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Damanti S, Cristel G, Ramirez GA, Bozzolo EP, Da Prat V, Gobbi A, Centurioni C, Di Gaeta E, Del Prete A, Calabrò MG, Calvi MR, Borghi G, Zangrillo A, De Cobelli F, Landoni G, Tresoldi M. Influence of reduced muscle mass and quality on ventilator weaning and complications during intensive care unit stay in COVID-19 patients. Clin Nutr 2022; 41:2965-2972. [PMID: 34465493 PMCID: PMC8364854 DOI: 10.1016/j.clnu.2021.08.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/27/2023]
Abstract
BACKGROUND & AIMS Sarcopenia, a loss of muscle mass, quality and function, which is particularly evident in respiratory muscles, has been associated with many clinical adverse outcomes. In this study, we aimed at evaluating the role of reduced muscle mass and quality in predicting ventilation weaning, complications, length of intensive care unit (ICU) and of hospital stay and mortality in patients admitted to ICU for SARS-CoV-2-related pneumonia. METHODS This was an observational study based on a review of medical records of all adult patients admitted to the ICU of a tertiary hospital in Milan and intubated for SARS-CoV-2-related pneumonia during the first wave of the COVID-19 pandemic. Muscle mass and quality measurement were retrieved from routine thoracic CT scans, when sections passing through the first, second or third lumbar vertebra were available. RESULTS A total of 81 patients were enrolled. Muscle mass was associated with successful extubation (OR 1.02, 95% C.I. 1.00-1.03, p = 0.017), shorter ICU stay (OR 0.97, 95% C.I. 0.95-0.99, p = 0.03) and decreased hospital mortality (HR 0.98, 95% C.I. 0.96-0.99, p = 0.02). Muscle density was associated with successful extubation (OR 1.07, 95% C.I. 1.01-1.14; p = 0.02) and had an inverse association with the number of complications in ICU (Β -0.07, 95% C.I. -0.13 - -0.002, p = 0.03), length of hospitalization (Β -1.36, 95% C.I. -2.21 - -0.51, p = 0.002) and in-hospital mortality (HR 0.88, 95% C.I. 0.78-0.99, p = 0.046). CONCLUSIONS Leveraging routine CT imaging to measure muscle mass and quality might constitute a simple, inexpensive and powerful tool to predict survival and disease course in patients with COVID-19. Preserving muscle mass during hospitalisation might have an adjuvant role in facilitating remission from COVID-19.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy,Corresponding author. Unit of General Medicine and Advanced Care, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Giulia Cristel
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Valentina Da Prat
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
| | - Agnese Gobbi
- Vita-Salute San Raffaele University, Milano, Italy
| | | | - Ettore Di Gaeta
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Andrea Del Prete
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy,Vita-Salute San Raffaele University, Milano, Italy
| | - Maria Grazia Calabrò
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Rosa Calvi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Borghi
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alberto Zangrillo
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco De Cobelli
- Department of Radiology, Centre for Experimental Imaging, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giovanni Landoni
- Vita-Salute San Raffaele University, Milano, Italy,Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Italy
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Ramirez GA, Argolini LM, Schioppo T, Sciascia S, Moroni L, Moroni G, Sinico RA, Bonelli G, Alberici F, Mescia F, Tamborini F, Miraglia P, Bellocchi C, Beretta L, Roccatello D, Bozzolo EP, Caporali R, Gerosa M, Dagna L. Chronic glucocorticoid maintenance treatment is associated with the risk of SARS-CoV-2 infection in patients with systemic lupus erythematosus who received vaccination. Ann Rheum Dis 2022; 81:annrheumdis-2022-222832. [PMID: 35922121 DOI: 10.1136/ard-2022-222832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/13/2022] [Indexed: 11/04/2022]
Affiliation(s)
- Giuseppe A Ramirez
- Università Vita-Salute San Raffaele, Milano, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Lorenza Maria Argolini
- Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Lombardia, Italy
- Unit of Rheumatology, ASST Gaetano Pini, Milano, Italy
