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Tiseo G, Barbieri C, Galfo V, Occhineri S, Matucci T, Almerigogna F, Kalo J, Sponga P, Cesaretti M, Marchetti G, Forniti A, Caroselli C, Ferranti S, Pogliaghi M, Polidori M, Fabiani S, Verdenelli S, Tagliaferri E, Riccardi N, Suardi LR, Carmignani C, Batini S, Puccetti L, Iapoce R, Menichetti F, Falcone M. Efficacy and Safety of Nirmatrelvir/Ritonavir, Molnupiravir, and Remdesivir in a Real-World Cohort of Outpatients with COVID-19 at High Risk of Progression: The PISA Outpatient Clinic Experience. Infect Dis Ther 2023; 12:257-271. [PMID: 36441485 PMCID: PMC9707131 DOI: 10.1007/s40121-022-00729-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [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: 09/26/2022] [Accepted: 11/09/2022] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Different antivirals are available for the treatment of outpatients with COVID-19. Our aim was to describe a real-world experience of outpatient management of COVID-19 subjects at high risk of progression. METHODS This prospective observational study conducted in the University Hospital of Pisa (January 2022-July 2022) included consecutive COVID-19 outpatients with at least one risk factor for disease progression. Patients received nirmatrelvir/ritonavir, molnupiravir, or 3-day remdesivir, according to the Italian Medicines Agency (AIFA) indications. All patients were followed up until 30 days from the first positive nasopharyngeal swab. The primary endpoint was a composite of death or hospitalization. Secondary endpoints were occurrence of adverse events and a negative test within 10 days from the first positive test. Multivariable analysis was performed to identify factors associated with death or hospitalization. RESULTS Overall, 562 outpatients were included: 114 (20.3%) received molnupiravir, 252 (44.8%) nirmatrelvir/ritonavir, and 196 (34.9%) 3-day remdesivir. The composite endpoint occurred in 2.5% of patients and was more frequent in patients treated with remdesivir (5.1%) compared with molnupiravir (1.8%) or nirmatrelvir/ritonavir (0.8%, ANOVA among groups p = 0.012). On multivariable Cox regression analysis, presence of ≥ 3 comorbidities, hematological disease, gastrointestinal symptoms, and each-day increment from symptoms onset were factors associated with death or hospitalization, while antiviral treatment was not a predictor. Adverse events occurred more frequently in the nirmatrelvir/ritonavir group (49.2%). Nirmatrelvir/ritonavir compared with remdesivir was associated with a higher probability of having a negative test within 10 days from the first positive one. CONCLUSION Death or hospitalization did not differ among high-risk COVID-19 outpatients treated with currently available antivirals. Safety and time to a negative test differed among the three drugs.
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Affiliation(s)
- Giusy Tiseo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Chiara Barbieri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Valentina Galfo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Sara Occhineri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Tommaso Matucci
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Francesco Almerigogna
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Jona Kalo
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Pietro Sponga
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Mario Cesaretti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriele Marchetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Arianna Forniti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Claudio Caroselli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Simone Ferranti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Manuela Pogliaghi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Marina Polidori
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Silvia Fabiani
