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Lotti E, Gori AM, Berteotti M, Rogolino A, Cesari F, Poli D, Vannini F, Bertelli A, Giusti B, Marcucci R. Natural history of anti-PF 4 antibodies in patients with vaccine-induced immune thrombocytopenia and thrombosis. Blood Transfus 2024; 22:246-252. [PMID: 38315531 PMCID: PMC11073623 DOI: 10.2450/bloodtransfus.544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/12/2023] [Indexed: 02/07/2024]
Affiliation(s)
- Elena Lotti
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Anna M. Gori
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Martina Berteotti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Angela Rogolino
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Daniela Poli
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Vannini
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Bertelli
- Atherothrombotic Disease Unit, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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Renda G, Bucciarelli V, Barbieri G, Lanuti P, Berteotti M, Malatesta G, Cesari F, Salvatore T, Giusti B, Gori AM, Marcucci R, De Caterina R. Ex Vivo Antiplatelet Effects of Oral Anticoagulants. J Cardiovasc Dev Dis 2024; 11:111. [PMID: 38667729 PMCID: PMC11049965 DOI: 10.3390/jcdd11040111] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/27/2024] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
BACKGROUND The impact of non-vitamin K antagonist oral anticoagulants (NOACs) on platelet function is still unclear. We conducted a comprehensive ex vivo study aimed at assessing the effect of the four currently marketed NOACs on platelet function. METHODS We incubated blood samples from healthy donors with concentrations of NOACs (50, 150 and 250 ng/mL), in the range of those achieved in the plasma of patients during therapy. We evaluated generation of thrombin; light transmittance platelet aggregation (LTA) in response to adenosine diphosphate (ADP), thrombin receptor-activating peptide (TRAP), human γ-thrombin (THR) and tissue factor (TF); generation of thromboxane (TX)B2; and expression of protease-activated receptor (PAR)-1 and P-selectin on the platelet surface. RESULTS All NOACs concentration-dependently reduced thrombin generation compared with control. THR-induced LTA was suppressed by the addition of dabigatran at any concentration, while TF-induced LTA was reduced by factor-Xa inhibitors. ADP- and TRAP-induced LTA was not modified by NOACs. TXB2 generation was reduced by all NOACs, particularly at the highest concentrations. We found a concentration-dependent increase in PAR-1 expression after incubation with dabigatran, mainly at the highest concentrations, but not with FXa inhibitors; P-selectin expression was not changed by any drugs. CONCLUSIONS Treatment with the NOACs is associated with measurable ex vivo changes in platelet function, arguing for antiplatelet effects beyond the well-known anticoagulant activities of these drugs. There are differences, however, among the NOACs, especially between dabigatran and the FXa inhibitors.
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Affiliation(s)
- Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences and Center for Advanced Studies and Technology, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy;
| | - Valentina Bucciarelli
- Cardiovascular Sciences Department, Azienda Ospedaliero-Universitaria delle Marche, 60121 Ancona, Italy;
| | - Giulia Barbieri
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Paola Lanuti
- Department of Medicine and Aging Sciences and Center for Advanced Studies and Technology, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy;
| | - Martina Berteotti
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Gelsomina Malatesta
- Cardiology Unit, National Institute of Health and Science on Aging (INRCA), 64125 Ancona, Italy;
| | - Francesca Cesari
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Tanya Salvatore
- Department of Neuroscience, Imaging and Clinical Sciences and Center for Advanced Studies and Technology, G. d’Annunzio University Chieti-Pescara, 66100 Chieti, Italy;
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50121 Florence, Italy; (G.B.); (M.B.); (F.C.); (B.G.); (A.M.G.); (R.M.)
| | - Raffaele De Caterina
- Cardiology Division 1-Pisa University Hospital, University of Pisa, 56124 Pisa, Italy;
- Fondazione Villa Serena per la Ricerca, 37011 Città Sant’Angelo, Italy
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Pagliai G, Tristan Asensi M, Dinu M, Cesari F, Bertelli A, Gori AM, Giusti B, Marcucci R, Sofi F, Colombini B. Effects of a dietary intervention with lacto-ovo-vegetarian and Mediterranean diets on apolipoproteins and inflammatory cytokines: results from the CARDIVEG study. Nutr Metab (Lond) 2024; 21:9. [PMID: 38302995 PMCID: PMC10832112 DOI: 10.1186/s12986-023-00773-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/19/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Apolipoproteins have been recently proposed as novel markers of cardiovascular disease (CVD) risk. However, evidence regarding effects of diet on apolipoproteins is limited. AIM To compare the effects of Mediterranean diet (MD) and lacto-ovo vegetarian diet (VD) on apolipoproteins and traditional CVD risk factors in participants with low-to-moderate CVD risk. METHODS Fifty-two participants (39 women; 49.1 ± 12.4 years), followed MD and VD for 3 months each. Medical and dietary information was collected at the baseline. Anthropometric parameters and blood samples were obtained at the beginning and the end of interventions. RESULTS MD and VD resulted in significant improvement in anthropometric and lipid profiles. Both diets led to a reduction in most of the inflammatory parameters. As for apolipoproteins, a significant change was observed for ApoC-I after VD (+ 24.4%; p = 0.020). MD led to a negative correlation between ApoC-III and carbohydrates (R = - 0.29; p = 0.039) whereas VD between ApoD and saturated fats (R = - 0.38; p = 0.006). A positive correlation emerged after VD between HDL and ApoD (R = 0.33; p = 0.017) and after MD between plasma triglycerides and ApoC-I (R = 0.32; p = 0.020) and ApoD (R = 0.30; p = 0.031). IL-17 resulted to be positively correlated with ApoB after MD (R = 0.31; p = 0.028) and with ApoC-III after VD (R = 0.32; p = 0.019). Subgroup analysis revealed positive effects on apolipoproteins from both diets, especially in women, individuals older than 50 years-old or with < 3 CVD risk factors. CONCLUSIONS Both diets seem to improve CVD risk, however, MD showed a greater positive effect on apolipoproteins in some subgroups, thus suggesting how diet may influence new potential markers of CVD risk. TRIAL REGISTRATION registered at clinicaltrials.gov (identifier: NCT02641834) on December 2015.
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Affiliation(s)
- Giuditta Pagliai
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Marta Tristan Asensi
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy.
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Francesca Cesari
- Atherotrombotic Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Alessia Bertelli
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
- Atherotrombotic Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
- Atherotrombotic Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
- Atherotrombotic Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
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Alfano F, Cesari F, Gori AM, Berteotti M, Salvadori E, Giusti B, Bertelli A, Kura A, Barbato C, Formelli B, Pescini F, Fainardi E, Chiti S, Marzi C, Diciotti S, Marcucci R, Poggesi A. The Role of Extracellular Matrix and Inflammation in the Stratification of Bleeding and Thrombotic Risk of Atrial Fibrillation on Oral Anticoagulant Therapy: Insights from Strat-Af Study. J Clin Med 2023; 12:6866. [PMID: 37959331 PMCID: PMC10647302 DOI: 10.3390/jcm12216866] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/20/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. We hypothesize that both circulating and neuroimaging-based markers might improve the prediction of bleeding and thrombotic risk in anticoagulated AF patients. The Strat-AF study is an observational, prospective, single-center study enrolling 170 patients with AF; recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging and circulating biomarkers assessment. The main outcome is the evaluation of cerebral microangiopathy related to the levels of circulating biomarkers of inflammation and extracellular matrix (ECM) remodeling. At multivariate logistic regression analysis adjusted for age, sex, CHA2DS2-VASc, HAS-BLED and type of anticoagulant, matrix metalloproteinases (MMP)-2 levels were significantly and positively associated with the presence of cerebral microbleeds (CMBs). A significant association between MMP-2, tissue inhibitor of metalloproteinases (TIMP)-1,-2,-4 levels and white matter hyperintensity was also found. Concerning the small vessel disease (SVD) score, MMP-2 and TIMP-1,-2 levels were associated with the presence of two and three or more signs of SVD, whereas TIMP-4 levels were associated with the presence of three signs of SVD with respect to patients with no instrumental signs of SVD. As regarding the presence of enlarged perivascular spaces (EPVS), a significant association was found for high levels of interleukin (IL)-8 and TIMP 1-2-3. These results demonstrate that patients with AF have evidence of impaired ECM degradation, which is an independent risk factor for thrombotic complications of AF patients on oral anticoagulant therapy. The incorporation of these markers in the prognostic schemes might improve their clinical capability in predicting stroke risk and thrombotic complications.
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Affiliation(s)
- Francesco Alfano
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Francesca Cesari
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Martina Berteotti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Alessia Bertelli
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
| | - Ada Kura
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
| | | | - Enrico Fainardi
- Neuroradiology Unit, Careggi University Hospital, Department of Experimental and Clinical Biomedical Sciences, University of Florence, 50134 Florence, Italy;
| | - Stefano Chiti
- Health Physics Unit, Careggi University Hospital, 50134 Florence, Italy;
| | - Chiara Marzi
- Institute of Applied Physics “Nello Carrara” (IFAC), National Research Council of Italy (CNR), 50019 Sesto Fiorentino, Italy;
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, 40126 Bologna, Italy;
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy; (F.A.); (F.C.); (A.M.G.); (M.B.); (B.G.); (A.B.); (A.K.)
- Center for Atherothrombotic Diseases, Careggi University Hospital, 50134 Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy; (E.S.); (C.B.); (B.F.); (A.P.)
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy;
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5
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Salvadori E, Barucci E, Barbato C, Formelli B, Cesari F, Chiti S, Diciotti S, Giusti B, Gori AM, Marzi C, Pescini F, Pracucci G, Fainardi E, Marcucci R, Poggesi A. Cognitive phenotypes and factors associated with cognitive decline in a cohort of older patients with atrial fibrillation: The Strat-AF study. Eur J Neurol 2023; 30:849-860. [PMID: 36692890 DOI: 10.1111/ene.15701] [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: 12/20/2022] [Accepted: 01/12/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The multifactorial relationship between atrial fibrillation (AF) and cognitive impairment needs to be elucidated. The aim of this study was to assess, in AF patients on oral anticoagulants (OACs), the prevalence of cognitive impairment, defined according to clinical criteria or data-driven phenotypes, the prevalence of cognitive worsening, and factors associated with cognitive outcomes. METHODS The observational prospective Strat-AF study enrolled AF patients aged ≥ 65 years who were receiving OACs. The baseline and 18-month protocol included clinical, functional, and cognitive assessment, and brain magnetic resonance imaging. Cognitive outcomes were: empirically derived cognitive phenotypes; clinical diagnosis of cognitive impairment; and longitudinal cognitive worsening. RESULTS Out of 182 patients (mean age 77.7 ± 6.7 years, 63% males), 82 (45%) received a cognitive impairment diagnosis, which was associated with lower education level and functional status, and higher level of atrophy. Cluster analysis identified three cognitive profiles: dysexecutive (17%); amnestic (25%); and normal (58%). Compared to the normal group, the dysexecutive group was older, and had higher CHA2 DS2 -VASc scores, while the amnestic group had worse cognitive and functional abilities, and medial temporal lobe atrophy (MTA). Out of 128 followed-up patients, 35 (27%) had cognitive worsening that was associated with lower education level, worse cognitive efficiency, CHA2 DS2 -VASc score, timing of OAC intake, history of stroke, diabetes, non-lacunar infarcts, white matter hyperintensities and MTA. In multivariate models, belonging to the dysexecutive or amnestic group was a main predictor of cognitive worsening. CONCLUSIONS In our cohort of older AF patients, CHA2 DS2 -VASc score, timing of OAC intake, and history of stroke influenced presence, type and progression of cognitive impairment. Empirically derived cognitive classification identified three groups with different clinical profiles and better predictive ability for cognitive worsening compared to conventional clinical diagnosis.