| | - Tommaso Schioppo
- Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Lombardia, Italy
- Unit of Rheumatology, ASST Gaetano Pini, Milano, Italy
| | - Savino Sciascia
- Research Centre of Immunopathology coordinating Centre of the Network for Rare Diseases of Piedmont and Aosta Valley, Ospedale San Giovanni Bosco, Torino, Piemonte, Italy
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| | - Luca Moroni
- Università Vita-Salute San Raffaele, Milano, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Gabriella Moroni
- Department of Internal Medicine, Humanitas University, Milan, Italy
- Department of Biomedical Sciences, IRCCS Humanitas Research Hospital, Rozzano, Lombardia, Italy
| | - Renato Alberto Sinico
- Nephrology Unit, University of Milano Bicocca, Milano, Italy
- Unit of Nephrology, ASST di Monza, Monza, Lombardia, Italy
| | - Grazia Bonelli
- Unit of Nephrology, ASST di Monza, Monza, Lombardia, Italy
| | - Federico Alberici
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Unit of Nephrology, Spedali Civili Hospital, Brescia, Italy
| | - Federica Mescia
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- Unit of Nephrology, Spedali Civili Hospital, Brescia, Italy
| | - Francesco Tamborini
- Nephrological Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, milano, Italy
| | - Paolo Miraglia
- Research Centre of Immunopathology coordinating Centre of the Network for Rare Diseases of Piedmont and Aosta Valley, Ospedale San Giovanni Bosco, Torino, Piemonte, Italy
| | - Chiara Bellocchi
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Clinical Science of Community Health, Section of Internal Medicine, Università degli Studi di Milano, Milano, Italy
| | - Lorenzo Beretta
- Referral Center for Systemic Autoimmune Diseases, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Dario Roccatello
- Research Centre of Immunopathology coordinating Centre of the Network for Rare Diseases of Piedmont and Aosta Valley, Ospedale San Giovanni Bosco, Torino, Piemonte, Italy
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| | - Enrica Paola Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Roberto Caporali
- Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Lombardia, Italy
- Unit of Rheumatology, ASST Gaetano Pini, Milano, Italy
| | - Maria Gerosa
- Department of Clinical Science of Community Health and Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milano, Lombardia, Italy
- Unit of Rheumatology, ASST Gaetano Pini, Milano, Italy
| | - Lorenzo Dagna
- Università Vita-Salute San Raffaele, Milano, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS Ospedale San Raffaele, Milano, Italy
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3
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Damanti S, Ramirez GA, Bozzolo EP, Da Prat V, Di Lucca G, Di Terlizzi G, Marinosci A, Scotti R, Strada S, Scarpellini P, Castiglioni B, Oltolini C, Ripa M, Din CT, Centurioni CE, Di Scala F, Gobbi A, Alba AC, Casiraghi GM, Morgillo A, Tresoldi M. Frailty as a predictor of mortality in COVID-19 patients receiving CPAP for respiratory insufficiency. Aging Clin Exp Res 2022; 34:945-949. [PMID: 35298829 PMCID: PMC8927756 DOI: 10.1007/s40520-021-02070-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 12/29/2021] [Indexed: 01/16/2023]
Abstract
Objective Exploring the association between frailty and mortality in a cohort of patients with COVID-19 respiratory insufficiency treated with continuous positive airway pressure. Methods Frailty was measured using a Frailty Index (FI) created by using the baseline assessment data on comorbidities and body mass index and baseline blood test results (including pH, lactate dehydrogenase, renal and liver function, inflammatory indexes and anemia). FI > 0.25 identified frail individuals. Results Among the 159 included individuals (81% men, median age of 68) frailty was detected in 69% of the patients (median FI score 0.3 ± 0.08). Frailty was associated to an increased mortality (adjusted HR 1.99, 95% CI 1.02–3.88, p = 0.04). Conclusions Frailty is highly prevalent among patients with COVID-19, predicts poorer outcomes independently of age. A personalization of care balancing the risk and benefit of treatments (especially the invasive ones) in such complex patients is pivotal. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-02070-z.