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Stefano Verdenelli
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Enrico Tagliaferri
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Niccolò Riccardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Lorenzo Roberto Suardi
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Claudia Carmignani
- Pharmaceutical Department, Azienda Ospedaliera Universitaria Pisana, Santa Chiara, Pisa, Italy
| | - Serena Batini
- Family Physician, Usl Nord-Ovest - Zona Pisana, Pisa, Italy
| | - Luca Puccetti
- Family Physician, Usl Nord-Ovest - Zona Pisana, Pisa, Italy
| | - Riccardo Iapoce
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Francesco Menichetti
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Marco Falcone
- Infectious Diseases Unit, Department of Clinical and Experimental Medicine, Azienda Ospedaliera Universitaria Pisana, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
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Fruschelli M, Marini D, Luciani D, Caroni F, Puccetti L. Report of two cases of subconjunctival haemorrhage as first sign of post‐pregnancy acquired haemophilia a (
AHA
). Acta Ophthalmol 2022. [DOI: 10.1111/j.1755-3768.2022.0229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Mario Fruschelli
- Ophthalmology Unit, Scienze Mediche Chirurgiche e Neuroscienze, Università di Siena Siena Italy
| | - Davide Marini
- Ophthalmology Unit, Scienze Mediche Chirurgiche e Neuroscienze, Università di Siena Siena Italy
| | - Diego Luciani
- Ophthalmology Unit, Scienze Mediche Chirurgiche e Neuroscienze, Università di Siena Siena Italy
| | - Federico Caroni
- Hemostasis and Thrombosis Unit, University Teaching Hospital of Siena University of Siena Siena Italy
| | - Luca Puccetti
- Hemostasis and Thrombosis Unit, University Teaching Hospital of Siena University of Siena Siena Italy
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Sicuranza A, Ferrigno I, Abruzzese E, Iurlo A, Galimberti S, Gozzini A, Luciano L, Stagno F, Russo Rossi A, Sgherza N, Cattaneo D, Zuanelli Brambilla C, Marzano C, Fava C, Mulas O, Cencini E, Santoni A, Sammartano V, Gozzetti A, Puccetti L, Bocchia M. Pro-Inflammatory and Pro-Oxidative Changes During Nilotinib Treatment in CML Patients: Results of a Prospective Multicenter Front-Line TKIs Study (KIARO Study). Front Oncol 2022; 12:835563. [PMID: 35178353 PMCID: PMC8844441 DOI: 10.3389/fonc.2022.835563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/14/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Tyrosine kinase inhibitors (TKI) may offer a normal life expectancy to Chronic Myeloid Leukemia (CML) patients. However, a higher than expected incidence of arterial occlusive events (AOEs) was observed during treatment with nilotinib. We previously showed an “inflammatory status” during nilotinib that may explain the increased incidence of AOEs. Thus, we conducted this prospective KIARO study involving 186 CML patients (89 imatinib, 59 nilotinib, 38 dasatinib). Interleukin 6 (IL6), interleukin 10 (IL10), Tumor Necrosis Factor-α (TNFα), oxLDL, and high-sensitivity C-reactive protein (hs-CRP) plasma levels were measured at diagnosis and during treatment, with the aim to investigate changes in the inflammatory status favoring AOEs of each patient. Clinical and biochemical pro-atherothrombotic profiles and the 10-year SCORE chart were also evaluated. We showed a pro-inflammatory/pro-oxidative milieu increasing along treatment with nilotinib compared with imatinib or dasatinib, as demonstrated by higher hs-CRP and oxLDL levels and increased IL6/IL10 and TNFα/IL10 ratios only in nilotinib cohort. After median follow-up of 23.3 months starting from TKI, 10/186 patients (5.4%) suffered an AOE. Approximately 5/10 (50%) AOEs occurred during nilotinib treatment despite a lower 10-year SCORE and a lower median age in this subgroup. A longer follow-up is needed to further confirm the active role of nilotinib in AOEs pathogenesis.
