Dalgisio Lecis
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Marialucia Milite
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Chiara Galluccio
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Saverio Muscoli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Francesco Romeo
- Department of Departmental Faculty of Medicine, UniCamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Correspondence:
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8
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De Vico P, Cammalleri V, Marchei M, Macrini M, Lecis D, Idone G, Massaro G, Di Landro A, Zingaro A, Di Luozzo M, Prandi FR, Ussia GP, Romeo F, Dauri M, Muscoli S. Target-controlled infusion during MitraClip procedures in deep-sedation with spontaneous breathing. Eur Rev Med Pharmacol Sci 2022; 26:8437-8443. [PMID: 36459026 DOI: 10.26355/eurrev_202211_30379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Percutaneous mitral valve repair with the MitraClip system is an alternative procedure for high-risk patients not suitable for conventional surgery. The MitraClip can be safely performed under general anesthesia (GA) or deep sedation (DS) with spontaneous breathing using a combination of propofol and remifentanil. This study aimed to evaluate the benefits of target-controlled infusion (TCI) of remifentanil and administration of propofol during DS compared with manual administration of total intravenous anesthesia (TIVA) medication during GA in patients undergoing MitraClip. We assessed the impact of these procedures in terms of remifentanil dose, hemodynamic profile, adverse events, and days of hospital stay after the process. PATIENTS AND METHODS From March 2013 to June 2015 (mean age 73.5 ± 9,54), patients underwent transcatheter MitraClip repair, 27 received DS via TCI and 27 GA with TIVA. RESULTS Acute procedural success was 100%. DS-TCI group, in addition to a significant reduction of remifentanil dose administrated (249 µg vs. 2865, p < 0.01), resulted in a decrease in vasopressor drugs requirement for hemodynamic adjustments (29.6% vs. 63%, p = 0.03) during the procedure and a reduction of hypotension (p = 0.08). The duration of postoperative hospitalization did not differ between the two groups (5.4 days vs. 5.8 days, p = 0.4). CONCLUSIONS Administration of remifentanil by TCI for DS in spontaneously breathing patients offers stable anesthesia conditions, with a lower amount of drugs, higher hemodynamic stability, and decreased side effects.
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Affiliation(s)
- P De Vico
- Department of Anesthesia and Intensive Care, Department of Cardiovascular Disease, Policlinico Tor Vergata, Rome, Italy.
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9
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Indolfi C, Barillà F, Basile C, Basso C, Cantaluppi V, Capasso G, Ciccone MM, Contessi S, Curcio A, De Nicola L, Esposito C, Imeraj A, Lecis D, Mancone M, Marengo M, Mercuro G, Merlo M, Metra M, Adamo M, Muscoli S, Nodari S, Pagura L, Paoletti E, Paolillo S, Pedrinelli R, Perrone Filardi P, Pertosa GB, Pezzato A, Pontremoli R, Romeo F, Ruggenenti P, Ronco C, Santoro A, Sinagra G, Spaccarotella C, Zippo D, Zoccali C, Messa P. [Italian Society of Cardiology-Italian Society of Nephrology Consensus document: The cardio-renal interaction in the prevention and treatment of cardiovascular diseases - Part II: From preventive strategies to treatment of patients with cardio-renal damage]. G Ital Cardiol (Rome) 2022; 23:793-812. [PMID: 36169130 DOI: 10.1714/3881.38645] [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: 06/16/2023]
Abstract
Chronic kidney disease and cardiovascular disease are strictly connected each other with a bidirectional interaction. Thus, the prevention of cardio-renal damage, as its appropriate treatment, are essential steps for a correct management of long-term patients' prognosis. Several preventive and therapeutic strategies, pharmacological and not, are now available for cardio-renal damage prevention and treatment, and for the management of its complications. The second part of this consensus document focuses on the management and treatment of cardio-renal damage, directing the attention on the correct use of drugs that may slow renal disease progression, on the application of preventive strategies in case of invasive cardiac procedures with the use of contrast agents, and on the accurate use of cardiological drugs in patients with chronic kidney disease.