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Frangi C, Damanti S, Bozzolo EP, Scotti R, Di Lucca G, Tresoldi M. Dyspnea as a symptom of progressive chronic myeloproliferative disease: a rare case of hemorrhagic alveolitis and pulmonary fibrosis, due to extramedullary erythropoiesis. JGG 2022. [DOI: 10.36150/2499-6564-n479] [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: 11/06/2022]
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Damanti S, Ramirez GA, Bozzolo EP, Rovere-Querini P, De Lorenzo R, Magnaghi C, Scotti R, Di Lucca G, Marinosci A, Strada S, Di Terlizzi G, Vitali G, Martinenghi S, Compagnone N, Landoni G, Tresoldi M. 6-Month Respiratory Outcomes and Exercise Capacity of COVID-19 Acute Respiratory Failure Patients Treated With CPAP. Intern Med J 2021; 51:1810-1815. [PMID: 33961728 PMCID: PMC8242499 DOI: 10.1111/imj.15345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/30/2021] [Accepted: 04/14/2021] [Indexed: 01/08/2023]
Abstract
Background COVID‐19 long‐term sequelae are ill‐defined since only a few studies have explored the long‐term consequences of this disease so far. Aims To evaluate the 6‐month respiratory outcome and exercise capacity of COVID‐19 acute respiratory failure (ARF) patients treated with continuous positive airway pressure (CPAP) during the first wave of the ongoing COVID‐19 pandemic. Methods A retrospective observational study included COVID‐19 patients with ARF. Interventions included CPAP during hospitalisation and 6‐month follow up. Frailty assessment was carried out through frailty index (FI), pO2/FiO2 during hospitalisation and at follow up, respiratory parameters, 6‐min walking test (6MWT) and the modified British Medical Research Council (mMRC) and Borg scale at follow up. Results More than half of the patients had no dyspnoea according to the mMRC scale. Lower in‐hospital pO2/FiO2 correlated with higher Borg scale levels after 6MWT (ρ 0.27; P 0.04) at the follow‐up visit. FI was positively correlated with length of hospitalisation (ρ 0.3; P 0.03) and negatively with the 6MWT distance walked (ρ −0.36; P 0.004). Conclusions Robust and frail patients with COVID‐19 ARF treated with CPAP outside the intensive care unit setting had good respiratory parameters and exercise capacity at 6‐month follow up, although more severe patients had slightly poorer respiratory performance compared with patients with higher PaO2/FiO2 and lower FI.
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Affiliation(s)
- Sarah Damanti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Alvise Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Enrica Paola Bozzolo
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Patrizia Rovere-Querini
- Vita-Salute San Raffaele University, Milan, Italy.,Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Cristiano Magnaghi
- Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Raffaella Scotti
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giuseppe Di Lucca
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Alessandro Marinosci
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Silvia Strada
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Gaetano Di Terlizzi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
| | - Giordano Vitali
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali
| | - Sabina Martinenghi
- Internal Medicine, Diabetes and Endocrinology Unit, San Raffaele Hospital and Scientific Institute, San, Raffaele, Mali.,Diabetes Research Institute, San Raffaele Hospital and Scientific Institute, San Raffaele Vita Salute University, Milan, Italy
| | | | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Moreno Tresoldi
- Unit of General Medicine and Advanced Care, IRCCS San Raffaele Scientific Institute, Mali
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6
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Bettiol A, Sinico RA, Schiavon F, Monti S, Bozzolo EP, Franceschini F, Govoni M, Lunardi C, Guida G, Lopalco G, Paolazzi G, Vacca A, Gregorini G, Leccese P, Piga M, Conti F, Fraticelli P, Quartuccio L, Alberici F, Salvarani C, Bettio S, Negrini S, Selmi C, Sciascia S, Moroni G, Colla L, Manno C, Urban ML, Vannacci A, Pozzi MR, Fabbrini P, Polti S, Felicetti M, Marchi MR, Padoan R, Delvino P, Caporali R, Montecucco C, Dagna L, Cariddi A, Toniati P, Tamanini S, Furini F, Bortoluzzi A, Tinazzi E, Delfino L, Badiu I, Rolla G, Venerito V, Iannone F, Berti A, Bortolotti R, Racanelli V, Jeannin G, Padula A, Cauli A, Priori R, Gabrielli A, Bond M, Tedesco M, Pazzola G, Tomietto P, Pellecchio M, Marvisi C, Maritati F, Palmisano A, Dejaco C, Willeit J, Kiechl S, Olivotto I, Willeit P, Prisco D, Vaglio A, Emmi G. Risk of acute arterial and venous thromboembolic events in eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome). Eur Respir J 2021; 57:13993003.04158-2020. [PMID: 33833031 DOI: 10.1183/13993003.04158-2020] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 12/21/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Alessandra Bettiol
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Renato Alberto Sinico