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Affiliation(s)
- Anna Sicuranza
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Ilaria Ferrigno
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | | | - Alessandra Iurlo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonella Gozzini
- Department of Cellular Therapies and Transfusion Medicine, AOU Careggi, Florence, Italy
| | | | - Fabio Stagno
- Hematology Section and BMT Unit, Rodolico Hospital, AOU Policlinico-V. Emanuele, Catania, Italy
| | | | - Nicola Sgherza
- Hematology and Transplant Center, Casa Sollievo della Sofferenza Hospital, San Giovanni Rotondo, Italy
| | - Daniele Cattaneo
- Hematology Division, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Cristina Marzano
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Carmen Fava
- Department of Clinical and Biological Sciences, University of Turin, Turin, Italy
| | - Olga Mulas
- Department of Medical Sciences and Public Health, University of Cagliari, Businco Hospital, Cagliari, Italy
| | - Emanuele Cencini
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Adele Santoni
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Vincenzo Sammartano
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Alessandro Gozzetti
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Luca Puccetti
- Hemostasis and Thrombosis Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
| | - Monica Bocchia
- Hematology Unit, University of Siena, Azienda Ospedaliero Universitaria Senese, Siena, Italy
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Puccetti L, Sammartano V, Calzoni P, Bacchiarri F, Santoni A, Fineschi D, Bocchia M. Real-life experience of edoxaban treatment for venous thromboembolism (VTE)/pulmonary embolism (PE) in patients with isolated positive Lupus Anticoagulant (LAC) during the COVID-19 pandemic lockdown in Italy. Eur Rev Med Pharmacol Sci 2022; 26:54-58. [PMID: 35049019 DOI: 10.26355/eurrev_202201_27747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Direct-acting oral anticoagulants (DOACs) have established indications, according to recent guidelines for the treatment and prevention of venous thromboembolism (VTE), including pulmonary embolism (PE), with a safer profile compared to vitamin K antagonist (VKA) in terms of a lower risk for major bleeding and no need of blood coagulation tests. However, DOACs are not indicated in the treatment of patients with triple-positive antiphospholipid syndrome (APS). This limitation is often extended in clinical practice to patients with isolated positivity. The COVID-19 pandemic has sometimes made it difficult to maintain a safe VKA treatment, due to the practical difficulties of performing INR. PATIENTS AND METHODS We evaluated 39 patients with a previous unprovoked VTE/PE, who were no longer eligible for VKA treatment due to the difficulty of performing INR during the COVID-19 pandemic lockdown, in Italy. All patients had a positive LAC and refused a long-term anticoagulation with low molecular weight heparin. They were shifted to edoxaban. RESULTS Any recurrence of VTE/PE occurred during the observation period (up to eight months of treatment), while only one minor bleeding event was recorded (Hazard ratio=0.06, 95% confidence interval 0.03-0.11, p=0.094). No arterial events occurred during the observation period. Hemoglobin, platelets, and creatinine were unchanged during the observation period. CONCLUSIONS Edoxaban treatment may be safe and effective in preventing the recurrence of VTE/PE in patients with isolated LAC positivity, without the occurrence of arterial events.
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Affiliation(s)
- L Puccetti
- Hemostasis and Thrombosis Unit, "Santa Maria alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy.
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Puccetti L, Bacchiarri F, Calzoni P, Santoni A, Bocchia M. Correction to: A fatal unsuspected case of acquired A hemophilia. Misleading role of therapy with acetylsalicylic acid? Intern Emerg Med 2021; 16:2343. [PMID: 34347258 PMCID: PMC8895097 DOI: 10.1007/s11739-021-02817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Luca Puccetti
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy.
| | - Francesca Bacchiarri
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Paola Calzoni
- Coagulative Disorders Laboratory Unit, Santa Maria Alle Scotte University Teaching Hospital of Siena, Siena, Italy
| | - Adele Santoni
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Monica Bocchia
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
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Puccetti L, Bacchiarri F, Calzoni P, Santoni A, Bocchia M. A fatal unsuspected case of acquired A hemophilia. Misleading role of therapy with acetylsalicylic acid? Intern Emerg Med 2021; 16:2339-2340. [PMID: 34100213 PMCID: PMC8183321 DOI: 10.1007/s11739-021-02760-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/10/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Luca Puccetti
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy.