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Affiliation(s)
| | | | - Carmen Barbato
- NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Francesca Cesari
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Health Physics Unit, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, Bologna, Italy
| | - Betti Giusti
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chiara Marzi
- Institute of Applied Physics "Nello Carrara" (IFAC), National Research Council of Italy (CNR), Florence, Italy
| | | | | | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Atherothrombotic Diseases Centre, Careggi University Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation, Florence, Italy
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Alfano F, Gori AM, Cesari F, Salvadori E, Berteotti M, Giusti B, Lotti E, Poggesi A, Marcucci R. 712 INFLAMMATION, HAEMOSTASIS AND EXTRACELLULAR MATRIX IN THE STRATIFICATION OF BLEEDING AND THROMBOTIC RISK OF ATRIAL FIBRILLATION ON ORAL ANTICOAGULANT THERAPY: INSIGHTS FROM STRAT-AF STUDY. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.105] [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
In anticoagulated atrial fibrillation patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. We hypothesize that biological markers – both circulating and neuroimaging-based – and their possible interaction, might improve the prediction of bleeding risk in atrial fibrillation patients under treatment with any type of oral anticoagulant.
Methods
The Strat-AF study is an observational, prospective, single-center hospital-based study enrolling patients with atrial fibrillation, aged 65 years or older, and with no contraindications to undergo magnetic resonance imaging. Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral magnetic resonance imaging and circulating biomarkers assessment. The main outcomes are the evaluation of cerebral microangiopathy using MRI (lacunar infarcts, non-lacunar infarcts, microbleeds, hyperintensity of the white matter, SVDs [small vessel disease score]) and the onset of ischemic or hemorrhagic stroke related to the levels of circulating biomarkers of inflammation (IL-6, IL-8, TNFα, IL-4, IL-10, CCL2, CXCL10, ICAM-1, VCAM-1, VEGF), haemostasis (PAI-1, CLT, vWF) and extracellular matrix remodeling (MMP-2,-7,-8,-9,-12, TIMP-1,-2,-3,-4). Starting from September 2017, 191 patients (mean age 78.1±6.7, range 65-97; 65.3% males) were enrolled. 56 patients (29.3%) were on vitamin K antagonists, and 135 (70.7%) were on direct oral anticoagulants. Follow-up clinical evaluation and brain MRI were performed at 18 months.
Results
At multivariate analysis, adjusted for age, sex, CHA2DS2-VASc, HAS-BLED and type of anticoagulant, independent predictors were: low levels of vWF and elevated levels of TIMP-2 for microbleeds [OR:0.62 95%CI(0.42-0.89), p=0.011and OR:1.25 (1.01-1.77), p=0.049 respectively]; elevated levels of IL-6 and TIMP-4 for hyperintensity of white matter [OR: 1.55 (1.01-2.58), p=0.049 and OR: 1.44 (1.01-2.07), p=0.047 respectively]; elevated levels of MMP-2 and of TIMP-1 and TIMP-2 for lacunar infarcts [OR: 1.33 (1.01-1.89), p=0.049, OR: 1.48(1.01-2.18), p=0.048 and 1.50 (1.05-2.16), p=0.028 respectively]; elevated levels of TIMP-1, TIMP-2, TIMP-3 for the appearance of at least 1 new lesion according to the SVD score [OR: 1.48 (1.01-2.19), p=0.046, OR:1.53 (1.05-2.23), p=0.028 and OR: 1.58 (1.09-2.31), p=0.016 respectively].
Conclusions
The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in atrial fibrillation and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion.
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Affiliation(s)
- Francesco Alfano
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Anna Maria Gori
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Francesca Cesari
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Emilia Salvadori
- Neurofarba Department, Neuroscience Section, University Of Florence , Florence , Italy
| | - Martina Berteotti
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Betti Giusti
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Elena Lotti
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
| | - Anna Poggesi
- Neurofarba Department, Neuroscience Section, University Of Florence , Florence , Italy
| | - Rossella Marcucci
- Department Of Experimental And Clinical Medicine, University Of Florence , Florence , Italy
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Alfano F, Maria Gori A, Cesari F, Salvadori E, Giusti B, Lotti E, Poggesi A, Marcucci R. 714 PLEIOTROPIC EFFECTS OF ANTICOAGULANT THERAPIES: IS THERE A DIFFERENCE BETWEEN AVK AND DOAC? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.106] [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
Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Emerging evidence suggests a significant role of inflammation in the pathogenesis and in the maintenance of AF. We hypothesize a different role of anticoagulant therapy (AVK vs. DOACs) in reducing the levels of inflammatory biomarkers in AF.
Methods
The Strat-AF study is an observational, prospective, single-center hospital-based study enrolling patients with atrial fibrillation, aged 65 years or older, and with no contraindications to undergo magnetic resonance imaging. Recruited patients are evaluated by means of a comprehensive protocol, with clinical and circulating biomarkers assessment. One of the main outcomes is the evaluation of the grade of inflammation in patients treated with AVK vs. DOACs. In order to evaluate the grade of inflammation, we calculated the ratios between pro- and anti-inflammatory cytokines (IL6/IL4, IL6/IL10, TNF-alpha/IL4, TNF-alpha/IL10). The pro-/anti-inflammatory ratios were divided into tertiles and were used to calculate a score of inflammation. Patients with ratios in the third tertile were assigned as patients with an elevated grade of inflammation not balanced by anti-inflammatory cytokines; patients with ratios in the other tertiles were assigned as patients with a low level of inflammation. Starting from September 2017, 191 patients (mean age 78.1±6.7, range 65-97; 65.3% males) were enrolled. 56 patients (29.3%) were on vitamin K antagonists, and 135 (70.7%) were on direct oral anticoagulants.
Results
Patients treated with DOACS had higher ratio values than patients treated with AVK [IL6/IL4: 0.15 (0.07-0.35) vs 0.05 (0.03-0.25), p=0.001; IL6/IL10: 0.70 (0.28-5.49) vs 0.54 (0.18-1.42), p=0.090; TNF-alpha/IL4: 0.16 (0.12-0.31) vs 0.13 (0.08-0.31), p= 0.055; TNF-apha/IL10: 0.97 (0.25-5.23) vs 0.75 (0.51-2.62), p=0.105]. According to pro-anti-inflammatory ratio tertiles, 28/135 DOAC patients (20.7%) had an elevated grade of inflammation not balanced by anti-inflammatory cytokines, whereas in AVK group only 5.4% (3/53) were classified as patients with high levels of inflammation (p=0.009). At multivariate logistic regression analysis, adjusted for age, sex, CHA2DS2-VASc, HAS-BLED, AVK treatment resulted an independent and protective predictor for having a high grade of inflammation not balanced by anti-inflammatory cytokine levels [OR=0.27 (0.08-0.97), p=0.045].
Conclusions
These result from Strat-AF study may be an essential step towards the exploration of the role and the contribute of anticoagulant therapy in reducing inflammation-related biomarkers in AF patients. Inflammation has also been associated with endothelial dysfunction, coagulation cascade activation and thrombogenesis. Thus, inflammation may contribute to both the occurrence/maintenance of AF and its thromboembolic complications. These results might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting
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Affiliation(s)
- Francesco Alfano
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
| | - Anna Maria Gori
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
| | - Francesca Cesari
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
| | - Emilia Salvadori
- Neurofarba Department, Neuroscience Section, University Of Florence , Florence
| | - Betti Giusti
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
| | - Elena Lotti
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
| | - Anna Poggesi
- Neurofarba Department, Neuroscience Section, University Of Florence , Florence
| | - Rossella Marcucci
- Department Of Experimental And Clinical Medicine , Univeristy Of Florence, Florence , Italy
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8
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Bianconi E, Del Freo G, Salvadori E, Barbato C, Formelli B, Pescini F, Pracucci G, Sarti C, Cesari F, Chiti S, Diciotti S, Gori AM, Marzi C, Fainardi E, Giusti B, Marcucci R, Bertaccini B, Poggesi A. Can CHA 2DS 2-VASc and HAS-BLED Foresee the Presence of Cerebral Microbleeds, Lacunar and Non-Lacunar Infarcts in Elderly Patients With Atrial Fibrillation? Data From Strat-AF Study. Front Neurol 2022; 13:883786. [PMID: 35645956 PMCID: PMC9135961 DOI: 10.3389/fneur.2022.883786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/13/2022] [Indexed: 11/13/2022] Open
Abstract
Anticoagulants reduce embolic risk in atrial fibrillation (AF), despite increasing hemorrhagic risk. In this context, validity of congestive heart failure, hypertension, age ≥ 75 years, diabetes, stroke, vascular disease, age 65-74 years and sex category (CHA2DS2-VASc) and hypertension, abnormal renal/liver function, stroke, bleeding history or predisposition, labile international normalized ratio, elderly, drugs/alcohol concomitantly (HAS-BLED) scales, used to respectively evaluate thrombotic and hemorrhagic risks, is incomplete. In patients with AF, brain MRI has led to the increased detection of "asymptomatic" brain changes, particularly those related to small vessel disease, which also represent the pathologic substrate of intracranial hemorrhage, and silent brain infarcts, which are considered risk factors for ischemic stroke. Routine brain MRI in asymptomatic patients with AF is not yet recommended. Our aim was to test predictive ability of risk stratification scales on the presence of cerebral microbleeds, lacunar, and non-lacunar infarcts in 170 elderly patients with AF on oral anticoagulants. Ad hoc developed R algorithms were used to evaluate CHA2DS2-VASc and HAS-BLED sensitivity and specificity on the prediction of cerebrovascular lesions: (1) Maintaining original items' weights; (2) augmenting weights' range; (3) adding cognitive, motor, and depressive scores. Accuracy was poor for each outcome considering both scales either in phase 1 or phase 2. Accuracy was never improved by the addition of cognitive scores. The addition of motor and depressive scores to CHA2DS2-VASc improved accuracy for non-lacunar infarcts (sensitivity = 0.70, specificity = 0.85), and sensitivity for lacunar-infarcts (sensitivity = 0.74, specificity = 0.61). Our results are a very first step toward the attempt to identify those elderly patients with AF who would benefit most from brain MRI in risk stratification.