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Affiliation(s)
- Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli
| | - Francesco Barillà
- Dipartimento di Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma
| | - Christian Basile
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Cristina Basso
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari e di Sanità Pubblica, Università degli Studi, Padova
| | - Vincenzo Cantaluppi
- Nefrologia, Dialisi e Trapianto, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara
| | - Giovambattista Capasso
- Sezione di Nefrologia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "L. Vanvitelli", Napoli
| | - Marco Matteo Ciccone
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Stefano Contessi
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Antonio Curcio
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Luca De Nicola
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università degli Studi della Campania "Luigi Vanvitelli", Napoli
| | - Ciro Esposito
- U.O.C. Nefrologia e Dialisi, ICS Maugeri S.p.A. SB, Università degli Studi, Pavia
| | - Amantia Imeraj
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG)
| | - Dalgisio Lecis
- Dipartimento di Cardiologia, Università degli Studi "Tor Vergata", Roma
| | - Massimo Mancone
- Dipartimento di Scienze Cardiovascolari, Medina Interna e Anestesiologia, Sapienza Università di Roma, Roma
| | | | - Giuseppe Mercuro
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi, Cagliari
| | - Marco Merlo
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Marco Metra
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Marianna Adamo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma
| | - Savina Nodari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Linda Pagura
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Ernesto Paoletti
- Clinica Nefrologica, Dialisi e Trapianto, Policlinico San Martino, Genova
| | - Stefania Paolillo
- Mediterranea Cardiocentro, Napoli - Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università degli Studi, Pisa
| | - Pasquale Perrone Filardi
- Mediterranea Cardiocentro, Napoli - Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Giovanni Battista Pertosa
- U.O.C. Nefrologia, Dialisi e Trapianto, Dipartimento dell'Emergenza e dei Trapianti di Organo (DETO), Università degli Studi "Aldo Moro", Bari
| | - Andrea Pezzato
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Roberto Pontremoli
- Università degli Studi di Genova ed IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Romeo
- Dipartimento di Cardiologia, International University "Unicamillus", Roma
| | - Piero Ruggenenti
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG) - Unità di Nefrologia ed Avvio al Trapianto, ASST Papa Giovanni XXIII, Bergamo
| | - Claudio Ronco
- U.O.C. Nefrologia Dialisi e Trapianto, Ospedale San Bortolo, Vicenza
| | - Antonio Santoro
- U.O.C. Nefrologia, Dialisi ed Ipertensione, Policlinico S. Orsola-Malpighi, Bologna
| | - Gianfranco Sinagra
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Carmen Spaccarotella
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Dauphine Zippo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Carmine Zoccali
- CNR-IFC Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Azienda Ospedaliera di Reggio Calabria
| | - Piergiorgio Messa
- U.O.C. Nefrologia, Dialisi e Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
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10
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Prandi FR, Barone L, Lecis D, Belli M, Sergi D, Milite M, Lerakis S, Romeo F, Barillà F. Biomolecular Mechanisms of Cardiorenal Protection with Sodium-Glucose Co-Transporter 2 Inhibitors. Biomolecules 2022; 12:1349. [PMID: 36291558 PMCID: PMC9599693 DOI: 10.3390/biom12101349] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 09/22/2022] [Accepted: 09/22/2022] [Indexed: 11/16/2022] Open
Abstract
Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia and associated with an increased risk of morbidity and mortality, primarily from cardiovascular and renal diseases. Sodium-glucose cotransporter 2 inhibitors (SGLT2-Is) are novel drugs for the treatment of type 2 DM and heart failure (HF). SGLT2-Is mediate protective effects on both the renal and cardiovascular systems. This review addresses the current knowledge on the biomolecular mechanisms of the cardiorenal protective effects of SGLT2-Is, which appear to act mainly through non-glucose-mediated pathways. Cardiorenal protection mechanisms lead to reduced chronic renal disease progression and improved myocardial and coronary endothelial function. Concomitantly, it is possible to observe reflected changes in biomarkers linked with diabetic kidney disease and HF.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Lucy Barone
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Dalgisio Lecis
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Domenico Sergi
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Marialucia Milite
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Stamatios Lerakis
- Department of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Romeo
- Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
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11
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Messa P, Barillà F, Basile C, Basso C, Cantaluppi V, Capasso G, Ciccone MM, Contessi S, Curcio A, De Nicola L, Esposito C, Imeraj A, Lecis D, Mancone M, Marengo M, Mercuro G, Merlo M, Metra M, Adamo M, Muscoli S, Nodari S, Pagura L, Paoletti E, Paolillo S, Pedrinelli R, Filardi PP, Pertosa GB, Pezzato A, Pontremoli R, Romeo F, Ruggenenti P, Ronco C, Santoro A, Sinagra G, Spaccarotella C, Zippo D, Zoccali C, Indolfi C. [Italian Society of Cardiology-Italian Society of Nephrology Consensus document: The cardio-renal interaction in the prevention and treatment of cardiovascular diseases - Part I: From cardiovascular risk factors to the mechanisms of cardio-renal syndrome]. G Ital Cardiol (Rome) 2022; 23:716-727. [PMID: 36039723 DOI: 10.1714/3860.38456] [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: 06/15/2023]
Abstract
Chronic kidney disease (CKD) and cardiovascular (CV) disease are highly prevalent conditions in the general population and are strictly connected to each other with a bidirectional interaction. In patients affected by CKD, the leading cause of morbidity and mortality is represented by CV disease, since CKD promotes the atherosclerotic process increasing inflammation, and modifying lipid and bone mineral metabolism. On the other side, a strict relationship exists between CKD and CV risk factors, which are prevalent in nephropathic patients and impose a stringent assessment of the risk of CV events in this population together with an optimized pharmacological approach, complicated by the coexistence of the two pathological conditions. The first part of this consensus document focuses on the mechanisms of cardio-renal damage and on the impact, as well as the management, of the main CV risk factors in the context of CKD.