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Franco Schiavon
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Sara Monti
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Enrica Paola Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Franco Franceschini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Marcello Govoni
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | | | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giuseppe Lopalco
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | | | - Angelo Vacca
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | | | - Pietro Leccese
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Matteo Piga
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Fabrizio Conti
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Fraticelli
- Dept of Internal Medicine, Clinica Medica, Ospedali Riuniti, Ancona, Italy
| | - Luca Quartuccio
- Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Federico Alberici
- Dept of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Nephrology Unit, Spedali Civili Hospital, Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy
| | - Carlo Salvarani
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Silvano Bettio
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Simone Negrini
- Internal Medicine, Clinical Immunology and Translational Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.,Centre of Excellence for Biomedical Research and Dept of Internal Medicine, University of Genoa, Genoa, Italy
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center IRCCS, Rozzano - Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Pieve Emanuele - Milan, Italy
| | - Savino Sciascia
- Center of Research of Immunopathology and Rare Diseases - Coordinating Center of the Network for Rare Diseases of Piedmont and Aosta Valley, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy.,SCU Nephrology and Dialysis, S. Giovanni Bosco Hospital, Dept of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Gabriella Moroni
- Nephrology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Loredana Colla
- Nephrology, Dialysis and Renal Transplant Division, Dept of Medical Sciences, "Città della Salute e della Scienza di Torino" University Hospital, University of Turin, Turin, Italy
| | - Carlo Manno
- Dept of Emergency and Organ Transplantation, Nephrology, Dialysis and Transplant Unit, University of Bari "Aldo Moro", Bari, Italy
| | - Maria Letizia Urban
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy
| | - Alfredo Vannacci
- Dept of Neurosciences, Psychology, Drug Research and Child Health (NEUROFARBA), University of Firenze, Firenze, Italy
| | - Maria Rosa Pozzi
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Paolo Fabbrini
- Nephrology Unit, Hospital San Gerardo Monza, University of Milano Bicocca, Milan, Italy
| | - Stefano Polti
- Dept of Medicine and Surgery, University of Milano - Bicocca and Nephrology Unit, ASST-Monza, Milan/Monza, Italy
| | - Mara Felicetti
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Maria Rita Marchi
- Respiratory Pathophysiology Division, University Hospital of Padova, Padova, Italy
| | - Roberto Padoan
- Operative Unit of Rheumatology, Dept of Medicine DIMED, University Hospital of Padova, Padova, Italy
| | - Paolo Delvino
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy.,University of Pavia, Pavia, Italy
| | - Roberto Caporali
- Division of Clinical Rheumatology, ASST Gaetano Pini-CTO Institute, Milan, Italy.,Dept of Clinical Sciences and Community Health, Research Center for Adult and Pediatric Rheumatic Diseases, Università degli Studi di Milano, Milan, Italy
| | - Carlomaurizio Montecucco
- Division of Rheumatology, IRCCS Policlinico S.Matteo Foundation and University of Pavia, Pavia, Italy
| | - Lorenzo Dagna
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Adriana Cariddi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases (UnIRAR), IRCCS-San Raffaele Scientific Institute, Milan, Italy
| | - Paola Toniati
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Silvia Tamanini
- Unit of Rheumatology and Clinical Immunology, University and ASST Spedali Civili, Brescia, Italy
| | - Federica Furini
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Alessandra Bortoluzzi
- Dept of Medical Sciences, University of Ferrara, Ferrara, Italy.,Rheumatology Unit, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Elisa Tinazzi
- Dept of Medicine, University of Verona, Verona, Italy
| | | | - Iuliana Badiu
- Allergy and Pneumology Unit, A.O.S. Croce e Carle, Cuneo, Italy
| | - Giovanni Rolla
- Dept of Medical Science, Allergy and Clinical Immunology, University of Torino and AO Ordine Mauriziano Umberto I, Turin, Italy
| | - Vincenzo Venerito
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Florenzo Iannone
- Rheumatology Unit, Dept of Emergency and Organ Transplantation (DETO), Polyclinic Hospital, University of Bari, Bari, Italy
| | - Alvise Berti
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy
| | | | - Vito Racanelli
- Dept of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari "Aldo Moro" Medical School, Bari, Italy