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Affiliation(s)
- Elisa Bianconi
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Giulia Del Freo
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Emilia Salvadori
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Milan, Italy
| | - Benedetta Formelli
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | | | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Cristina Sarti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering “Guglielmo Marconi”, University of Bologna, Cesena, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- Institute of Applied Physics “Nello Carrara” (IFAC), National Research Council of Italy (CNR), Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Bruno Bertaccini
- Department of Statistics, Computer Science, Applications ≪ G. Parenti ≫, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Milan, Italy
- Stroke Unit, Careggi University Hospital, Florence, Italy
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9
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Ceschia N, Scheggi V, Gori AM, Rogolino AA, Cesari F, Giusti B, Cipollini F, Marchionni N, Alterini B, Marcucci R. Diffuse prothrombotic syndrome after ChAdOx1 nCoV-19 vaccine administration: a case report. J Med Case Rep 2021; 15:496. [PMID: 34615534 PMCID: PMC8493358 DOI: 10.1186/s13256-021-03083-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccine-induced immune thrombotic thrombocytopenia is emerging as one of the most relevant side effects of adenoviral-based vaccines against coronavirus disease 2019. Given the novelty of this disease, the medical community is seeking new evidence and clinical experiences on the management of these patients. CASE PRESENTATION In this article, we describe the case of a 73-year-old Caucasian woman who presented with diffuse prothrombotic syndrome, both in the arterial and venous districts, following the first dose administration of ChAdOx1 CoV-19 vaccine. The main thrombotic sites included the brain, with both a cortical ischemic lesion and thromboses of the left transverse and sigmoid sinuses and the lower limbs, with deep venous thrombosis accompanied by subsegmental pulmonary thromboembolism. The deep venous thrombosis progressively evolved into acute limb ischemia, requiring surgical intervention with thromboendoarterectomy. Anticoagulation was maintained throughout the whole hospitalization period and continued in the outpatient setting using vitamin K antagonists for a recommended period of 6 months. CONCLUSIONS This case describes the management of vaccine-induced immune thrombotic thrombocytopenia in a complicated clinical scenario, including multisite arterial and venous thromboses. Given the complexity of the patient presentation, this case may implement the comprehension of the mechanisms and clinical features of this disease; it also provides a picture of the challenges related to the management, often requiring a multidisciplinary approach.
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Affiliation(s)
- Nicole Ceschia
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Valentina Scheggi
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy.
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Angela Antonietta Rogolino
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Francesca Cesari
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Franco Cipollini
- Department of Internal Medicine, Ospedale San Jacopo, Via Ciliegiole 97, 51100, Pistoia, Italy
| | - Niccolò Marchionni
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Brunetto Alterini
- Department of Cardiothoracovascular Medicine, AOU Careggi, Largo G. A. Brambilla 3, 50134, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Largo G. A. Brambilla 3, 50134, Florence, Italy
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10
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Dinu M, Colombini B, Pagliai G, Giangrandi I, Cesari F, Gori A, Giusti B, Marcucci R, Sofi F. Effects of vegetarian versus Mediterranean diet on kidney function: Findings from the CARDIVEG study. Eur J Clin Invest 2021; 51:e13576. [PMID: 33955547 PMCID: PMC8459224 DOI: 10.1111/eci.13576] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/12/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND The aim of the present study was to assess the effects of a lacto-ovo-vegetarian diet (VD), compared to a Mediterranean diet (MD), on kidney function in a group of subjects with medium-to-low cardiovascular risk profile. METHODS We analysed 107 subjects (82 women, 25 men; median age 52) who followed a VD (n = 54) and a MD (n = 53) for 3 months in the CARDIVEG study, a randomized, open, crossover trial that compared the effects of these 2 diets on cardiovascular disease risk. RESULTS The effect of the two diets on kidney function markers was evaluated by conducting a general linear model for repeated measurements adjusted for possible confounding factors such as age, sex, physical activity, alcohol, smoking, hypertension, LDL cholesterol, glucose and body weight change. A significant reduction in creatinine (-5.3%; P < .001), urea nitrogen levels (-9%; P = .001), blood urea nitrogen (BUN) (-8.7%; P = .001) and BUN/creatinine ratio (-5.8%; P < .001), and an increase in estimated glomerular filtration rate (eGFR) (+3.5%; P = .001) was observed during the VD period. On the contrary, no significant changes were noted in the MD group. Variations obtained in the two dietary interventions were significantly different (P < .0001) for creatinine levels, BUN/creatinine and eGFR, for which opposite trends were observed in the VD and MD groups. CONCLUSIONS In a selected group of subjects with medium-to-low cardiovascular risk profile, a 3 month VD period determined significant improvements in kidney function markers. Further trials are needed to confirm these results.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Barbara Colombini
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | - Giuditta Pagliai
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
| | | | - Francesca Cesari
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Annamaria Gori
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Betti Giusti
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Rossella Marcucci
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Atherohtombotic Diseases UnitCareggi University HospitalFlorenceItaly
| | - Francesco Sofi
- Department of Experimental and Clinical MedicineUniversity of FlorenceFlorenceItaly
- Clinical Nutrition UnitCareggi University HospitalFlorenceItaly
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11
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Salvadori E, Galmozzi F, Uda F, Barbato C, Camilleri E, Cesari F, Chiti S, Diciotti S, Donnini S, Formelli B, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Poggesi A. Association Between Motor and Cognitive Performances in Elderly With Atrial Fibrillation: Strat-AF Study. Front Neurol 2020; 11:571978. [PMID: 33281708 PMCID: PMC7691488 DOI: 10.3389/fneur.2020.571978] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/30/2020] [Indexed: 01/22/2023] Open
Abstract
Background/Objective: Growing evidence suggests a close relationship between motor and cognitive abilities, but possible common underlying mechanisms are not well-established. Atrial fibrillation (AF) is associated with reduced physical performance and increased risk of cognitive decline. The study aimed to assess in a cohort of elderly AF patients: (1) the association between motor and cognitive performances, and (2) the influence and potential mediating role of cerebral lesions burden. Design: Strat-AF is a prospective, observational study investigating biological markers for cerebral bleeding risk stratification in AF patients on oral anticoagulants. Baseline cross-sectional data are presented here. Setting: Thrombosis outpatient clinic (Careggi University Hospital). Participants: One-hundred and seventy patients (mean age 77.7 ± 6.8; females 35%). Measurements: Baseline protocol included: neuropsychological battery, motor assessment [Short Physical Performance Battery (SPPB), and walking speed], and brain magnetic resonance imaging (MRI) used for the visual assessment of white matter hyperintensities, lacunar and non-lacunar infarcts, cerebral microbleeds, and global cortical and medial temporal atrophies. Results: Mean Montreal Cognitive Assessment (MoCA) total score was 21.9 ± 3.9, SPPB total score 9.5 ± 2.2, and walking speed 0.9 ± 0.2. In univariate analyses, both SPPB and walking speed were significantly associated with MoCA (r = 0.359, r = 0.372, respectively), visual search (r = 0.361, r = 0.322), Stroop (r = −0.272, r = −0.263), short story (r = 0.263, r = 0.310), and semantic fluency (r = 0.311, r = 0.360). In multivariate models adjusted for demographics, heart failure, physical activity, and either stroke history (Model 1) or neuroimaging markers (Model 2), both SPPB and walking speed were confirmed significantly associated with MoCA (Model 1: β = 0.256, β = 0.236; Model 2: β = 0.276, β = 0.272, respectively), visual search (Model 1: β = 0.350, β = 0.313; Model 2: β = 0.344, β = 0.307), semantic fluency (Model 1: β = 0.223, β = 0.261), and short story (Model 2: β = 0.245, β = 0.273). Conclusions: In our cohort of elderly AF patients, a direct association between motor and cognitive functions consistently recurred using different evaluation of the performances, without an evident mediating role of cerebral lesions burden.
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Affiliation(s)
| | - Francesco Galmozzi
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Francesca Uda
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Carmen Barbato
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Eleonora Camilleri
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Stefano Chiti
- Department Health Professions, U.O. Research and Development, Careggi University Hospital, Florence, Italy
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Samira Donnini
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Benedetta Formelli
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Silvia Galora
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering 'Guglielmo Marconi', University of Bologna, Bologna, Italy
| | - Anna Melone
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | - Damiano Mistri
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Giovanni Pracucci
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy
| | | | - Cristina Sarti
- Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Atherothrombotic Diseases Center, Careggi University Hospital, Florence, Italy
| | - Anna Poggesi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Neuroscience Section, NEUROFARBA Department, University of Florence, Florence, Italy.,Stroke Unit, Careggi University Hospital, Florence, Italy
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12
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Poggesi A, Barbato C, Galmozzi F, Camilleri E, Cesari F, Chiti S, Diciotti S, Galora S, Giusti B, Gori AM, Marzi C, Melone A, Mistri D, Pescini F, Pracucci G, Rinnoci V, Sarti C, Fainardi E, Marcucci R, Salvadori E. Role of Biological Markers for Cerebral Bleeding Risk STRATification in Patients with Atrial Fibrillation on Oral Anticoagulants for Primary or Secondary Prevention of Ischemic Stroke (Strat-AF Study): Study Design and Methodology. Medicina (Kaunas) 2019; 55:E626. [PMID: 31548494 PMCID: PMC6843419 DOI: 10.3390/medicina55100626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 09/09/2019] [Accepted: 09/19/2019] [Indexed: 01/31/2023]
Abstract
Background and Objectives: In anticoagulated atrial fibrillation (AF) patients, the validity of models recommended for the stratification of the risk ratio between benefits and hemorrhage risk is limited. Cerebral small vessel disease (SVD) represents the pathologic substrate for primary intracerebral hemorrhage and ischemic stroke. We hypothesize that biological markers-both circulating and imaging-based-and their possible interaction, might improve the prediction of bleeding risk in AF patients under treatment with any type of oral anticoagulant. Materials and Methods: The Strat-AF study is an observational, prospective, single-center hospital-based study enrolling patients with AF, aged 65 years or older, and with no contraindications to magnetic resonance imaging (MRI), referring to Center of Thrombosis outpatient clinic of our University Hospital for the management of oral anticoagulation therapy. Recruited patients are evaluated by means of a comprehensive protocol, with clinical, cerebral MRI, and circulating biomarkers assessment at baseline and after 18 months. The main outcome is SVD progression-particularly microbleeds-as a selective surrogate marker of hemorrhagic complication. Stroke occurrence (ischemic or hemorrhagic) and the progression of functional, cognitive, and motor status will be evaluated as secondary outcomes. Circulating biomarkers may further improve predictive potentials. Results: Starting from September 2017, 194 patients (mean age 78.1 ± 6.7, range 65-97; 61% males) were enrolled. The type of AF was paroxysmal in 93 patients (48%), and persistent or permanent in the remaining patients. Concerning the type of oral anticoagulant, 57 patients (29%) were on vitamin K antagonists, and 137 (71%) were on direct oral anticoagulants. Follow-up clinical evaluation and brain MRI are ongoing. Conclusions: The Strat-AF study may be an essential step towards the exploration of the role of a combined clinical biomarker or multiple biomarker models in predicting stroke risk in AF, and might sustain the incorporation of such new markers in the existing stroke prediction schemes by the demonstration of a greater incremental value in predicting stroke risk and improvement in clinical outcomes in a cost-effective fashion.
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Affiliation(s)
- Anna Poggesi
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
| | - Carmen Barbato
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Francesco Galmozzi
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Eleonora Camilleri
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, 50134 Florence, Italy.
| | - Stefano Chiti
- Department Health Professions, U.O.c Research and Development, 50134 Careggi University Hospital, 50134 Florence, Italy.
| | - Stefano Diciotti
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Silvia Galora
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Chiara Marzi
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi", University of Bologna, 40136 Bologna, Italy.
| | - Anna Melone
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Damiano Mistri
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | | | - Giovanni Pracucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Valentina Rinnoci
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
| | - Cristina Sarti
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
| | - Enrico Fainardi
- Neuroradiology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Careggi University Hospital, 50134 Florence, Italy.
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, 50134 Florence, Italy.
| | - Emilia Salvadori
- Stroke Unit, Careggi University Hospital, 50134 Florence, Italy.
- NEUROFARBA Department, Neuroscience Section, University of Florence, 50134 Florence, Italy.
- IRCCS Don Carlo Gnocchi, 50143 Florence, Italy.