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Affiliation(s)
- Piergiorgio Messa
- U.O.C. Nefrologia, Dialisi e Trapianti di Rene, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano
| | - Francesco Barillà
- Dipartimento di Medicina dei Sistemi, Università degli Studi "Tor Vergata", Roma
| | - Christian Basile
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Cristina Basso
- Dipartimento di Scienze Cardiologiche, Toraciche e Vascolari e di Sanità Pubblica, Università degli Studi, Padova
| | - Vincenzo Cantaluppi
- Nefrologia, Dialisi e Trapianto, Ospedale Maggiore della Carità, Università del Piemonte Orientale, Novara
| | - Giovambattista Capasso
- Sezione di Nefrologia, Dipartimento di Scienze Mediche Traslazionali, Università degli Studi della Campania "L. Vanvitelli", Napoli
| | - Marco Matteo Ciccone
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Stefano Contessi
- Dipartimento Cardiotoracovascolare, Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), Università degli Studi, Trieste
| | - Antonio Curcio
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro
| | - Luca De Nicola
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania "Luigi Vanvitelli", Napoli
| | - Ciro Esposito
- U.O.C. Nefrologia e Dialisi, ICS Maugeri S.p.A. SB, Università di Pavia, Pavia
| | - Amantia Imeraj
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Centro di Ricerche Cliniche per le Malattie Rare "Aldo e Cele Daccò", Ranica (BG)
| | - Dalgisio Lecis
- Dipartimento di Cardiologia, Università degli Studi "Tor Vergata", Roma
| | - Massimo Mancone
- Dipartimento di Scienze Cardiovascolari, Medina Interna, e Anestesiologia, Sapienza Università di Roma, Roma
| | | | - Giuseppe Mercuro
- Dipartimento di Scienze Mediche e Sanità Pubblica, Università degli Studi, Cagliari
| | - Marco Merlo
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Marco Metra
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Marianna Adamo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Saverio Muscoli
- U.O.C. Cardiologia, Fondazione Policlinico "Tor Vergata", Roma
| | - Savina Nodari
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Linda Pagura
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Ernesto Paoletti
- Clinica Nefrologica, Dialisi e Trapianto, Policlinico San Martino, Genova
| | - Stefania Paolillo
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Mediterranea Cardiocentro, Napoli
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università degli Studi, Pisa
| | - Pasquale Perrone Filardi
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Mediterranea Cardiocentro, Napoli
| | - Giovanni Battista Pertosa
- U.O.C. Nefrologia, Dialisi e Trapianto, Dipartimento dell'Emergenza e dei Trapianti di Organo (DETO), Università degli Studi "Aldo Moro", Bari
| | - Andrea Pezzato
- Nefrologia, Dipartimento di Scienze Mediche e Chirurgiche Avanzate, Università della Campania "Luigi Vanvitelli", Napoli
| | - Roberto Pontremoli
- Università degli Studi di Genova ed IRCCS Ospedale Policlinico San Martino, Genova
| | - Francesco Romeo
- Dipartimento di Cardiologia, International University "Unicamillus", Roma
| | - Piero Ruggenenti
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli - Unità di Nefrologia ed Avvio al Trapianto, ASST Papa Giovanni XXIII, Bergamo
| | - Claudio Ronco
- U.O.C. Nefrologia Dialisi e Trapianto, Ospedale San Bortolo, Vicenza
| | - Antonio Santoro
- U.O.C. Nefrologia, Dialisi ed Ipertensione, Policlinico S. Orsola-Malpighi, Bologna
| | - Gianfranco Sinagra
- Cardiologia Universitaria, Azienda Universitario-Ospedaliera Policlinico di Bari, Bari
| | - Carmen Spaccarotella
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli "Federico II", Napoli
| | - Dauphine Zippo
- Dipartimento di Specialità Medico-Chirurgiche, Scienze Radiologiche e Sanità Pubblica, Università degli Studi, Brescia
| | - Carmine Zoccali
- CNR-IFC Epidemiologia Clinica e Fisiopatologia delle Malattie Renali e dell'Ipertensione Arteriosa, Azienda Ospedaliera di Reggio Calabria
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi "Magna Graecia", Catanzaro - Mediterranea Cardiocentro, Napoli
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12
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Muscoli S, Lecis D, Prandi FR, Ylli D, Chiocchi M, Cammalleri V, Lauro D, Andreadi A. Risk of sudden cardiac death in a case of spontaneous coronary artery dissection presenting with thyroid storm. Eur Rev Med Pharmacol Sci 2022; 26:3712-3717. [PMID: 35647853 DOI: 10.26355/eurrev_202205_28867] [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: 06/15/2023]
Abstract
OBJECTIVE Spontaneous coronary artery dissection (SCAD) is a spontaneous separation of the coronary artery wall whose etiology appears to be poorly understood. SCAD is a rare cause of acute coronary syndromes, and it is a life-threatening condition. CASE REPORT We report the case of a young woman who developed SCAD during a thyroid storm (TS). RESULTS To the best of our knowledge, this is the first reported case of SCAD during a TS, and it suggests a possible association between high levels of circulating thyroid hormones and SCAD susceptibility. CONCLUSIONS Early identification of SCAD predisposing factors is important to identify high-risk patients. In patients presenting to the emergency department because of chest pain with a history of dysthyroidism, early determination of thyroid hormones and troponin could prevent certain forms of sudden cardiac death.
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Affiliation(s)
- S Muscoli
- Division of Cardiology, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
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13
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Prandi FR, Milite M, Celotto R, Lecis D, Marchei M, Romeo F, Barillà F. Antithrombotic therapy management in a man with ST elevation myocardial infarction and triple positive antiphospholipid syndrome: case report and literature review. Eur Rev Med Pharmacol Sci 2022; 26:755-758. [PMID: 35179741 DOI: 10.26355/eurrev_202202_27983] [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: 06/14/2023]
Abstract
OBJECTIVE Antiphospholipid syndrome (APS) is a systemic autoimmune disorder associated with vascular complications including acute myocardial infarction (AMI). AMI pathogenesis in APS is considered to be acute thrombosis of coronary arteries, in contrast to typical AMI where the pathogenesis is atherosclerotic plaque rupture. Therapeutic management is therefore a clinical challenge. There is no consensus among experts about optimal antithrombotic therapy in secondary prevention. The role of coronary stents is still to be determined, due to the higher rates of stent thrombosis after percutaneous coronary intervention (PCI) in APS patients. CASE REPORT We described the case of a 51-year-old male, smoker, that presented with anterior ST elevation myocardial infarction (STEMI) as first manifestation of APS. The patient underwent primary PCI on left main and ostial left anterior descending artery. RESULTS We discussed antithrombotic therapy management after PCI in our patient and reviewed literature on current therapeutic management of this specific population. CONCLUSIONS APS patients with STEMI should undergo PCI, usually associated with thrombus aspiration, and in select cases stent implantation in the culprit lesion. In the latter case, triple antithrombotic therapy with short-term dual antiplatelet therapy and long-term anticoagulant therapy is recommended. Clinicians should include autoimmune etiologies in the differential diagnosis of underlying causes of AMI.