| | - Guido Jeannin
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy
| | - Angela Padula
- Rheumatology Dept of Lucania, San Carlo Hospital, Potenza, Italy
| | - Alberto Cauli
- Rheumatology, Dept of Medical Sciences and Public Health, University Clinic, Cagliari, Italy
| | - Roberta Priori
- Rheumatology Unit, Dept of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Armando Gabrielli
- Dept of Internal Medicine, Università Politecnica delle Marche, Ancona, Italy
| | - Milena Bond
- Dept of Rheumatology, Santa Chiara Hospital, Trento, Italy.,Rheumatology Clinic, Dept of Medicine (DAME), University of Udine, Udine, Italy
| | - Martina Tedesco
- Nephrology Unit, ASST Spedali Civili, Brescia, Italy.,Dept of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Giulia Pazzola
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Paola Tomietto
- Rheumatology Unit, Internal Medicine Dept, Cattinara Teaching Hospital (ASUITS), Trieste, Italy
| | - Marco Pellecchio
- Struttura Complessa Medicina Interna 1 P.O. Levante, ASL 2 Savona, Savona, Italy
| | - Chiara Marvisi
- Azienda USL-IRCCS di Reggio Emilia and University of Modena and Reggio Emilia, Reggio Emilia, Italy.,Nephrology Unit, University Hospital, Parma, Italy
| | - Federica Maritati
- Dept of Experimental Diagnostic and Specialty Medicine (DIMES), Nephrology, Dialysis and Renal Transplant Unit, St. Orsola Hospital, University of Bologna, Bologna, Italy
| | | | - Christian Dejaco
- Hospital of Brunico (SABES-ASDAA), Dept of Rheumatology, Brunico, Italy.,Dept of Rheumatology and Immunology, Medical University Graz, Graz, Austria
| | - Johann Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Iacopo Olivotto
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,Cardiomyopathy Unit, Careggi University Hospital, Florence, Italy
| | - Peter Willeit
- Dept of Neurology, Medical University of Innsbruck, Innsbruck, Austria.,Dept of Public Health and Primary Care, University of Cambridge, Cambridge, UK.,These authors contributed equally to this manuscript
| | - Domenico Prisco
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
| | - Augusto Vaglio
- Nephrology and Dialysis Unit, Meyer Children's Hospital, Florence, Italy.,Dept of Experimental, Clinical and Biomedical Sciences "Mario Serio", University of Firenze, Florence, Italy.,These authors contributed equally to this manuscript
| | - Giacomo Emmi
- Dept of Experimental and Clinical Medicine, University of Firenze, Firenze, Italy.,These authors contributed equally to this manuscript
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7
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Preziosa P, Rocca MA, Ramirez GA, Bozzolo EP, Canti V, Pagani E, Valsasina P, Moiola L, Rovere-Querini P, Manfredi AA, Filippi M. Structural and functional brain connectomes in patients with systemic lupus erythematosus. Eur J Neurol 2019; 27:113-e2. [PMID: 31306535 DOI: 10.1111/ene.14041] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/01/2019] [Accepted: 07/08/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND AND PURPOSE Systemic lupus erythematosus (SLE) is an immune-mediated disease that may affect the nervous system. We explored the topographical organization of structural and functional brain connectivity in patients with SLE and its correlation with neuropsychiatric (NP) involvement and autoantibody profiles. METHODS Graph theoretical analysis was applied to diffusion tensor magnetic resonance imaging (MRI) and resting-state functional MRI data from 32 patients with SLE and 32 age- and sex-matched healthy controls. Structural and functional connectivity matrices between 116 cortical/subcortical brain regions were estimated using a bivariate correlation analysis, and global and nodal network metrics were calculated. RESULTS Structural, but not functional, global network properties (strength, transitivity, global efficiency and path length) were abnormal in patients with SLE versus controls (P < 0.0001), especially in patients with anti-double-stranded DNA (ADNA) autoantibodies (P = 0.03). No difference was found according to NP involvement or anti-phospholipid autoantibody status. Patients with SLE and controls shared identical structural hubs and the majority of functional hubs. In patients with SLE, all structural hubs showed reduced strength and clustering coefficient compared with controls (P from 0.001 to <0.0001), especially in patients with ADNA autoantibodies. Only a few differences in functional hub properties were found between patients with SLE and controls. Structural and functional hub measures did not differ according to NP involvement or anti-phospholipid autoantibody status. Significant correlations were found between clinical, MRI and network measures (r from -0.56 to 0.60, P from 0.0003 to 0.05). CONCLUSIONS Abnormalities of global and nodal structural connectivity occur in patients with SLE, especially with ADNA autoantibodies, with a diffuse disruption of structural integrity. Functional network integrity may contribute to preserve clinical functions.