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13
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Dinu M, Colombini B, Pagliai G, Cesari F, Gori A, Giusti B, Marcucci R, Sofi F. Effects of a dietary intervention with Mediterranean and vegetarian diets on hormones that influence energy balance: results from the CARDIVEG study. Int J Food Sci Nutr 2019; 71:362-369. [PMID: 31462113 DOI: 10.1080/09637486.2019.1658723] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A randomised, open, crossover trial with two intervention periods was used to compare the effects of a 3-month dietary intervention with Mediterranean diet (MD) and vegetarian diet (VD) on hormones that influence energy balance, and to investigate the relationship with changes in body composition. After 3 months, no significant differences between the two diets were observed. Both MD and VD resulted in a significant (p < .05) reduction in leptin-to-adiponectin ratio and anthropometric parameters, MD resulted in a significant decrease in leptin levels (-7.4%), while VD determined a significant increase in adiponectin (+6.8%) and a significant decrease in visfatin (-12.7%) levels. In both groups, changes in leptin, insulin and HOMA-IR were significantly and positively correlated with changes in anthropometric parameters. In conclusion, both MD and VD have led to a slight but significant improvement in hormones that influence energy balance. The effect was more evident in participants who lost weight and fat mass.
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Affiliation(s)
- Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Barbara Colombini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Annamaria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy.,IRCCS Don Carlo Gnocchi Foundation, Milan, Italy
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14
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Mucciolo DP, Marcucci R, Sodi A, Cesari F, Murro V, Rogolino A, Rizzo S, Giusti B, Virgili G, Prisco D, Gori AM. Circulating endothelial and progenitor cells in age-related macular degeneration. Eur J Ophthalmol 2019; 30:956-965. [PMID: 31328962 DOI: 10.1177/1120672119863306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate circulating endothelial and circulating progenitor cells as biomarkers in age-related macular degeneration patients (both exudative and atrophic forms) in order to establish the possible clinical implication of their assessment. METHODS We have enrolled 44 age-related macular degeneration patients: 22 patients with a recently diagnosed exudative (neovascular) form (Group A) and 22 patients with an atrophic (dry) form (Group B). The control group consisted of 22 age and sex-matched healthy subjects (Group C). The number of circulating endothelial progenitor cells (CD34+/KDR+, CD133+/KDR+, and CD34+/KDR+/CD133+), circulating progenitor cells (CD34+, CD133+, and CD34+/CD133+), and circulating endothelial cells were determined in the peripheral venous blood samples by flow cytometry. Neovascular age-related macular degeneration patients were evaluated at baseline and 4 weeks after a loading phase of three consequent intravitreal injections of ranibizumab. RESULTS Comparing age-related macular degeneration patients with the control group, endothelial progenitor cell and circulating progenitor cell levels were not significantly different, while age-related macular degeneration patients showed significantly higher levels of circulating endothelial cells (p = 0.001). Anti-vascular endothelial growth factor treatment with intravitreal ranibizumab was associated with a significant reduction of endothelial progenitor cell levels, with no significant influence on circulating progenitor cells and circulating endothelial cells. CONCLUSION We reported higher levels of circulating endothelial cells in age-related macular degeneration patients in comparison with the control group, thereby supporting the hypothesis of an involvement of endothelial dysregulation in the age-related macular degeneration and a reduction of the endothelial progenitor cell level in neovascular age-related macular degeneration patients after three intravitreal injections of ranibizumab.
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Affiliation(s)
- Dario Pasquale Mucciolo
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea Sodi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Francesca Cesari
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vittoria Murro
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Angela Rogolino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stanislao Rizzo
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Betti Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Careggi Teaching Hospital, Florence, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Cesari F, Dinu M, Pagliai G, Rogolino A, Giusti B, Gori AM, Casini A, Marcucci R, Sofi F. Mediterranean, but not lacto-ovo-vegetarian, diet positively influence circulating progenitor cells for cardiovascular prevention: The CARDIVEG study. Nutr Metab Cardiovasc Dis 2019; 29:604-610. [PMID: 30952572 DOI: 10.1016/j.numecd.2019.02.005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 01/29/2019] [Accepted: 02/14/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate the possible association between dietary habits and progenitor cells using data obtained from a randomized crossover trial using two different diets, lacto-ovo-vegetarian (VD) and Mediterranean (MD), the CARDIVEG study. METHODS AND RESULTS Eighty clinically healthy subjects with a low-to-moderate cardiovascular risk profile (61 F; 19 M; mean age: 50.7 ± 11.6 years) were randomly assigned to isocaloric VD and MD diets lasting three months each, and then crossed. The two diets showed no effects on endothelial progenitor cells and circulating endothelial cells but opposite effects on circulating progenitor cells. In fact, VD determined significant (p < 0.05) and negative changes on circulating progenitor cells, with an average geometric variation of -130 cells/106 events for CD34+/CD45-/dim, -80 cells/106 events for CD133+/CD45-/dim, and -84 cells/106 events for CD34+/CD133+/CD45-/dim while MD determined significant (p < 0.05) and positive changes for CD34+/CD45-/dim levels, with a geometric mean increase of +54 cells/106 events. No significant correlations were observed between changes in progenitor cells and changes in inflammatory parameters during the VD phase. On the other hand, during the MD phase negative correlations between changes of CD34+/CD45-/dim and interleukin-6 (R = -0.324; p = 0.004) as well as interleukin-8 (R = -0.228; p = 0.04) and monocyte chemotactic protein-1 (R = -0.277; p = 0.01), were observed. These correlations remained significant also after adjustment for confounding factors only for CD34+/CD45-/dim and interleukin-6 (β = -0.282; p = 0.018) and monocyte chemotactic protein-1 (β = -0.254; p = 0.031). CONCLUSIONS MD, but not VD, reported a significant and positive effect on circulating progenitor cells in a group of subjects at low-to-moderate cardiovascular risk, probably acting through the modulation of inflammatory parameters.
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Affiliation(s)
- F Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - M Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - G Pagliai
- Department of Experimental and Clinical Medicine, University of Florence, Italy
| | - A Rogolino
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - B Giusti
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A Casini
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - F Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy.
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Sofi F, Dinu M, Pagliai G, Cesari F, Gori AM, Sereni A, Becatti M, Fiorillo C, Marcucci R, Casini A. Low-Calorie Vegetarian Versus Mediterranean Diets for Reducing Body Weight and Improving Cardiovascular Risk Profile: CARDIVEG Study (Cardiovascular Prevention With Vegetarian Diet). Circulation 2018; 137:1103-1113. [PMID: 29483085 DOI: 10.1161/circulationaha.117.030088] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 10/31/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Only a few randomized dietary intervention studies that investigated the effects of lacto-ovo vegetarian diet (Vd) in clinically healthy omnivorous subjects are available. METHODS We randomly assigned to overweight omnivores with a low-to-moderate cardiovascular risk profile a low-calorie Vd compared with a low-calorie Mediterranean diet (MD), each lasting 3 months, with a crossover design. The primary outcome was the difference in body weight, body mass index, and fat mass changes between the 2 groups. Secondary outcomes were differences in circulating cardiovascular disease risk parameters changes between the 2 groups. RESULTS One hundred eighteen subjects (mean age: 51.1 years, females: 78%) were enrolled. The total participation rate at the end of the study was 84.7%. No differences between the 2 diets in body weight were observed, as reported by similar and significant reductions obtained by both Vd (-1.88 kg) and MD (-1.77 kg). Similar results were observed for body mass index and fat mass. In contrast, significant differences between the 2 interventions were obtained for low-density lipoprotein cholesterol, triglycerides, and vitamin B12 levels. The difference between the Vd and MD groups, in terms of end-of-diet values, was recorded at 9.10 mg/dL for low-density lipoprotein cholesterol (P=0.01), 12.70 mg/dL for triglycerides (P<0.01), and 32.32 pg/mL for vitamin B12 (P<0.01). Finally, no significant difference was found between Vd and MD interventions in oxidative stress markers and inflammatory cytokines, except for interleukin-17, which improved only in the MD group. Forty-six participants during the Vd period and 35 during the MD period reached the target values for ≥1 cardiovascular risk factor. CONCLUSIONS Both Vd and MD were effective in reducing body weight, body mass index, and fat mass, with no significant differences between them. However, Vd was more effective in reducing low-density lipoprotein cholesterol levels, whereas MD led to a greater reduction in triglyceride levels. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT02641834.
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Affiliation(s)
- Francesco Sofi
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.) .,Clinical Nutrition Unit (F.S., A.C.).,Don Carlo Gnocchi Foundation Italy, Onlus Istituto di Ricerca e Cura a Carattere Scientifico, Florence, Italy (F.S.)
| | - Monica Dinu
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.)
| | - Giuditta Pagliai
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.)
| | | | - Anna Maria Gori
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.).,Atherothrombotic Unit (A.M.G., A.S., R.M.), Careggi University Hospital, Florence, Italy
| | - Alice Sereni
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.).,Atherothrombotic Unit (A.M.G., A.S., R.M.), Careggi University Hospital, Florence, Italy
| | - Matteo Becatti
- Clinical and Experimental Biomedical Sciences (M.B., C.F.), University of Florence, Italy
| | - Claudia Fiorillo
- Clinical and Experimental Biomedical Sciences (M.B., C.F.), University of Florence, Italy
| | - Rossella Marcucci
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.).,Atherothrombotic Unit (A.M.G., A.S., R.M.), Careggi University Hospital, Florence, Italy
| | - Alessandro Casini
- Departments of Experimental and Clinical Medicine (F.S., M.D., G.P., R.M., A.M.G., A.S., A.C.).,Clinical Nutrition Unit (F.S., A.C.)
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Cesari F, Sofi F, Molino Lova R, Vannetti F, Pasquini G, Cecchi F, Marcucci R, Gori AM, Macchi C. Aging process, adherence to Mediterranean diet and nutritional status in a large cohort of nonagenarians: Effects on endothelial progenitor cells. Nutr Metab Cardiovasc Dis 2018; 28:84-90. [PMID: 29167060 DOI: 10.1016/j.numecd.2017.09.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/09/2017] [Accepted: 09/11/2017] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND AIM Adherence to the Mediterranean Diet (MD) has been associated with a longer and better life. The aim of this study was to examine the effects of adherence to the MD, and of nutritional habits on endothelial progenitor (EPCs) and circulating progenitor (CPCs) cells in a cohort of nonagenarians enrolled within the Mugello Study, an epidemiological study aimed at investigating both clinically relevant geriatric items and various health issues, including those related to nutritional status. METHODS AND RESULTS Four hundred twenty-one nonagenarians (306 F, 115 M, mean age: 93.1 ± 3.2 years) were evaluated. Adherence to MD was assessed through the Mediterranean Diet Score. Elderly subjects who were in the fourth quartile of the Mediterranean diet score showed significantly higher EPCs than subjects grouped into the other three quartiles. After adjustment for confounders, elderly subjects who were in the highest quartile of adherence to the MD score reported to have EPCs' levels significantly higher than those who reported lower values of adherence to the MD. Furthermore, by analyzing different food categories, it was reported that daily consumption of olive oil and a higher consumption of fruit and vegetables showed higher CPCs CD34+ and EPCs CD34+/KDR+ than subjects with not daily or lower consumption. CONCLUSION Our results support the hypothesis that the adherence to MD, as well as a daily consumption of olive oil and fruit and vegetables, characteristics of MD, may protect against the development of endothelial dysfunction through increasing EPCs and CPCs in older age.