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Affiliation(s)
- F R Prandi
- Division of Cardiology, University of Rome Tor Vergata, Rome, Italy.
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14
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Milite M, Celotto R, Sanseviero A, Lecis D, Benedetto D, Di Luozzo M, Barillà F. 462 Accidental detection of an anomalous origin of the coronary arteries in a patient with STEMI: a case report. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Coronary artery anomalies and variants are relatively uncommon congenital disorders of the coronary artery anatomy and constitute the second most common cause of sudden cardiac death in young competitive athletes. Normally there are two main coronary arteries, which stem from the sinuses of Valsalva and descend towards the cardiac apex. The most frequent anomalous origin of the coronary arteries associated with sudden cardiac death is the anomalous origin of a coronary artery from the contralateral sinus, particularly if the anomalous coronary artery has a course between the aorta and the pulmonary artery. The diagnosis of a coronary artery anomaly is insidious since patients are usually asymptomatic. Indeed, in most of the cases, coronary anomalies are discovered incidentally during coronary angiography or on autopsy following sudden cardiac death. However, in some cases, symptoms like angina, syncope, heart failure, and myocardial infarction may occur. We want to describe the case of a 54 years old man who went to another hospital of our district with chest pain. The EKG showed an infero-lateral STEMI. The patient underwent systemic thrombolysis complicated by arrhythmic storm, treated with effective DC shock, then he was urgently transferred to our Hospital to perform a PCI rescue. The coronary angiography showed a critical stenosis of the right coronary artery, treated with the implantation of a zotarolimus-eluting coronary stent system. Surprisingly, an abnormal origin of the anterior interventricular artery and circumflex artery from seperated hosts in the right coronary sinus was detected. A computed tomography showed the separated origin of the right coronary artery and the left main from the right coronary sinus; moreover, the left main presented a retroaortic course between the bulb and the left atrium; the left anterior intraventricular artery run anterior to the aortic root. During hospitalization, a diagnosis of diabetes was made with consequent setting of adequate hypoglycemic therapy. Serial echocardiograms showed an improval in the ejection fraction (from 35–40% to 50%). The patient was discharged in well clinical conditions and 1 month later at the follow-up, during an outpatient visit, he was fully asymptomatic. The dynamic EKG according to Holter showed rare isolated ventricular beats; laboratory tests were normal. The anomalous origin of a coronary ostium from the contralateral sinus is the most frequently anomaly which is associated with sudden cardiac death, in particular when the left coronary artery origins from the right sinus. The rapid advancement of the imaging techniques, including CT, CMR, intravascular ultrasound, and optical coherence tomography, have provided us with a wealth of new information on this subject. Coronary artery CT offers the best performance in terms of spatial resolution, acquisition time, and image contrast but the use is limited due the dose of ionizing radiation and the use of contrast agents, in particular taking into account that most patients are young. CMR is capable of visualizing the origin of the coronary arteries non-invasively, without use of ionizing radiation and contrast agents. Currently however, due to spatial resolution, the capability of CMR to visualize smaller coronary branches is still a limiting factor preventing full assessment of coronary arteries using this modality. Developments and more widespread access to advanced cardiac imaging will undoubtedly lead to earlier diagnoses. The taxonomies of the anomalous origin of coronary arteries are inconsistent and complex and so we want to make our contribution to the register of cases of abnormal origin of coronary arteries for the risk of sudden cardiac death and ischaemic events related to.
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15
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Lecis D, Muscoli S, Marchei M, Sergi D, Di Luozzo M, Prandi FR, Sanseviero A, Belli M, Idone G, Cammalleri V, Romeo F, Barillà F. 733 Evaluation of pulmonary pressures in patients underwent to MitraClip. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab147.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Mitral regurgitation (MR) is the second most frequent valve heart disease in Europe and its underlying mechanism primary-organic (due to disease of the mitral leaflets), or secondary-functional (where valve leaflets and chordae are structurally normal and MR results from alterations in left ventricle and left atrium geometry), determines the therapeutic approach. Transcatheter Edge-to-Edge Repair (TEER) with MitraClip implantation is a minimal-invasive treatment that according to 2021 ESC Guidelines should be considered (class indication IIa) in selected symptomatic patients with severe MR despite optimal medical therapy, not eligible for surgery and fulfilling COAPT trial inclusion criteria, suggesting an increased chance of responding to treatment. Optimal valve morphology features for TEER are central pathology (second scallop), no leaflet calcifications, mitral valve area >4 cm2, mobile length of posterior leaftel >10 mm, coaptation depth <11mm, normal leaflet strength and mobility, flail width <15 mm, flail gap <10 mm. TEER may be considered (class IIb) only in selected cases when the COAPT criteria are not fulfilled with the aim of improving symptoms and quality of life. MR occurs during systole, that at normal heart rates represents 30–50% of the cardiac cycle. As such, marked left atrial (LA) pressure elevation is present only transiently, representing less of a drive to development of secondary pulmonary hypertension compared to chronic LA pressure elevation seen in severe mitral stenosis. Anyway, in patients with severe MR echocardiography often reveals elevated systolic pulmonary artery pressure (PAPs) and MitraClip implantation usually is associated with a slight increase of the trans-mitral gradient with possible repercussions on pulmonary pressures. To better describe the effect of MitraClip implantation on pulmonary pressures and clinical outcomes we did a retrospective study enrolling in the period 2012–2021 25 patients with severe mitral regurgitation treated with TEER. We aimed to evaluate the clinical outcomes (symptoms, signs of heart failure, NYHA functional class) and the pulmonary pressures assessed by an echocardiographic examination before and after the intervention. At 6-month follow-up all patients with repaired mitral regurgitation showed an improvement in the NYHA class (from IV to II) and no need for re-hospitalization. We observed a trend in the reduction of the mean sistolic pulmonary arterial pressure of 2.68 mmHg ± 15 mmHg (P 0.39, 95% C.I. −9.03 to 3.67) with an unchanged left ventricle ejection fraction. Moreover, the echocardiographic exam showed a normalization of the S and D waves pattern in the pulmonary veins at the PW Doppler evaluation. We can assume that the clinical improvement and the reduction of dyspnoea in these patients underwent TEER is related to a reduction of pressures in the pulmonary circulation regardless of the ejection fraction. This finding could be used as a tool that the cardiologist has to evaluate in the echocardiography lab to reveal a new mitral valve disfunction. Considering the small sample, a greater number of patients will be enrolled to highlight the statistical significance.