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Affiliation(s)
- P Preziosa
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - M A Rocca
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - G A Ramirez
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E P Bozzolo
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - V Canti
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - E Pagani
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Valsasina
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Rovere-Querini
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - A A Manfredi
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases and Division of Immunology, Transplantation and Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - M Filippi
- Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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8
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Tombetti E, Colombo B, Di Chio MC, Sartorelli S, Papa M, Salerno A, Bozzolo EP, Tombolini E, Benedetti G, Godi C, Lanzani C, Rovere-Querini P, Del Maschio A, Ambrosi A, De Cobelli F, Sabbadini MG, Baldissera E, Corti A, Manfredi AA. Chromogranin-A production and fragmentation in patients with Takayasu arteritis. Arthritis Res Ther 2016; 18:187. [PMID: 27531191 PMCID: PMC4987982 DOI: 10.1186/s13075-016-1082-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/22/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chromogranin-A (CgA) is a secretory protein processed into peptides that regulate angiogenesis and vascular cells activation, migration and proliferation. These processes may influence arterial inflammation and remodelling in Takayasu arteritis (TA). METHODS Plasma levels of full-length CgA (CgA439), CgA fragments lacking the C-terminal region (CgA-FRs) and the N-terminal fragment, CgA1-76 (vasostatin-1, VS-1) were analysed in 42 patients with TA and 20 healthy age-matched controls. Vascular remodelling was longitudinally assessed by imaging. CgA peptides were related to markers of systemic and local inflammation, disease activity and vascular remodelling. RESULTS Levels of CgA-FRs and VS-1 were increased in TA. Treatment with proton-pump inhibitors (PPIs) and arterial hypertension partially accounted for CgA levels and high inter-patient variability. CgA439, CgA-FRs and VS-1 levels did not reflect disease activity or extent. Markers of systemic or local inflammation correlated with higher CgA-FRs and VS-1 in normotensive patients and with higher CgA439 in hypertensive patients. Treatment with non-biologic anti-rheumatic agents was associated with increased CgA-FRs and a distinctive regulation of CgA processing. Reduced blood levels of anti-angiogenic CgA peptides were associated with vascular remodelling in the groups of patients on PPIs and with arterial hypertension. CONCLUSIONS The plasma levels of CgA fragments are markedly increased in TA as a consequence of disease- and therapy-related variables. Anti-angiogenic forms of CgA may limit vascular remodelling. Given the effect of the various CgA peptides, it is advisable to limit the therapeutic prescriptions that might influence CgA-derived peptide levels to clearly agreed medical indications until further data become available.
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Affiliation(s)
- Enrico Tombetti
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy. .,Vita-Salute San Raffaele University, 20132, Milan, Italy.
| | - Barbara Colombo
- Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Maria Chiara Di Chio
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Silvia Sartorelli
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Maurizio Papa
- Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Annalaura Salerno
- Vita-Salute San Raffaele University, 20132, Milan, Italy.,Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Enrica Paola Bozzolo
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | | | - Giulia Benedetti
- Vita-Salute San Raffaele University, 20132, Milan, Italy.,Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Claudia Godi
- Department of Neuroradiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Chiara Lanzani
- Genomics of Renal Disease and Hypertension Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Patrizia Rovere-Querini
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Alessandro Del Maschio
- Vita-Salute San Raffaele University, 20132, Milan, Italy.,Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | | | - Francesco De Cobelli
- Vita-Salute San Raffaele University, 20132, Milan, Italy.,Department of Radiology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Maria Grazia Sabbadini
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
| | - Elena Baldissera
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy
| | - Angelo Corti
- Vita-Salute San Raffaele University, 20132, Milan, Italy.,Division of Oncology, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Angelo A Manfredi
- Department of Medicine and Division of Immunology, Transplantation & Infectious Diseases, IRCCS San Raffaele Scientific Institute, via Olgettina 60, 20132, Milan, Italy.,Vita-Salute San Raffaele University, 20132, Milan, Italy
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9
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Campochiaro C, Ramirez GA, Bozzolo EP, Lanzillotta M, Berti A, Baldissera E, Dagna L, Praderio L, Scotti R, Tresoldi M, Roveri L, Mariani A, Balzano G, Castoldi R, Doglioni C, Sabbadini MG, Della-Torre E. IgG4-related disease in Italy: clinical features and outcomes of a large cohort of patients. Scand J Rheumatol 2015; 45:135-45. [PMID: 26398142 DOI: 10.3109/03009742.2015.1055796] [Citation(s) in RCA: 94] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To describe the clinical features, treatment response, and follow-up of a large cohort of Italian patients with immunoglobulin (Ig)G4-related disease (IgG4-RD) referred to a single tertiary care centre. METHOD Clinical, laboratory, histological, and imaging features were retrospectively reviewed. IgG4-RD was classified as 'definite' or 'possible' according to international consensus guidelines and comprehensive diagnostic criteria for IgG4-RD. Disease activity was assessed by means of the IgG4-RD Responder Index (IgG4-RD RI). RESULTS Forty-one patients (15 females, 26 males) were included in this study: 26 with 'definite' IgG4-RD and 15 with 'possible' IgG4-RD. The median age at diagnosis was 62 years. The median follow-up was 36 months (IQR 24-51). A history of atopy was present in 30% of patients. The pancreas, retroperitoneum, and major salivary glands were the most frequently involved organs. Serum IgG4 levels were elevated in 68% of cases. Thirty-six patients were initially treated with glucocorticoids (GCs) to induce remission. IgG4-RD RI decreased from a median of 7.8 at baseline to 2.9 after 1 month of therapy. Relapse occurred in 19/41 patients (46%) and required additional immunosuppressive drugs to maintain long-term remission. Multiple flares occurred in a minority of patients. A single case of orbital pseudotumour did not respond to medical therapy and underwent surgical debulking. CONCLUSIONS IgG4-RD is an elusive inflammatory disease to be considered in the differential diagnosis of isolated or multiple tumefactive lesions. Long-term disease control can be achieved with corticosteroids and immunosuppressive drugs in the majority of cases.