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Affiliation(s)
- F Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - F Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Clinical Nutrition Unit, Careggi University Hospital, Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy.
| | - R Molino Lova
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - F Vannetti
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - G Pasquini
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - F Cecchi
- Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
| | - R Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - A M Gori
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - C Macchi
- Department of Experimental and Clinical Medicine, University of Florence, Italy; Don Carlo Gnocchi Foundation, Onlus IRCCS, Florence, Italy
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Fedi S, Sofi F, Brogi D, Tellini I, Cesari F, Sestini I, Gazzini A, Comeglio M, Abbate R, Gensini GF. Low protein Z plasma levels are independently associated with acute coronary syndromes. Thromb Haemost 2017; 90:1173-8. [PMID: 14652653 DOI: 10.1160/th03-04-0237] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryProtein Z (PZ) is a single chain vitamin-K-dependent glycoprotein synthesized by the liver. Studies in vivo and in vitro suggest that PZ plays an important role in inhibiting coagulation as it serves as cofactor for the inactivation of factor Xa by forming a complex with the plasma PZ-dependent protease inhibitor. Recently, conflicting findings on plasma PZ levels in patients with ischemic stroke have been published.Aim of our study was to investigate the role of PZ in acute coronary syndromes (ACS). PZ plasma levels were determined in 223 (189 M; 34 F) patients with ACS referring to the Coronary Intensive Therapy Unit of University of Florence and in 265 (219 M; 46 F) healthy subjects. Patients under oral anticoagulation treatment as well as subjects with positivity for antiphospholipid antibodies were excluded. None had liver or kidney dysfunction. The mean PZ plasma level was lower in patients (1508 ± 730 ng/mL) than in controls (1728 ± 594 ng/mL) (p < 0.0001). PZ levels below the 5th percentile (565 ng/mL) of normal values distribution in control subjects were found in 15.7% of patients and in 4.9% of controls (p <0 .0001). At multivariate analysis, PZ levels below 565 ng/mL were associated with ACS (OR=3.3; 99%CI 1.1-9.7; p = 0.004). The contemporary presence of low PZ levels and smoking habit leads to an increased risk of ACS (OR=9.5; 99%CI 2.4-37.2; p < 0.0001). In conclusion, our results suggest a possible role of PZ in the occurrence of arterial thrombosis.
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Affiliation(s)
- Sandra Fedi
- Department of Medical and Surgical Critical Care, Section of Clinical Medicine and Cardiology, University of Florence, and Thrombosis Center, Azienda Ospedaliera Careggi, Viale G. Morgagni 85, 50134 Florence, Italy.
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Marcucci R, Gori A, Burgisser C, Francini S, Roberts A, Sofi F, Gensini G, Abbate R, Fattirolli F, Cesari F. Adherence to lifestyle modifications after a cardiac rehabilitation program and endothelial progenitor cells. Thromb Haemost 2017; 112:196-204. [DOI: 10.1160/th13-10-0869] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Accepted: 02/13/2014] [Indexed: 11/05/2022]
Abstract
SummaryAn increase of endothelial progenitor cells (EPCs) among acute myo-cardial infarction (AMI) patients participating in a cardiac rehabilitation (CR) program has been reported, but no data on the impact of adherence to lifestyle recommendations provided during a CR program on EPCs are available. It was our aim to investigate the effect of adherence to lifestyle recommendations on EPCs, inflammatory and functional parameters after six months of a CR program in AMI patients. In 110 AMI patients (90 male/20 female; mean age 57.9 ± 9.4 years) EPCs, high sensitivity C-reactive protein (hsCRP), N-terminal pro-brain natriuretic peptide (NT-ProBNP) levels, and cardiopulmonary testings were determined at the end of the CR (T1) and at a six-month follow-up (T2). At T2 we administered a questionnaire assessing dietary habits and physical activity. At T2, we observed a decrease of EPCs (p<0.05), of hsCRP (p=0.009) and of NT-ProBNP (p<0.0001). Patient population was divided into three categories by Healthy Lifestyle (HL) score (none/low, moderate and high adherence to lifestyle recommendations). We observed a significant association between adherence to lifestyle recommendations, increase in EPCs and exercise capacity between T1 and T2 (Δ EPCs p for trend <0.05; ΔWatt max p for trend=0.004). In a multivariate logistic regression analyses, being in the highest tertile of HL score affected the likelihood of an increase of EPC levels at T2 [OR (95% confidence interval): 3.36 (1.0–10.72) p=0.04]. In conclusion, adherence to lifestyle recommendations provided during a CR program positively influences EPC levels and exercise capacity.
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Cesari F, Pratesi G, Cellai AP, Pulli R, Pratesi C, Gensini GF, Abbate R, Fedi S, Sofi F. Low protein Z levels in patients with peripheral arterial disease. Thromb Haemost 2017. [DOI: 10.1160/th07-04-0300] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryConflicting findings regarding the association between protein Z and atherosclerotic disease have been reported. The aim of this case-control study was to evaluate the role of protein Z in a peripheral localization of atherosclerosis. We studied protein Z levels in 120 patients (102 male, 18 female; median age: 75 years) admitted to the Unit of Vascular Surgery of the University of Florence with a clinical manifestation of peripheral arterial disease (PAD), and in 360 healthy subjects selected to be comparable to the patients group in terms of age and gender. Protein Z levels were found to be significantly (p < 0.05) lower in PAD patients [1,594 (89–3,635) ng/ml] compared to the healthy control group [1,728 (300–3,736) ng/ml].A logistic regression analysis showed, at univariate analysis, a significantly increased risk of PAD in patients with low levels of protein Z (<5th percentile of our control group: < 601 ng/ml) (OR: 5.72, 95%CI 3.07–10.66; p < 0.0001). After adjustment for age, gender and traditional cardiovascular risk factors the association was confirmed (OR: 5.83, 95%CI 2.83–12.01; p < 0.0001). Moreover, a significant association between low protein Z levels and clinical severity of the disease, evaluated through Fontaine’s stages, was reported after adjustment for age, gender, and traditional cardiovascular risk factors (general linear model, p for trend: 0.03). In conclusion, our data shows an association between low protein Z levels and the occurrence of PAD. These findings provide evidence for the role of protein Z in the pathogenesis of the atherosclerotic disease.
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Sofi F, Caporale R, Capalbo A, Marcucci R, Macchi C, Lova RM, Cellai T, Vannucci M, Gensini GF, Abbate R, Gori AM, Cesari F. Relationship between exercise capacity, endothelial progenitor cells and cytochemokines in patients undergoing cardiac rehabilitation. Thromb Haemost 2017. [DOI: 10.1160/th08-10-0644] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryNo data are available about the possible role of endothelial progenitor cells (EPCs), cytochemokines and N-terminal pro-brain natriuretic peptide (NT-proBNP) in determining a different response to short period of cardiologic rehabilitation (CR), as measured by the improvement of exercise capacity. In a population of 86 cardiac surgery patients, we evaluated the numbers of EPCs, pro- and anti-inflammatory cytokines (IL-6,IL-8, IL-10, IL-1ra), hs-C-reactive protein (CRP), vascular endothelial growth factor (VEGF) and NT-proBNP before (T1), and after 15 days of CR (T2). EPCs were measured by flow cytometry, and the exercise capacity was measured at T1 and T2 by using the six-minute walk test (6MWT). At T2, a significant increase of 6MWT (p<0.0001) was detected. No significant increase of EPCs was observed, while a significant (at least p<0.05) decrease in cytochemokines, CRP and NT-ProBNP levels was evidenced. By analyzing the median improvement of 6MWT, only patients with a median improvement ≥23% showed a significant (p<0.05) increase of EPCs at T2, with significant correlations between EPCs, VEGF and IL-10. On the contrary, in patients with a median improvement <23% a negative correlation between CRP and EPCs was observed. Finally, CD34+/KDR+ EPCs showed significant correlation with IL-8 at T1. In conclusion, a short period of CR intervention determines a different pattern of modifications for EPCs in relation to the improvement of exercise capacity.
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Cesari F, Gori A, Caporale R, Fanelli A, Casola G, Balzi D, Barchielli A, Valente S, Giglioli C, Gensini G, Abbate R, Marcucci R. Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Thromb Haemost 2017; 109:846-53. [DOI: 10.1160/th12-09-0709] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 03/01/2013] [Indexed: 11/05/2022]
Abstract
SummaryReticulated platelets (RP) are newly-formed platelets with a greater mass, a residual amount of RNA and an increased prothrombotic potential. No studies investigating the association between RP and the risk of cardiovascular death in acute coronary syndrome (ACS) patients are available. In the frame of the AMI-Florence 2 study, we investigated RP in 229 (154 M/ 75 F) ACS patients (125 ST-elevation myocardial infarction [STEMI]; 104 Non-STEMI/Unstable Angina). RP were measured by using the Sysmex XE-2100 haematology analyzer and were expressed as the percentage of RP out of the total optical platelet count (immature platelet fraction; IPF) and as the percentage of RP highly fluorescent (H-IPF). At one-year follow-up, 22 out of 229 patients (9.6%) died from cardiovascular causes. Higher values of IPF (p=0.05) and H-IPF (p=0.006) were detected in dead compared to alive patients. A receiver operating characteristics curve analysis identified IPF ≥3.3% and H-IPF ≥0.9% as optimal cut-off values to predict cardiovascular death. At the multivariate model adjusted for the Global Registry of Acute Coronary Events (GRACE) risk score, the association between RP and cardiovascular death remained significant for both IPF [OR (95%CI) : 4.15 (1.24–13.91) p=0.02] and H-IPF [OR (95%CI): H-IPF 5.03 (1.38–18.38) p=0.01]. In conclusion, RP are independent predictors of cardiovascular death and may be useful in improving risk stratification for ACS patients. Future prospective studies to evaluate the role of RP in determining cardiovascular events are warranted.
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Dinu M, Macchia D, Pagliai G, Gori AM, Cesari F, Marcucci R, Sofi F, Casini A. Symptomatic efficacy of buckwheat products in Non-Celiac Gluten Sensitivity (NCGS). Asia Pac J Clin Nutr 2017; 26:630-636. [PMID: 28582812 DOI: 10.6133/apjcn.072016.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Buckwheat (Fagopyrum esculentum) is a gluten-free grain with acclaimed benefi-cial effects on human health. Our aim was to assess the effect of buckwheat products on intestinal/extra-intestinal symptoms and biochemical parameters in patients with Non-Celiac Gluten Sensitivity (NCGS). METHODS AND STUDY DESIGN A randomized, crossover trial with two intervention phases was conducted on 19 NCGS patients over a 12 week-period. The participants were assigned to consume products made from buckwheat or to maintain their normal gluten-free diet for 6 weeks in a random order. Symptoms due to NCGS were evaluated using two questionnaires. RESULTS During the intervention period with buckwheat products, patients experienced a signifi-cant decrease in the severity of abdominal pain and bloating (p=0.03). In contrast, the control group showed a significant worsening trend for the majority of NCGS symptoms such as nausea, headache, joint/muscle pain, and attention disorders. The replacement diet with buckwheat products also resulted in a significant increase of serum magnesium (+4.7%) and a significant reduction in the circulating levels of some pro-inflammatory cytokines such as interferon gamma (-33.3%) and monocyte chemotactic protein-1 (-46.5%). CONCLUSION The study supports the positive effects of buckwheat for NCGS patients, showing that this alternative cereal can contribute to the re-duction of both negative gastro-intestinal and related symptoms, and nutritional deficiencies, and lead to an im-provement in inflammatory profile.