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Affiliation(s)
- Dalgisio Lecis
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Saverio Muscoli
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Massimo Marchei
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Domenico Sergi
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Marco Di Luozzo
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | | | - Angela Sanseviero
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Martina Belli
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Gaetano Idone
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Valeria Cammalleri
- Department of Cardiology, Policlinico Universitario Campus Bio-Medico, Rome, Italy
| | | | - Francesco Barillà
- Department of Cardiology, Fondazione Policlinico Tor Vergata, Rome, Italy
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Prandi FR, Milite M, Celotto R, Lecis D, Marchei M, Romeo F, Barillà F. 432 ACS-STEMI in a young man with triple positive antiphospholipid syndrome: clinical implications about antithrombotic therapy management. Eur Heart J Suppl 2021. [DOI: 10.1093/eurheartj/suab140.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Antiphospholipid antibody syndrome (APS) is a systemic autoimmune disorder characterized by venous and arterial thromboembolic (TE) disease, and/or pregnancy morbidity, associated with persistent elevated antiphospholipid antibodies (lupus anticoagulant, LA, anticardiolipin, aCL, and anti-beta2-glycoprotein I, anti-β2GPI). A 51 year-old man, smoker, presented to our ER with chest pain. EKG showed Q waves and STE in the anterior leads, with increased troponin levels. A diagnosis of anterior STEMI was made and he was taken into our catheterization laboratory, where a high burden thrombotic plaque determining LM and ostial LAD subocclusion was treated with PPCI and a DES implantation; in addition, multiple failed PCI attempts were performed on a distal LAD occlusion, and an integrilin bolus was administered. The patient was admitted to our CICU and a DAPT with ASA and Ticagrelor was started. TTE showed LVEF 40%, apical akinesis, septal and anterior hypokinesis, and no significant valve disease. An aPTT abnormal value (100.5 s; reference range 25–38.5 s) was detected, not corrected by aPTT mixing study. Given suspected autoimmune prothrombotic state, normal Hb and PLT values and low bleeding risk, LMWH 100 IU/kg every 12 h was started, in addition to DAPT with switch from Ticagrelor to Clopidogrel. LA and aCL and anti-β2GPI IgG were positive, with negativity of others rheumatologic tests, confirming primary APS diagnosis. Repeat TTE showed EF 50%. The patient was discharged in ‘triple therapy’ (DAPT plus LMWH), and referred to the rheumatology clinic. LA, aCL, and anti-β2GPI tests 12 weeks later were positive, confirming a triple positive APS and satisfying revised Sapporo criteria. The rheumatologist switched therapy to Clopidogrel plus Warfarin. At 3 months follow-up, the patient, former smoker, was asymptomatic and TTE confirmed EF 50%, so he was recommended to continue with his medical therapy. APS is rarely associated with AMI (∼5.5%) and in only 2.8% cases AMI represents the onset of the disease. AMI pathogenesis in APS is considered to be acute thrombosis of coronary arteries, in contrast with atherosclerotic plaque rupture in typical AMI. Key discriminators to identify APS as potential underlying cause of AMI include young age, previous unprovoked thromboses, low platelets count (they are consumed in the thrombotic process), high aPTT value (LA may interfere with assembly of the prothrombinase complex on phospholipids), coronary artery thromboses in the setting of otherwise normal otherwise appearing coronary arteries. APS antibodies have also pro-inflammatory activity on vascular endothelial cells, leading to accelerated atherosclerosis. aGAPSS score (high risk ≥10) is useful for risk stratification of recurrent thrombosis and AMI in young patients with APS. The treatment of AMI in APS is therefore a clinical challenge. Strict management of additional CV risk factors is crucial. VKA (INR >3 with Warfarin, INR2–3 with Warfarin and ASA) should be provided for life, because of the very high risk of recurrent TE. DOACs are less effective and less safe than VKAs for TE prevention in APS. The role of coronary stents, considering higher rates of stent thrombosis after PCI in APS patients triple therapy concomitant risks, requires further studies. Due to lack of large, randomized, prospective studies, there is no clear experts consensus about optimal antithrombotic therapy in secondary prevention after arterial TE. APS patients with STEMI should undergo PCI, usually associated with thrombus aspiration, and in selected cases DES implantation in culprit lesion followed by triple antithrombotic therapy with short-term DAPT and long-term VKA.