| | - Francesca Bacchiarri
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Paola Calzoni
- Coagulative Disorders Laboratory Unit, Santa Maria Alle Scotte University Teaching Hospital of Siena, Siena, Italy
| | - Adele Santoni
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
| | - Monica Bocchia
- Hemathology Unit/Coagulative Disorders, "Santa Maria Alle Scotte" University Teaching Hospital of Siena, University of Siena, Siena, Italy
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Trovato E, Cortonesi G, Russo F, Puccetti L, Orsini C, Cinotti E, Rubegni P. Psoriasis successfully treated with guselkumab in a patient with systemic lupus erythematosus and acquired hemophilia A. Ital J Dermatol Venerol 2021; 157:286-287. [PMID: 34282863 DOI: 10.23736/s2784-8671.21.07054-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
| | - Giulio Cortonesi
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy -
| | - Filomena Russo
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
| | - Luca Puccetti
- Hematology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
| | - Corinne Orsini
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
| | - Elisa Cinotti
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
| | - Pietro Rubegni
- Dermatology Unit, Department of Medical, Surgical and Neurological sciences, Santa Maria alle Scotte Hospital, Siena University, Siena, Italy
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Barsotti S, Lorenzoni V, Di Battista M, d'Ascanio A, Silvia B, Puccetti L, Turchetti G, Della Rossa A, Mosca M. Prostanoids in scleroderma microangiopathy: clinical and pharmacoeconomic comparison between two intravenous regimens. Scand J Rheumatol 2021; 50:307-313. [PMID: 33622195 DOI: 10.1080/03009742.2020.1845395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: Intravenous iloprost (ILO) has widely demonstrated its effectiveness and safety in systemic sclerosis (SSc) patients. Unfortunately, there is no clear consent about dosage, duration, frequency, and infusion modality. The aim of this study was to compare two different therapeutic schemes in the same cohort of consecutive SSc subjects, evaluating differences in terms of effectiveness [digital ulcer (DU) outcome], safety, and direct healthcare costs.Method: This was a retrospective observational study of 47 patients classified with SSc treated with intravenous ILO for severe Raynaud's phenomenon and/or DUs. Two regimens were compared: a continuous inpatient scheme and a daily outpatient scheme. Demographics and clinical data, concomitant therapies, adverse events, and data on resource use and costs were collected.Results: The number of DUs rose slightly with the switch from the continuous to the daily scheme (0.61 ± 1.2 vs 1.1 ± 1.7). Moreover, in the daily scheme there was an increase in the number of therapeutic cycles (2.4 ± 0.7 vs 4.71 ± 1.4, p < 0.001) and an increase in patients treated with other vasoactive drugs. There was a reduction in ILO tolerability and more than half of the patients suspended the treatment. Five patients required hospitalization for severe and refractory DUs in the daily scheme. Moreover, the costs of the two treatments were comparable [median 7174 (range 2748-18 524) EUR vs 6284 (3232-22 706) EUR, p = 0.712].Conclusion: Treatment with a daily scheme of ILO is characterized by worse tolerability and a higher dropout rate compared to a low-flow regimen, with similar costs. We suggest that a low-flow continuous therapeutic scheme is preferable in SSc patients.