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Affiliation(s)
- Monicau Dinu
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy.
| | - Donatella Macchia
- Unit of Allergology and Clinical Immunology, S. Giovanni di Dio Hospital, Florence, Italy
| | - Giuditta Pagliai
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy.,Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Francesca Cesari
- Central Laboratory, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy.,Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy.,Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy.,Don Carlo Gnocchi Foundation Italy, Onlus IRCCS, Florence, Italy
| | - Alessandro Casini
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Italy.,Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
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Sofi F, Dinu M, Pagliai G, Cesari F, Marcucci R, Casini A. Erratum to: ‘Mediterranean versus vegetarian diet for cardiovascular disease prevention (the CARDIVEG study): study protocol for a randomized controlled trial’. Trials 2016; 17:253. [PMID: 27198547 PMCID: PMC4872361 DOI: 10.1186/s13063-016-1395-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 05/13/2016] [Indexed: 11/22/2022] Open
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Pescini F, Donnini I, Cesari F, Nannucci S, Valenti R, Rinnoci V, Poggesi A, Gori AM, Giusti B, Rogolino A, Carluccio A, Bianchi S, Dotti MT, Federico A, Balestrino M, Adriano E, Abbate R, Inzitari D, Pantoni L. Circulating Biomarkers in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy Patients. J Stroke Cerebrovasc Dis 2016; 26:823-833. [PMID: 27876311 DOI: 10.1016/j.jstrokecerebrovasdis.2016.10.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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: 04/12/2016] [Revised: 07/28/2016] [Accepted: 10/23/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited cerebral microangiopathy presenting with variable features, including migraine, psychiatric disorders, stroke, and cognitive decline and variable disability. On neuroimaging, CADASIL is characterized by leukoencephalopathy, multiple lacunar infarcts, and microbleeds. Previous studies suggest a possible role of endothelial impairment in the pathogenesis of the disease. METHODS We assessed plasma levels of von Willebrand factor (vWF) and thrombomodulin (TM) and the blood levels of endothelial progenitor cells (EPCs) and circulating progenitor cells (CPCs) in 49 CADASIL patients and 49 age-matched controls and their association with clinical/functional and neuroimaging features. RESULTS In multivariate analysis, CADASIL patients had significantly higher vWF and lower EPC levels. TM levels were similar in the 2 groups. CADASIL patients with a more severe clinical phenotype (history of stroke or dementia) presented lower CPC levels in comparison with patients with a milder phenotype. On correlation analysis, lower CPC levels were associated with worse performances on neuropsychological, motor and functional tests, and with higher lesion load on brain magnetic resonance imaging (degree of leukoencephalopathy and number of lacunar infarcts). CONCLUSIONS This is the first CADASIL series in which multiple circulating biomarkers have been studied. Our findings support previous studies on the presence and the possible modulating effect of endothelial impairment in the disease. Furthermore, our research data suggest that blood CPCs may be markers of disease severity.
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Affiliation(s)
- Francesca Pescini
- Emergency Department, Stroke Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ida Donnini
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Francesca Cesari
- Cardio-Thorax and Vascular Department, Atherothrombotic Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Serena Nannucci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy; Department of Emergency Neurology, C. Mondino National Neurological Institute, Pavia, Italy
| | - Raffaella Valenti
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Valentina Rinnoci
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Anna Poggesi
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Cardio-Thorax and Vascular Department, Atherothrombotic Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy; Don Carlo Gnocchi IRCCS Foundation, Florence, Italy
| | - Betti Giusti
- Cardio-Thorax and Vascular Department, Atherothrombotic Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Angela Rogolino
- Cardio-Thorax and Vascular Department, Atherothrombotic Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Alessandra Carluccio
- Department of Medical Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Silvia Bianchi
- Department of Medical Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Maria Teresa Dotti
- Department of Medical Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Antonio Federico
- Department of Medical Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Maurizio Balestrino
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
| | - Enrico Adriano
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
| | - Rosanna Abbate
- Cardio-Thorax and Vascular Department, Atherothrombotic Diseases Unit, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Domenico Inzitari
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy; Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Leonardo Pantoni
- NEUROFARBA Department, Neuroscience Section, University of Florence, Florence, Italy.
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Sereni A, Cesari F, Gori AM, Maggini N, Marcucci R, Casini A, Sofi F. Cardiovascular benefits from ancient grain bread consumption: findings from a double-blinded randomized crossover intervention trial. Int J Food Sci Nutr 2016; 68:97-103. [DOI: 10.1080/09637486.2016.1216528] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Alice Sereni
- Unit of Atherothrombotic Diseases, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Francesca Cesari
- Unit of Atherothrombotic Diseases, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Unit of Atherothrombotic Diseases, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Niccolò Maggini
- Unit of Atherothrombotic Diseases, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rossella Marcucci
- Unit of Atherothrombotic Diseases, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessandro Casini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation Florence, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation Florence, Florence, Italy
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Whittaker A, Dinu M, Cesari F, Gori AM, Fiorillo C, Becatti M, Casini A, Marcucci R, Benedettelli S, Sofi F. A khorasan wheat-based replacement diet improves risk profile of patients with type 2 diabetes mellitus (T2DM): a randomized crossover trial. Eur J Nutr 2016; 56:1191-1200. [PMID: 26853601 PMCID: PMC5346426 DOI: 10.1007/s00394-016-1168-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/26/2016] [Indexed: 12/11/2022]
Abstract
PURPOSES The aim of the present study was to examine whether a replacement diet with products made with organic ancient khorasan wheat could provide additive protective effects in reducing glucose, insulin, lipid and inflammatory risk factors, and in restoring blood redox balance in type 2 diabetes mellitus (T2DM) patients compared to diet with product made with modern organic wheat. METHODS We conducted a randomized, double-blinded crossover trial with two intervention phases on 21 T2DM patients (14 females, 7 males). The participants were assigned to consume products (bread, pasta, crackers and biscuits) made using semi-whole flour from organic wheat that was either from ancient khorasan wheat or modern control wheat for 8 weeks in a random order. An 8-week washout period was implemented between the interventions. Laboratory analyses were performed both at the beginning and at the end of each intervention phase. RESULTS The metabolic risk profile improved only after the khorasan intervention period, as measured by a reduction in total and LDL cholesterol (mean reduction: -3.7 and -3.4 %, respectively), insulin (-16.3 %) and blood glucose (-9.1 %). Similarly, there was a significant reduction in circulating levels of reactive oxygen species (ROS), vascular endothelial growth factor (VEGF) and interleukin-1ra, and a significant increase of total antioxidant capacity (+6.3 %). No significant differences from baseline were noted after the modern control wheat intervention phase. The change (from pre- to post-intervention) between the two intervention arms was significantly different (p < 0.05) for total and LDL-c, insulin and HOMA index. CONCLUSIONS A replacement diet with ancient khorasan wheat consumption provided additive protection in reducing total and LDL cholesterol, insulin, blood glucose, ROS production, and some inflammatory risk factors, which are all key factors warranting of control in secondary prevention of T2DM compared to a diet with products made with modern wheat.
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Affiliation(s)
- Anne Whittaker
- Department of Agrifood Production and Environmental Sciences, University of Florence, Florence, Italy
| | - Monica Dinu
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Francesca Cesari
- Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Anna Maria Gori
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Claudia Fiorillo
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Matteo Becatti
- Department of Clinical and Experimental Biomedical Sciences, University of Florence, Florence, Italy
| | - Alessandro Casini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Atherothrombotic Diseases, Careggi University Hospital, Florence, Italy
| | - Stefano Benedettelli
- Department of Agrifood Production and Environmental Sciences, University of Florence, Florence, Italy
| | - Francesco Sofi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Unit of Clinical Nutrition, Careggi University Hospital, Florence, Italy
- Don Carlo Gnocchi Foundation Italy, Onlus IRCCS, Florence, Italy
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Michelucci A, Cesari F, Ricciardi G, Attanà P, Pieragnoli P, Ristalli F, Padeletti L, Gori AM, Gensini GF, Abbate R. Left ventricular mass and progenitor cells in chronic heart failure patients. Intern Emerg Med 2015; 10:329-35. [PMID: 25387824 DOI: 10.1007/s11739-014-1149-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 10/27/2014] [Indexed: 01/19/2023]
Abstract
The aim of the study was to evaluate the association between circulating (CPCs) and endothelial (EPCs) progenitor cells and left ventricular (LV) remodeling in chronic heart failure (HF). 85 HF patients, ranging 29-89 years, 83.5% males, 45.9% ischemic, NYHA functional class II-IV, with a LV ejection fraction ≤40% were studied. LV ejection fraction, LV end-diastolic and end-systolic (LVESV) volumes, LV mass and tricuspid annular plane systolic excursion (TAPSE) were evaluated, and, when indicated, indexed for body surface area (BSA). CPCs and EPCs number was assessed using flow cytometry. CPCs were defined as CD34+, CD133+ and CD34+/CD133+. EPCs, identified through their expression of KDR, were defined as CD34+/KDR+, CD133+/KDR+ and CD34+/CD133+/KDR+. All EPCs were negatively related to LVESV/BSA (r = -0.24, p = 0.02 for all EPC's populations), and to LVmass/BSA (CD34+KDR+; r = -0.30, p = 0.005; CD133+KDR+; r = -0.31, p = 0.004; CD34+CD133+KDR+; r = -0.29, p = 0.007). No differences in EPCs levels in relation to cardiovascular risk factors, medications, etiology, age or gender were observed. CPCs number was higher in women, and lower in ischemic patients. In logistic regression analyses, the low EPCs' number was associated with an increased likelihood of abnormal LVmass/BSA. CPCs proved to be higher and EPCs lower in patients with severely abnormal LVmass/BSA (gr/m(2), ≥122 in women and ≥149 in men). Our results suggest a correlation between LV remodeling and progenitor cells. This is noteworthy considering that it has been suggested that bone marrow-derived EPCs participate in cardiac regeneration and function recovery in the setting of progressive HF.
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Affiliation(s)
- Antonio Michelucci
- Section of Arrhythmology, Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla 3, 50134, Florence, Italy,
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Cesari F, Marcucci R, Gori AM, Burgisser C, Francini S, Sofi F, Gensini GF, Abbate R, Fattirolli F. Adherence to lifestyles modifications after a Cardiac Rehabilitation program (CR) and Endothelial Progenitor Cells (EPCs): a 6-months follow-up study. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sofi F, Giorgi G, Cesari F, Gori AM, Mannini L, Parisi G, Casini A, Abbate R, Gensini GF, Poli BM. The atherosclerotic risk profile is affected differently by fish flesh with a similar EPA and DHA content but different n-6/n-3 ratio. Asia Pac J Clin Nutr 2013; 22:32-40. [PMID: 23353608 DOI: 10.6133/apjcn.2013.22.1.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The aim of this study was to evaluate the effect of consuming gilthead sea bream fillets, with different n-6/ n-3 ratios, on atherosclerotic biomarkers. Twenty healthy subjects were included in a randomised single-blinded cross-over trial. Participants were randomized into 2 groups, both of which received approximately 630 g per week of gilthead sea bream fed with either 100% fishmeal (FM) or partial replacement with plant proteins (PP) over two consecutive 10 week periods, respectively. Group A consumed firstly the FM fillets followed by the PP fillets, whereas the reverse order was adopted for group B. Group A reported a significant decrease of 29.3% (Δ = -26 mg/dL) in total cholesterol after the first phase of the intervention, before returning to baseline levels after the dietary intervention with fish fed with PP. Similarly, in group A, both LDL-cholesterol and triglycerides decreased significantly by 21.6% (Δ = -19 mg/dL) and 11.7% (Δ = -10.7 mg/dL), respectively, before increasing again after the intervention. Improvements in the inflammatory cytokines, interleukin-6 and -8 were also noted. Moreover, whole blood viscosity appeared significantly improved in group A, as seen by a significant increase of 7.59% (Δ = +4.59 mPA) for erythrocyte filtration rate. In conclusion, similar EPA+DHA content with different n- 6/n-3 ratio fish flesh intake was shown to have varied affects on lipid, inflammatory and haemorheological parameters in a group of healthy subjects.