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Affiliation(s)
| | | | - Roberto Celotto
- UOC Cardiologia, Università degli Studi di Roma Tor Vergata, Italy
| | - Dalgisio Lecis
- UOC Cardiologia, Università degli Studi di Roma Tor Vergata, Italy
| | - Massimo Marchei
- UOC Cardiologia, Università degli Studi di Roma Tor Vergata, Italy
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Massaro G, Lecis D, Martuscelli E, Chiricolo G, Sangiorgi GM. Clinical Features and Management of COVID-19–Associated Hypercoagulability. Card Electrophysiol Clin 2021; 14:41-52. [PMID: 35221084 PMCID: PMC8556574 DOI: 10.1016/j.ccep.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Abstract
Atherosclerotic cardiovascular disease is a leading cause of death and morbidity globally. Over the past several years, arterial inflammation has been implicated in the pathophysiology of athero-thrombosis, substantially confirming what pathologist Rudolf Virchow had observed in the 19th century. Lipid lowering, lifestyle changes, and modification of other risk factors have reduced cardiovascular complications of athero-thrombosis, but a substantial residual risk remains. In view of the pathogenic role of inflammation in athero-thrombosis, directly targeting inflammation has emerged as an additional potential therapeutic option; and some early promising results have been suggested by the Canakinumab Anti-inflammatory Thrombosis Outcome Study (CANTOS), in which canakinumab, a fully human monoclonal antibody targeting the pro-inflammatory and pro-atherogenic cytokine interleukin 1 beta, was shown to reduce cardiovascular events.
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Affiliation(s)
- Prediman K Shah
- Helga and Walter Oppenheimer Atherosclerosis Research Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Dalgisio Lecis
- Helga and Walter Oppenheimer Atherosclerosis Research Center, Smidt Heart Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA.,Department of Cardiovascular Medicine, "Tor Vergata" University of Rome, Rome, Italy
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Melchiorri G, Viero V, Sorge R, Triossi T, Campagna A, Volpe SL, Lecis D, Tancredi V, Andreoli A. Body composition analysis to study long-term training effects in elite male water polo athletes. J Sports Med Phys Fitness 2018. [DOI: 10.23736/s0022-4707.17.07208-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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D'Amario D, Leone AM, Narducci ML, Smaldone C, Lecis D, Inzani F, Luciani M, Siracusano A, La Neve F, Manchi M, Pelargonio G, Perna F, Bruno P, Massetti M, Pitocco D, Cappetta D, Esposito G, Urbanek K, De Angelis A, Rossi F, Piacentini R, Angelini G, Li Puma DD, Grassi C, De Paolis E, Capoluongo E, Silvestri V, Merlino B, Marano R, Crea F. Human cardiac progenitor cells with regenerative potential can be isolated and characterized from 3D-electro-anatomic guided endomyocardial biopsies. Int J Cardiol 2017; 241:330-343. [PMID: 28343765 DOI: 10.1016/j.ijcard.2017.02.106] [Citation(s) in RCA: 5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 02/01/2017] [Accepted: 02/21/2017] [Indexed: 01/26/2023]
Abstract
AIMS In the present study, we aimed to develop a percutaneous approach and a reproducible methodology for the isolation and expansion of Cardiac Progenitor Cells (CPCs) from EndoMyocardial Biopsies (EMB) in vivo. Moreover, in an animal model of non-ischemic heart failure (HF), we would like to test whether CPCs obtained by this methodology may engraft the myocardium and differentiate. METHODS AND RESULTS EMB were obtained using a preformed sheath and a disposable bioptome, advanced via right femoral vein in 12 healthy mini pigs, to the right ventricle. EMB were enzymatically dissociated, cells were expanded and sorted for c-kit. We used 3D-Electro-Anatomic Mapping (3D-EAM) to obtain CPCs from 32 patients affected by non-ischemic cardiomyopathy. The in vivo regenerative potential of CPCs was tested in a rodent model of drug-induced non-ischemic cardiomyopathy. c-kit positive CPCs replicative capacity was assessed in 30 patients. Telomere length averaged 7.4±0.4kbp and telomerase activity was present in all preparations (1.7×105 copies). The in situ hybridization experiments showed that injected human CPCs may acquire a neonatal myocyte phenotype given the expression of the alpha-sarcomeric actin together with the presence of the Alu probe, suggesting a beneficial impact on LV performance. CONCLUSIONS The success in obtaining CPCs characterized by high regenerative potential, in vitro and in vivo, from EMB indicates that harvesting without thoracotomy in patients affected by either ischemic or non-ischemic cardiomyopathy is feasible. These initial results may potentially expand the future application of CPCs to all patients affected by HF not undergoing surgical procedures.
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Affiliation(s)
- Domenico D'Amario
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
| | - Antonio Maria Leone
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Lucia Narducci
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Costantino Smaldone
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Dalgisio Lecis
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Frediano Inzani
- Department of Pathology, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Luciani
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Andrea Siracusano
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Federica La Neve
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Melissa Manchi
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Gemma Pelargonio
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Perna
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimo Massetti
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - Dario Pitocco
- Institute of Internal Medicine and Diabetes Care Unit, Catholic University of the Sacred Heart, Rome, Italy
| | - Donato Cappetta
- Department of Experimental Medicine, Section of Pharmacology, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Grazia Esposito
- Department of Experimental Medicine, Section of Pharmacology, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Konrad Urbanek
- Department of Experimental Medicine, Section of Pharmacology, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonella De Angelis
- Department of Experimental Medicine, Section of Pharmacology, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Section of Pharmacology, Università della Campania "Luigi Vanvitelli", Naples, Italy
| | - Roberto Piacentini
- Institute of Human Physiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia Angelini
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | | | - Claudio Grassi
- Institute of Human Physiology, Catholic University of the Sacred Heart, Rome, Italy; San Raffaele Pisana Scientific Institute for Research, Hospitalization and Health Care, Rome, Italy
| | - Elisa De Paolis
- Laboratory of Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
| | - Ettore Capoluongo
- Laboratory of Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Silvestri
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Biagio Merlino
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Riccardo Marano
- Department of Radiological Sciences, Institute of Radiology, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart, Rome, Italy.