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Affiliation(s)
- C Campochiaro
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - G A Ramirez
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - E P Bozzolo
- b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M Lanzillotta
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Berti
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - E Baldissera
- b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Dagna
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Praderio
- b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - R Scotti
- b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M Tresoldi
- b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - L Roveri
- c Division of Gastroenterology and Gastrointestinal Endoscopy , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - A Mariani
- d Pancreas Unit, Department of Surgery , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - G Balzano
- e Pathology Unit , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - R Castoldi
- e Pathology Unit , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - C Doglioni
- e Pathology Unit , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - M G Sabbadini
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
| | - E Della-Torre
- a Unit of Medicine and Clinical Immunology , IRCCS San Raffaele Scientific Institute , Milan , Italy.,b Department of Neurology , IRCCS San Raffaele Scientific Institute , Milan , Italy
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10
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Della-Torre E, Campochiaro C, Bozzolo EP, Dagna L, Scotti R, Nicoletti R, Stone JH, Sabbadini MG. Methotrexate for maintenance of remission in IgG4-related disease: Fig. 1. Rheumatology (Oxford) 2015; 54:1934-6. [DOI: 10.1093/rheumatology/kev244] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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11
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Ammirati E, Bozzolo EP, Contri R, Baragetti A, Palini AG, Cianflone D, Banfi M, Uboldi P, Bottoni G, Scotti I, Pirillo A, Grigore L, Garlaschelli K, Monaco C, Catapano AL, Sabbadini MG, Manfredi AA, Norata GD. Cardiometabolic and immune factors associated with increased common carotid artery intima-media thickness and cardiovascular disease in patients with systemic lupus erythematosus. Nutr Metab Cardiovasc Dis 2014; 24:751-759. [PMID: 24787906 DOI: 10.1016/j.numecd.2014.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/26/2013] [Accepted: 01/11/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Patients with systemic lupus erythematosus (SLE) have a higher prevalence of subclinical atherosclerosis and higher risk of cardiovascular (CV) events compared to the general population. The relative contribution of CV-, immune- and disease-related risk factors to accelerated atherogenesis in SLE is unclear. METHODS AND RESULTS Fifty SLE patients with long-lasting disease (mean age 44 ± 10 years, 86% female) and 50 sex- and age-matched control subjects were studied. Common carotid artery intima-media thickness (CCA-IMT) was used as a surrogate marker of atherosclerosis. We evaluated traditional and immune- and disease-related factors, assessed multiple T-cell subsets by 10-parameter-eight-colour polychromatic flow cytometry and addressed the effect of pharmacological therapies on CCA-IMT. In SLE patients, among several cardiometabolic risk factors, only high-density lipoprotein levels (HDL) and their adenosine triphosphate-binding cassette transporter 1 (ABCA-1)-dependent cholesterol efflux capacity were markedly reduced (p < 0.01), whereas the CCA-IMT was significantly increased (p = 0.03) compared to controls. CCA-IMT correlated with systolic blood pressure, low-density lipoprotein (LDL) cholesterol and body mass index (BMI), but not with disease activity and duration. The activated CD4(+)HLA-DR(+) and CCR5(+) T-cell subsets were expanded in SLE patients. Patients under hydroxychloroquine (HCQ) therapy showed lower CCA-IMT (0.62 ± 0.08 vs. 0.68 ± 0.10 mm; p = 0.03) and better risk-factor profile and presented reduced circulating pro-atherogenic effector memory T-cell subsets and a parallel increased percentage of naïve T-cell subsets. CONCLUSION HDL represents the main metabolic parameter altered in SLE patients. The increased CCA-IMT in SLE patients may represent the net result of a process in which 'classic' CV risk factors give a continuous contribution, together with immunological factors (CD4(+)HLA-DR(+) T cells) which, on the contrary, could contribute through flares of activity of various degrees over time. Patients under HCQ therapy present a modified metabolic profile, a reduced T-cell activation associated with decreased subclinical atherosclerosis.