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Affiliation(s)
- Francesco Sofi
- Department of Clinica and Experimental Medicine, Thrombosis Centre, Florence, Italy.
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Cesari F, Gori AM, Romagnuolo I, Abbate R. [Endothelial progenitor cells and vascular health: effects of lifestyle's modifications]. Monaldi Arch Chest Dis 2012; 78:66-72. [PMID: 23167147 DOI: 10.4081/monaldi.2012.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
During the last years increasing evidence showed that bone marrow-derived cells with angiogenic capability, named endothelial progenitor cells (EPCs), possess the capacity to home to sites of vascular injury, so contributing to the neoangiogenesis in vivo and to the maintenance of the homeostasis of vascular endothelium. Currently, potent triggers for the mobilisation of EPCs from bone-marrow are known. In addition to some pharmacological treatment such as statins, erythropoietin, PPAR-gamma agonists and angiotensin-II receptor antagonists, the effects of healthy lifestyle, via mobilization and functional improvement of EPC, is increasingly recognized. In this review we analyze, the effects of lifestyle interventions on EPCs. In particular we will focus on physical activity and cardiac rehabilitation protocols, weight reduction, and smoking cessation. Moreover, the negative effects of depression, mood disturbances and type D-personality on EPCs are also considered.
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Affiliation(s)
- Francesca Cesari
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Cioni G, Marcucci R, Cesari F, Valente S, Giglioli C, Abbate R, Boddi M. C0287 Assessment of endothelial function by peripheral arterial tonometry in patients with previous acute coronary syndrome identifies systemic atherosclerosis independently of traditional risk factors. Thromb Res 2012. [DOI: 10.1016/j.thromres.2012.08.249] [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: 10/27/2022]
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Cesari F, Sofi F, Gori AM, Corsani I, Capalbo A, Caporale R, Abbate R, Gensini GF, Casini A. Physical activity and circulating endothelial progenitor cells: an intervention study. Eur J Clin Invest 2012; 42:927-32. [PMID: 22463054 DOI: 10.1111/j.1365-2362.2012.02670.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND To assess the effect of a personalized physical activity programme on weight and circulating (CPC) and endothelial progenitor cells (EPC) in overweight and obese subjects. MATERIALS AND METHODS Anthropometric measurements with body composition, cardiopulmonary test, maximal stress exercise test with maximal oxygen uptake (VO(2max) ) and a series of biochemical analyses were taken before (T0) and after 3 months of physical activity (T1) in a total of 80 overweight and obese subjects. CPC and EPC were determined using flow cytometry and were defined as CD34+, CD133+ and CD34+/CD133+ for CPC and CD34+KDR+, CD133+KDR+ and CD34+CD133+KDR+ for EPC. RESULTS At the end of the programme, we divided the population into two groups, compliant individuals (group A, n = 47) and noncompliant individuals (group B, n = 33). Group A reported significant reductions of weight by 3·1% (P < 0·0001) and fat mass by 4·4% (P < 0·0001), while group B showed a percentage of increase in fat mass by 1·5% at T1. In group A, a trend of increase at T1 for circulating levels of CPC and EPC was observed, reaching the statistical significance for all the three types of EPC. On the contrary, group B showed no significant increase in CPC and EPC. Furthermore, a significant correlation between decrease in fat mass and increase in CD133+/KDR+ EPC was reported in group A (r = 0·50; P = 0·04). CONCLUSION Three months of physical activity significantly improved anthropometric measurements. A beneficial effect of increased number of EPC in compliant individuals, in relation to weight loss, was observed.
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Affiliation(s)
- Francesca Cesari
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
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Abstract
OBJECTIVE Increasing evidence suggests an association between insomnia and cardiovascular disease. We performed a systematic review with meta-analysis of all the available prospective studies that investigated the association between insomnia and risk of developing and/or dying from cardiovascular disease. DESIGN Systematic review and meta-analysis of prospective cohort studies. METHODS We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library and bibliographies of retrieved articles up to December 2011. Studies were included if they were prospective, had assessment of insomnia or sleep complaints at baseline, evaluated subjects free of cardiovascular disease at baseline and measured the association between insomnia and risk of developing and/or dying from cardiovascular disease. RESULTS After the review process 13 prospective studies were included in the final analysis. These studies included 122,501 subjects followed for a time ranging from three to 20 years. A total of 6332 cardiovascular events occurred during the follow-up. Insomnia was assessed through questionnaire and defined as either difficulty of initiating or maintaining sleep or presence of restless, disturbed nights. The cumulative analysis for all the studies under a random-effects model showed that insomnia determined an increased risk (+45%) of developing or dying from cardiovascular disease during the follow-up (relative risk 1.45, 95% confidence interval 1.29-1.62; p < 0.00001), with no evidence of heterogeneity across the studies (I 2: 19%; p = 0.14). CONCLUSION Insomnia is associated with an increased risk of developing and/or dying from cardiovascular disease.
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Affiliation(s)
- Francesco Sofi
- Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence, Italy
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Cesari F, Marcucci R, Gori AM, Burgisser C, Francini S, Sofi F, Gensini GF, Abbate R, Fattirolli F. Impact of a cardiac rehabilitation program and inflammatory state on endothelial progenitor cells in acute coronary syndrome patients. Int J Cardiol 2012; 167:1854-9. [PMID: 22626841 DOI: 10.1016/j.ijcard.2012.04.157] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 04/13/2012] [Accepted: 04/28/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Among the benefits of a cardiac rehabilitation (CR) program for patients after an acute coronary syndrome (ACS) is the mobilization of endothelial progenitor cells (EPCs). However not all patients respond to CR with an increase of EPC. We performed this study to identify the characteristics of patients who will not benefit from an increase of EPCs at the end of a CR program. METHODS 112 ACS patients were admitted to a four-week CR program. EPCs, high sensitivity C-reactive protein (hsCRP) and NT-ProBNP levels were determined at the beginning (T1) and at the end (T2) of the CR program. All patients performed a cardiopulmonary exercise test at T1 and at T2. EPCs were defined as CD34+KDR+, CD133+KDR+ and CD34+CD133+KDR+. hsCRP and NT-ProBNP were measured by nephelometric and immunometric method, respectively. RESULTS At T2, we observed a significant increase of EPCs (p=0.001), VO2 peak, Watt max HDL-cholesterol (p<0.0001) and a significant decrease (p<0.001) of hsCRP and NT-ProBNP, triglycerides, HbA1c, systolic blood pressure and waist circumference. Variations of VO2 peak were significantly correlated with the variations of EPCs. Patients with increased EPCs showed significantly (p=0.01) lower baseline levels of CRP and higher basal Watt max (p=0.04). In a multivariate logistic regression analysis, the lowest tertile of baseline hsCRP significantly affected the likelihood of having an increase of EPCs at the end of the CR program. CONCLUSIONS A CR program determines an increase of EPCs with a decrease of CRP and NT-ProBNP. A different trend for EPCs can be detected among patients correlated to CRP levels and exercise tolerance.
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Affiliation(s)
- Francesca Cesari
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
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Cesari F, Nath D. Technology: A deeper peek into living organisms. Nature 2012; 481:454. [PMID: 22281592 DOI: 10.1038/481454a] [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: 11/09/2022]
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Zanazzi M, Cesari F, Rosso G, Farsetti S, Caroti L, Gori AM, Cerini G, Cioni G, Bertoni E, Abbate R, Salvadori M. Reticulated platelets and platelet reactivity in renal transplant recipients receiving antiplatelet therapy. Transplant Proc 2010; 42:1156-7. [PMID: 20534248 DOI: 10.1016/j.transproceed.2010.03.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Renal transplant recipients are at increased risk of cardiovascular morbidity and mortality. We assessed platelet reactivity and reticulated platelets (RPs) in 90 recipients, 51 (56.6%) of whom were not receiving acetylsalicylic acid (ASA) therapy (group A) and 39 (43.3%) who were receiving ASA therapy, 100 mg (group B), and in 60 healthy controls (group C). METHODS Reticulated platelets were measured using a hematology automated analyzer (XE-2100; Sysmex Corp, Kobe, Japan) and were expressed as the percentage of RPs in the total optical platelet count (immature platelet fraction [IPF]), as the percentage of highly fluorescent RPs, and as the absolute number of RPs (IPF#). Platelet function was assessed using optical aggregometry (platelet aggregation) induced using 1 mmol/L of arachidonic acid, 2 or 10 micromol/L of adenosine diphosphate, or 2 microg/mL of collagen. RESULTS Group A demonstrated significantly higher values of RP compared with group B or group C. Group B demonstrated a substantially higher percentage of RPs compared with group C, which was significant only for the IPF parameter. Multiple regression analysis demonstrated that IPF and IPF# were significantly and positively related to collagen-induced platelet aggregation. CONCLUSION We documented the presence of higher concentrations of RPs in transplant recipients compared with a control population, and a significant association between RPs and platelet function.
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Affiliation(s)
- M Zanazzi
- Renal Unit, Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence and Careggi University Hospital, Florence, Italy.
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Cesari F, Marcucci R, Gori AM, Caporale R, Fanelli A, Paniccia R, Zanazzi M, Bertoni E, Larti A, Salvadori M, Gensini GF, Abbate R. High platelet turnover and reactivity in renal transplant recipients patients. Thromb Haemost 2010; 104:804-10. [PMID: 20694276 DOI: 10.1160/th10-02-0124] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2010] [Accepted: 06/18/2010] [Indexed: 11/05/2022]
Abstract
Renal transplant recipients (RTRs) patients are at increased risk of cardiovascular morbidity and mortality. We aimed this study to assess reticulated platelets (RP), platelet reactivity and von Willebrand factor (vWF) levels in RTRs patients. In 150 RTRs patients [84 (56%) not on acetylsalicylic acid (ASA) treatment, group A; 66 (44%) on ASA 100 mg treatment, group B] and in 60 healthy control subjects, RP were measured by a Sysmex XE-2100 and were expressed as the percentage of RP of the total optical platelet count (immature platelet fraction; IPF), as the percentage of RP highly fluorescent (H-IPF) and as the absolute number of RP (IPF#). Platelet function was assessed by optical aggregometry (PA) induced by 1 mmol arachidonic acid (AA-PA), 2 and 10 μM ADP (ADP2-PA and ADP10-PA) and 2 μg/ml collagen (Coll-PA). vWF levels were measured by using a miniVidas analyser. Group A and group B showed significant higher values of RP than controls. At a multiple linear regression analysis IPF and IPF# were significantly and positively related to collagen-PA. By analysing group B according to residual platelet reactivity (RPR), we observed a significant higher number of RP among patients with RPR by collagen. Moreover at a multiple logistic regression analysis, IPF# significantly affected the risk of having a RPR by collagen. With regard to vWF, RTRs patients showed higher levels than control subjects. We documented a higher platelet turn-over in both groups of RTRs patients and increased platelet reactivity in RTRs patients not on ASA therapy than controls.