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Anania M, Cetti E, Lecis D, Cleris L, Mazzoni M, Pagliardini S, Manenti G, Greco A. Targeting COPZ1 in thyroid tumour cells. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)61329-1] [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: 10/21/2022]
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Carlessi L, Poli EF, Bechi G, Mantegazza M, Pascucci B, Narciso L, Dogliotti E, Sala C, Verpelli C, Lecis D, Delia D. Functional and molecular defects of hiPSC-derived neurons from patients with ATM deficiency. Cell Death Dis 2014; 5:e1342. [PMID: 25032865 PMCID: PMC4123100 DOI: 10.1038/cddis.2014.310] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 05/30/2014] [Accepted: 06/16/2014] [Indexed: 11/21/2022]
Abstract
Loss of ataxia telangiectasia mutated (ATM) kinase, a key factor of the DNA damage response (DDR) pathway, causes the cancer predisposing and neurodegenerative syndrome ataxia-telangiectasia (A-T). To investigate the mechanisms of neurodegeneration, we have reprogrammed fibroblasts from ATM-null A-T patients and normal controls to pluripotency (human-induced pluripotent stem cells), and derived from these neural precursor cells able to terminally differentiate into post-mitotic neurons positive to >90% for β-tubulin III+/microtubule-associated protein 2+. We show that A-T neurons display similar voltage-gated potassium and sodium currents and discharges of action potentials as control neurons, but defective expression of the maturation and synaptic markers SCG10, SYP and PSD95 (postsynaptic density protein 95). A-T neurons exhibited defective repair of DNA double-strand breaks (DSBs) and repressed phosphorylation of ATM substrates (e.g., γH2AX, Smc1-S966, Kap1-S824, Chk2-T68, p53-S15), but normal repair of single-strand breaks, and normal short- and long-patch base excision repair activities. Moreover, A-T neurons were resistant to apoptosis induced by the genotoxic agents camptothecin and trabectedin, but as sensitive as controls to the oxidative agents. Most notably, A-T neurons exhibited abnormal accumulation of topoisomerase 1-DNA covalent complexes (Top1-ccs). These findings reveal that ATM deficiency impairs neuronal maturation, suppresses the response and repair of DNA DSBs, and enhances Top1-cc accumulation. Top1-cc could be a risk factor for neurodegeneration as they may interfere with transcription elongation and promote transcriptional decline.
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Affiliation(s)
- L Carlessi
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - E Fusar Poli
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - G Bechi
- Department of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Amadeo 42, 20133 Milano, Italy
| | - M Mantegazza
- Department of Neurophysiopathology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Amadeo 42, 20133 Milano, Italy
- Institute of Molecular and Cellular Pharmacology (IPMC) CNRS UMR7275 and University of Nice-Sophia Antipolis, 660 Route des Lucioles, 06560 Valbonne, France
| | - B Pascucci
- CNR Institute of Crystallography, Via Salaria, Km. 29.300, 00016 Monterotondo Scalo, Roma, Italy
| | - L Narciso
- Department of Food Safety and Veterinary Public Health, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - E Dogliotti
- Department of Environment and Primary Prevention, Istituto Superiore di Sanità, Viale Regina Elena 299, 00161 Roma, Italy
| | - C Sala
- CNR Institute of Neuroscience and Department of Biotechnology and Translational Medicine, Via Vanvitelli 32, 20129 Milano, Italy
| | - C Verpelli
- CNR Institute of Neuroscience and Department of Biotechnology and Translational Medicine, Via Vanvitelli 32, 20129 Milano, Italy
| | - D Lecis
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
| | - D Delia
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Amadeo 42, 20133 Milano, Italy
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23
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Mingozzi M, Manzoni L, Arosio D, Dal Corso A, Manzotti M, Innamorati F, Pignataro L, Lecis D, Delia D, Seneci P, Gennari C. Synthesis and biological evaluation of dual action cyclo-RGD/SMAC mimetic conjugates targeting αvβ3/αvβ5 integrins and IAP proteins. Org Biomol Chem 2014; 12:3288-302. [DOI: 10.1039/c4ob00207e] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Dual action cyclo-RGD/SMAC mimetic conjugates endowed with in vitro activity against anti-apoptotic IAPs and pro-angiogenetic integrins are reported.
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Affiliation(s)
- M. Mingozzi
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - L. Manzoni
- Istituto di Scienze e Tecnologie Molecolari
- Consiglio Nazionale delle Ricerche
- I-20133 Milano, Italy
| | - D. Arosio
- Istituto di Scienze e Tecnologie Molecolari
- Consiglio Nazionale delle Ricerche
- I-20133 Milano, Italy
| | - A. Dal Corso
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - M. Manzotti
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - F. Innamorati
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - L. Pignataro
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - D. Lecis
- Fondazione IRCCS Istituto Nazionale dei Tumori
- Dipartimento di Oncologia Sperimentale e Medicina Molecolare
- I-20133 Milan, Italy
| | - D. Delia
- Fondazione IRCCS Istituto Nazionale dei Tumori
- Dipartimento di Oncologia Sperimentale e Medicina Molecolare
- I-20133 Milan, Italy
| | - P. Seneci
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
| | - C. Gennari
- Università degli Studi di Milano
- Dipartimento di Chimica
- Milan, Italy
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Lecis D, De Cesare M, Perego P, Conti A, Corna E, Drago C, Seneci P, Walczak H, Colombo MP, Delia D, Sangaletti S. Smac mimetics induce inflammation and necrotic tumour cell death by modulating macrophage activity. Cell Death Dis 2013; 4:e920. [PMID: 24232096 PMCID: PMC3847325 DOI: 10.1038/cddis.2013.449] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 06/10/2013] [Revised: 10/11/2013] [Accepted: 10/15/2013] [Indexed: 12/30/2022]
Abstract
Smac mimetics (SMs) comprise a class of small molecules that target members of the inhibitor of apoptosis family of pro-survival proteins, whose expression in cancer cells hinders the action of conventional chemotherapeutics. Herein, we describe the activity of SM83, a newly synthesised dimeric SM, in two cancer ascites models: athymic nude mice injected intraperitoneally with IGROV-1 human ovarian carcinoma cells and immunocompetent BALB/c mice injected with murine Meth A sarcoma cells. SM83 rapidly killed ascitic IGROV-1 and Meth A cells in vivo (prolonging mouse survival), but was ineffective against the same cells in vitro. IGROV-1 cells in nude mice were killed within the ascites by a non-apoptotic, tumour necrosis factor (TNF)-dependent mechanism. SM83 administration triggered a rapid inflammatory event characterised by host secretion of TNF, interleukin-1β and interferon-γ. This inflammatory response was associated with the reversion of the phenotype of tumour-associated macrophages from a pro-tumoural M2- to a pro-inflammatory M1-like state. SM83 treatment was also associated with a massive recruitment of neutrophils that, however, was not essential for the antitumoural activity of this compound. In BALB/c mice bearing Meth A ascites, SM83 treatment was in some cases curative, and these mice became resistant to a second injection of cancer cells, suggesting that they had developed an adaptive immune response. Altogether, these results indicate that, in vivo, SM83 modulates the immune system within the tumour microenvironment and, through its pro-inflammatory action, leads cancer cells to die by necrosis with the release of high-mobility group box-1. In conclusion, our work provides evidence that SMs could be more therapeutically active than expected by stimulating the immune system.