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Affiliation(s)
- E Ammirati
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy; The Heart Transplantation Division, Ospedale Niguarda Ca' Granda, Milan, Italy.
| | - E P Bozzolo
- The Department of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | - R Contri
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
| | - A Baragetti
- Center for The Study of Atherosclerosis, Italian Society for The Study of Atherosclerosis Lombardia Chapter, Bassini Hospital Cinisello Balsamo, Milan, Italy; Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
| | - A G Palini
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy; The Flow Cytometry Resource, Advanced Cytometry Technical Applications Laboratory, Milan, Italy; Nestlé Institute of Health Science, Flow Cytometry, EPFL Innovation Park, 1015 Lausanne, Switzerland.
| | - D Cianflone
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
| | - M Banfi
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
| | - P Uboldi
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy.
| | - G Bottoni
- The Hull York Medical School, York, UK.
| | - I Scotti
- San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
| | - A Pirillo
- Center for The Study of Atherosclerosis, Italian Society for The Study of Atherosclerosis Lombardia Chapter, Bassini Hospital Cinisello Balsamo, Milan, Italy.
| | - L Grigore
- Center for The Study of Atherosclerosis, Italian Society for The Study of Atherosclerosis Lombardia Chapter, Bassini Hospital Cinisello Balsamo, Milan, Italy; The Multimedica IRCCS, Milan, Italy.
| | - K Garlaschelli
- Center for The Study of Atherosclerosis, Italian Society for The Study of Atherosclerosis Lombardia Chapter, Bassini Hospital Cinisello Balsamo, Milan, Italy.
| | | | - A L Catapano
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; The Multimedica IRCCS, Milan, Italy.
| | - M G Sabbadini
- The Department of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | - A A Manfredi
- The Department of Medicine, San Raffaele Scientific Institute, Milan, Italy.
| | - G D Norata
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Milan, Italy; The Blizard Institute, Barts and The London School of Medicine & Dentistry, Queen Mary University, London, UK.
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12
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Della Torre E, Bozzolo EP, Passerini G, Doglioni C, Sabbadini MG. IgG4-related pachymeningitis: evidence of intrathecal IgG4 on cerebrospinal fluid analysis. Ann Intern Med 2012; 156:401-3. [PMID: 22393144 DOI: 10.7326/0003-4819-156-5-201203060-00025] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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13
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Dagna L, Girlanda S, Langheim S, Rizzo N, Bozzolo EP, Sabbadini MG, Ferrarini M. Erdheim-Chester disease: report on a case and new insights on its immunopathogenesis. Rheumatology (Oxford) 2010; 49:1203-6. [PMID: 20097905 DOI: 10.1093/rheumatology/kep461] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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14
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Di Comite G, Bozzolo EP, Praderio L, Tresoldi M, Sabbadini MG. Meningeal involvement in Wegener's granulomatosis is associated with localized disease. Clin Exp Rheumatol 2006; 24:S60-4. [PMID: 16859598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Meningeal involvement is a rare occurrence in Wegener's Granulomatosis (WG). A Medline search uncovered only 48 previously reported cases. Here we describe the clinical features of meningeal involvement in WG and to evaluate the association with systemic disease extension. Through a systematic literature review of papers concerning meningeal involvement in WG, we collected and analysed data about sex, age, disease extension, symptoms, cerebrospinal fluid examination, imaging, ANCA and histology about previously reported patients. Headache is almost always the first symptom of meningeal involvement in WG. Later in the course of the disease other abnormalities may develop. Among them cranial nerve palsy, seizures and encephalopathy are the most frequent. Diagnosis is obtained by neuroimaging, which may disclose two distinct patterns of meningeal thickening: diffuse or focal. 62.9% of patients tests positive for ANCA. Histology typically shows necrotizing granulomatosis. Meningeal involvement is by far more frequent in the setting of localized WG. Meningitis is a rare complication of WG. It usually develops in patients with localized disease who are more likely to have destructive lesions of the upper airways. It may be recognized by a constellation of clinical and radiological findings and by histological signs of necrotizing granulomatosis, with little or no vasculitis.
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Affiliation(s)
- G Di Comite
- Clinical Immunology and Rheumatology Unit, H. San Raffaele Scientific Institute, Milan, Italy
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