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Affiliation(s)
- Francesca Cesari
- Department of Medical and Surgical Critical Care, Thrombosis Centre, Center for the Study at Molecular and Clinical Level of Chronic, Degenerative and Neoplastic Diseases to Develop Novel Therapies, University of Florence, Italy.
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Sofi F, Ghiselli L, Cesari F, Gori AM, Mannini L, Casini A, Vazzana C, Vecchio V, Gensini GF, Abbate R, Benedettelli S. Effects of Short-Term Consumption of Bread Obtained by an Old Italian Grain Variety on Lipid, Inflammatory, and Hemorheological Variables: An Intervention Study. J Med Food 2010; 13:615-20. [DOI: 10.1089/jmf.2009.0092] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Francesco Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Impruneta, Florence, Italy
- Regional Agency for Nutrition, University Hospital of Careggi, Florence, Italy
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
| | - Lisetta Ghiselli
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
- Department of Agronomy and Land Management, University of Florence, Florence, Italy
| | - Francesca Cesari
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
| | - Anna Maria Gori
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Impruneta, Florence, Italy
| | - Lucia Mannini
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
| | - Alessandro Casini
- Regional Agency for Nutrition, University Hospital of Careggi, Florence, Italy
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
| | - Concetta Vazzana
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
- Department of Agronomy and Land Management, University of Florence, Florence, Italy
| | - Vincenzo Vecchio
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
- Department of Agronomy and Land Management, University of Florence, Florence, Italy
| | - Gian Franco Gensini
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
- Don Carlo Gnocchi Foundation, Impruneta, Florence, Italy
| | - Rosanna Abbate
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
| | - Stefano Benedettelli
- Multidisciplinary Centre of Research on Food Sciences, University of Florence, Florence, Italy
- Department of Agronomy and Land Management, University of Florence, Florence, Italy
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Sofi F, Giangrandi I, Cesari F, Corsani I, Abbate R, Gensini GF, Casini A. Effects of a 1-year dietary intervention with n-3 polyunsaturated fatty acid-enriched olive oil on non-alcoholic fatty liver disease patients: a preliminary study. Int J Food Sci Nutr 2010; 61:792-802. [PMID: 20465434 DOI: 10.3109/09637486.2010.487480] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Non-alcoholic fatty liver disease (NAFLD) is a worldwide diffuse condition due to alimentary, environment and genetic factors. The aim of our preliminary study was to evaluate the effectiveness of long-term consumption of food enriched with n-3 polyunsaturated fatty acids (PUFA) in patients with NAFLD. METHODS Eleven patients were enrolled; six (four males, two females) were planned for oral administration of 6.5 ml olive oil enriched with n-3 PUFA for 12 months, while five (four males, one female) were used as controls. RESULTS Consumption of olive oil enriched with n-3 PUFA demonstrated a significant improvement of liver echo-texture and of the Doppler Perfusion Index after 12 months (after: 0.19 ± 0.02 vs. pre: 0.15 ± 0.03; P < 0.05), whereas no significant changes were seen at the end of follow-up in controls. Moreover, patients who consumed the olive oil enriched with n-3 PUFA showed a significant amelioration of liver enzymes, and of triglycerides (post: 132.8 ± 63.7 vs. pre: 164.5 ± 85.5 mg/dl; P = 0.04) in a general linear model adjusted for age and gender. Interestingly, patients reported to have a significant increase of adiponectin levels (post: 1,487.9 ± 96.7 vs. pre: 1,143 ± 24.8 μg/ml; P = 0.04). CONCLUSION The results of this preliminary study showed that long-term consumption of olive oil enriched with n-3 PUFA in patients with NAFLD is able to decrease circulating liver enzymes and triglycerides, with a significant improvement of adiponectin levels.
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Affiliation(s)
- Francesco Sofi
- Regional Agency of Nutrition, Azienda Ospedaliero-Universitaria Careggi, University of Florence, Florence, Italy.
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Cesari F. A new signature for splicing. Nat Rev Mol Cell Biol 2010. [DOI: 10.1038/nrm2859] [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: 11/09/2022]
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Cesari F. It's good to talk. Nat Rev Mol Cell Biol 2010. [DOI: 10.1038/nrm2837] [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: 11/09/2022]
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Sofi F, Buccioni A, Cesari F, Gori AM, Minieri S, Mannini L, Casini A, Gensini GF, Abbate R, Antongiovanni M. Effects of a dairy product (pecorino cheese) naturally rich in cis-9, trans-11 conjugated linoleic acid on lipid, inflammatory and haemorheological variables: a dietary intervention study. Nutr Metab Cardiovasc Dis 2010; 20:117-124. [PMID: 19473822 DOI: 10.1016/j.numecd.2009.03.004] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 02/27/2009] [Accepted: 03/06/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND AIM Some studies recently reported a favourable effect for cis-9, trans-11 conjugated linoleic acid (CLA) on plasma lipoprotein profile of healthy subjects. Aim of this crossover intervention study was to evaluate the influence of a short-term dietary intake of a cheese derived from sheep's milk naturally rich in CLA on several atherosclerotic biomarkers, in comparison with a commercially available cheese. METHODS AND RESULTS Ten subjects (6 F; 4 M) with a median age of 51.5 followed for 10 weeks a diet containing 200 g/week of cheese naturally rich in CLA (intervention period) and for the same period a diet containing a commercially available cheese of the same quantity (placebo period). Consumption of the dairy product naturally rich in cis-9, trans-11 CLA determined a significant (p<0.05) reduction in inflammatory parameters such as interleukin-6 (pre: 8.08+/-1.57 vs. post: 4.58+/-0.94 pg/mL), interleukin-8 (pre: 45.02+/-5.82 vs. post: 28.59+/-2.64 pg/mL), and tumour necrosis factor-alpha (pre: 53.58+/-25.67 vs. post: 32.09+/-17.42 pg/mL) whereas no significant differences in the placebo period were observed. With regard to haemorheological parameters, the test period significantly ameliorated erythrocytes' filtration rate (pre: 7.61+/-0.71% vs. post: 9.12+/-0.97%; p=0.03) with respect to the placebo period. Moreover, a reduction in the extent of platelet aggregation, induced by arachidonic acid [pre: 87.8+/-1.76% vs. post: 77.7+/-3.56%; p=0.04] was observed during the test period in comparison with the placebo period. CONCLUSIONS Dietary short-term intake of the tested dairy product naturally rich in cis-9, trans-11 CLA appeared to cause favourable biochemical changes of atherosclerotic markers.
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Affiliation(s)
- F Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy.
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Sofi F, Cesari F, Abbate R, Gensini GF, Broze G, Fedi S. A meta-analysis of potential risks of low levels of protein Z for diseases related to vascular thrombosis. Thromb Haemost 2010; 103:749-56. [PMID: 20076855 DOI: 10.1160/th09-09-0645] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Accepted: 11/22/2009] [Indexed: 11/05/2022]
Abstract
The relationship between protein Z levels and thrombosis is controversial. We performed a systematic review and meta-analysis of the available studies to assess the association between protein Z and vascular thrombotic diseases. We conducted an electronic literature search through MedLine, Embase, Google Scholar, Web of Science, The Cochrane Library, bibliographies of retrieved articles and abstracts of congresses up to October, 2009. Studies were included if they analysed protein Z levels in patients with vascular thrombotic diseases. After the review process, 28 case-control studies (33 patient cohorts), including 4,218 patients with thrombotic diseases and 4,778 controls, were selected for analysis. The overall analysis using a random-effects model showed that low protein Z levels were associated with an increased risk of thrombosis (odds ratio [OR] 2.90, 95% confidence interval [CI] 2.05-4.12; p<0.00001). On subgroup analysis, a significant association was found between low protein Z levels and arterial vascular diseases (OR 2.67, 95%CI 1.60-4.48; p=0.0002), pregnancy complications (OR 4.17, 95%CI 2.31-7.52; p<0.00001), and venous thromboembolic diseases (OR 2.18, 95%CI 1.19-4.00; p=0.01). The results of this meta-analysis are consistent with a role for protein Z deficiency in thrombotic diseases, including arterial thrombosis, pregnancy complications and venous thromboembolism.
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Affiliation(s)
- Francesco Sofi
- Department of Medical and Surgical Critical Care, Thrombosis Centre, University of Florence, Florence, Italy.
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Heinrichs A, Cesari F, Wrighton K, Baumann K, David R. From the editors. Nat Rev Mol Cell Biol 2010; 11:1. [PMID: 20050302 DOI: 10.1038/nrm2829] [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: 11/09/2022]
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Pescini F, Cesari F, Giusti B, Sarti C, Zicari E, Bianchi S, Dotti MT, Federico A, Balestrino M, Enrico A, Gandolfo C, Gori AM, Abbate R, Pantoni L, Inzitari D. Bone marrow-derived progenitor cells in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy. Stroke 2009; 41:218-23. [PMID: 20035077 DOI: 10.1161/strokeaha.109.563726] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is an inherited disease due to cerebral microangiopathy presenting with variable pictures, including stroke, progressive cognitive impairment, and disability. Mechanisms leading from vessel structural changes to parenchymal damage and eventually to clinical expression are not fully understood. Among pathogenic processes, endothelial dysfunction has been hypothesized. Endothelial progenitor cells and circulating progenitor cells (CPCs) derived from bone marrow participate in endothelium structure and function maintenance and contribute to ischemic area revascularization. No data are available about these cells in CADASIL. Our objective in this study was to evaluate endothelial progenitor cells and CPCs role in CADASIL. METHODS Twenty-nine patients with CADASIL and 29 sex- and age-matched control subjects were enrolled. Cells were measured in peripheral blood using flow cytometry. Endothelial progenitor cells were defined as positive for CD34/KDR, CD133/KDR, and CD34/CD133/KDR; and CPCs as positive for CD34, CD133, and CD34/CD133. RESULTS Endothelial progenitor cells were significantly lower in patients with CADASIL than in control subjects (CD34/KDR: 0.05 versus 0.1 cells/microL, P=0.005; CD133/KDR: 0.07 versus 0.1 cells/microL, P=0.006; CD34/CD133/KDR: 0.05 versus 0.1 cells/microL, P=0.001). The difference remained significant after adjusting for age, sex, and statin use. CPCs were not significantly lower in CADASIL, but patients with stroke or dementia had significantly reduced CPC levels than patients without (CD34: 1.68 versus 2.95 cells/microL, P=0.007; CD133: 1.40 versus 2.82 cells/microL, P=0.004; CD34/CD133: 1.44 versus 2.75 cells/microL, P=0.004). CPC levels significantly correlated with cognitive and motor performance measures. CONCLUSIONS We have documented an association between endothelial progenitor cells and CPCs and CADASIL, extending previous data about the presence of endothelial dysfunction in this disease and its potential role in modulating phenotype.
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Affiliation(s)
- Francesca Pescini
- Department of Neurological and Psychiatric Sciences, Thrombosis Center, University of Florence, Florence, Italy.
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Cesari F. A variant function for H2AZ. Nat Rev Mol Cell Biol 2009. [DOI: 10.1038/nrm2770] [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: 11/09/2022]
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