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Affiliation(s)
- D Lecis
- Department of Experimental Oncology and Molecular Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan 20133, Italy
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Lecis D, Drago C, Manzoni L, Seneci P, Scolastico C, Mastrangelo E, Bolognesi M, Anichini A, Kashkar H, Walczak H, Delia D. Novel SMAC-mimetics synergistically stimulate melanoma cell death in combination with TRAIL and Bortezomib. Br J Cancer 2010; 102:1707-16. [PMID: 20461078 PMCID: PMC2883696 DOI: 10.1038/sj.bjc.6605687] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [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] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND XIAP (X-linked inhibitor of apoptosis protein) is an anti-apoptotic protein exerting its activity by binding and suppressing caspases. As XIAP is overexpressed in several tumours, in which it apparently contributes to chemoresistance, and because its activity in vivo is antagonised by second mitochondria-derived activator of caspase (SMAC)/direct inhibitor of apoptosis-binding protein with low pI, small molecules mimicking SMAC (so called SMAC-mimetics) can potentially overcome tumour resistance by promoting apoptosis. METHODS Three homodimeric compounds were synthesised tethering a monomeric SMAC-mimetic with different linkers and their affinity binding for the baculoviral inhibitor repeats domains of XIAP measured by fluorescent polarisation assay. The apoptotic activity of these molecules, alone or in combination with tumour necrosis factor-related apoptosis-inducing ligand (TRAIL) and/or Bortezomib, was tested in melanoma cell lines by MTT viability assays and western blot analysis of activated caspases. RESULTS We show that in melanoma cell lines, which are typically resistant to chemotherapeutic agents, XIAP knock-down sensitises cells to TRAIL treatment in vitro, also favouring the accumulation of cleaved caspase-8. We also describe a new series of 4-substituted azabicyclo[5.3.0]alkane monomeric and dimeric SMAC-mimetics that target various members of the IAP family and powerfully synergise at submicromolar concentrations with TRAIL in inducing cell death. Finally, we show that the simultaneous administration of newly developed SMAC-mimetics with Bortezomib potently triggers apoptosis in a melanoma cell line resistant to the combined effect of SMAC-mimetics and TRAIL. CONCLUSION Hence, the newly developed SMAC-mimetics effectively synergise with TRAIL and Bortezomib in inducing cell death. These findings warrant further preclinical studies in vivo to verify the anticancer effectiveness of the combination of these agents.
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Affiliation(s)
- D Lecis
- Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Via G Venezian 1, 20133 Milano, Italy
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Carlessi L, De Filippis L, Lecis D, Vescovi A, Delia D. DNA-damage response, survival and differentiation in vitro of a human neural stem cell line in relation to ATM expression. Cell Death Differ 2009; 16:795-806. [PMID: 19229246 DOI: 10.1038/cdd.2009.10] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Ataxia-telangiectasia (A-T) is a neurodegenerative disorder caused by defects in the ATM kinase, a component of the DNA-damage response (DDR). Here, we employed an immortalized human neural stem-cell line (ihNSC) capable of differentiating in vitro into neurons, oligodendrocytes and astrocytes to assess the ATM-dependent response and outcome of ATM ablation. The time-dependent differentiation of ihNSC was accompanied by an upregulation of ATM and DNA-PK, sharp downregulation of ATR and Chk1, transient induction of p53 and by the onset of apoptosis in a fraction of cells. The response to ionizing radiation (IR)-induced DNA lesions was normal, as attested by the phosphorylation of ATM and some of its substrates (e.g., Nbs1, Smc1, Chk2 and p53), and by the kinetics of gamma-H2AX nuclear foci formation. Depletion in these cells of ATM by shRNA interference (shATM) attenuated the differentiation-associated apoptosis and response to IR, but left unaffected the growth, self-renewal and genomic stability. shATM cells generated a normal number of MAP2/beta-tubulin III+ neurons, but a reduced number of GalC+ oligodendrocytes, which were nevertheless more susceptible to oxidative stress. Altogether, these findings highlight the potential of ihNSCs as an in vitro model system to thoroughly assess, besides ATM, the role of DDR genes in neurogenesis and/or neurodegeneration.
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Affiliation(s)
- L Carlessi
- Department of Experimental Oncology, Fondazione IRCSS Istituto Nazionale Tumori, Milan, Italy
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