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Affiliation(s)
- S Barsotti
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - V Lorenzoni
- Institute of Management, Scuola Superiore Sant'Anna of Pisa, Pisa, Italy
| | - M Di Battista
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A d'Ascanio
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - B Silvia
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - L Puccetti
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - G Turchetti
- Institute of Management, Scuola Superiore Sant'Anna of Pisa, Pisa, Italy
| | - A Della Rossa
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Mosca
- Division of Rheumatology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Lucarini L, Magnelli L, Schiavone N, Crisci A, Innocenti A, Puccetti L, Cianchi F, Peri S, Supuran CT, Papucci L, Masini E. Plasmatic carbonic anhydrase IX as a diagnostic marker for clear cell renal cell carcinoma. J Enzyme Inhib Med Chem 2018; 33:234-240. [PMID: 29251173 PMCID: PMC7011953 DOI: 10.1080/14756366.2017.1411350] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/22/2017] [Accepted: 11/27/2017] [Indexed: 12/18/2022] Open
Abstract
Carbonic anhydrase (CA, EC 4.2.1.1) IX is regarded as a tumour hypoxia marker and CA inhibitors have been proposed as a new class of antitumor agents, with one such agent in Phase II clinical trials. The expression of some CAs, in particular the isoforms CA IX and CA XII, has been correlated with tumour aggressiveness and progression in several cancers. The aim of this study was to evaluate the possibility that CA IX could represent a marker related to clear cell Renal Cell Carcinoma (ccRCC). Bcl-2 and Bax, and the activity of caspase-3, evaluated in tissue biopsies from patients, were congruent with resistance to apoptosis in ccRCCs with respect to healthy controls, respectively. In the same samples, the CA IX and pro-angiogenic factor VEGF expressions revealed that both these hypoxia responsive proteins were strongly increased in ccRCC with respect to controls. CA IX plasma concentration and CA activity were assessed in healthy volunteers and patients with benign kidney tumours and ccRCCs. CA IX expression levels were found strongly increased only in plasma from ccRCC subjects, whereas, CA activity was found similarly increased both in plasma from ccRCC and benign tumour patients, compared to healthy volunteers. These results show that the plasmatic level of CA IX, but not the CA total activity, can be considered a diagnostic marker of ccRCCs. Furthermore, as many reports exist relating CA IX inhibition to a better outcome to anticancer therapy in ccRCC, plasma levels of CA IX could be also predictive for response to therapy.
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Affiliation(s)
- Laura Lucarini
- Department of Neuroscience, Psychiatry and Drug Area and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology and Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
| | - Lucia Magnelli
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Nicola Schiavone
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Alfonso Crisci
- Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Innocenti
- Department of Neuroscience, Psychiatry and Drug Area and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology and Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
| | | | - Fabio Cianchi
- Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Sara Peri
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Claudiu T. Supuran
- Department of Neuroscience, Psychiatry and Drug Area and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology and Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
| | - Laura Papucci
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Florence, Italy
| | - Emanuela Masini
- Department of Neuroscience, Psychiatry and Drug Area and Child Health (NEUROFARBA), Section of Pharmacology and Toxicology and Section of Pharmaceutical Sciences, University of Florence, Florence, Italy
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Battaggia A, Scalisi A, Puccetti L. Hyperuricemia does not seem to be an independent risk factor for coronary heart disease. Clin Chem Lab Med 2018; 56:e59-e62. [PMID: 28917080 DOI: 10.1515/cclm-2017-0487] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 08/09/2017] [Indexed: 01/08/2023]
Affiliation(s)
| | - Andrea Scalisi
- Azienda Sanitaria Provinciale di Palermo, Medicina Generale, Palermo, Sicilia, Italy
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Bocchia M, Sicuranza A, Abruzzese E, Iurlo A, Sirianni S, Gozzini A, Galimberti S, Aprile L, Martino B, Pregno P, Sorà F, Alunni G, Fava C, Castagnetti F, Puccetti L, Breccia M, Cattaneo D, Defina M, Mulas O, Baratè C, Caocci G, Sica S, Gozzetti A, Luciano L, Crugnola M, Annunziata M, Tiribelli M, Pacelli P, Ferrigno I, Usala E, Sgherza N, Rosti G, Bosi A, Raspadori D. Residual Peripheral Blood CD26 + Leukemic Stem Cells in Chronic Myeloid Leukemia Patients During TKI Therapy and During Treatment-Free Remission. Front Oncol 2018; 8:194. [PMID: 29900128 PMCID: PMC5988870 DOI: 10.3389/fonc.2018.00194] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [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: 03/02/2018] [Accepted: 05/14/2018] [Indexed: 12/16/2022] Open
Abstract
Chronic myeloid leukemia (CML) patients in sustained "deep molecular response" may stop TKI treatment without disease recurrence; however, half of them lose molecular response shortly after TKI withdrawing. Well-defined eligibility criteria to predict a safe discontinuation up-front are still missing. Relapse is probably due to residual quiescent TKI-resistant leukemic stem cells (LSCs) supposedly transcriptionally low/silent and not easily detectable by BCR-ABL1 qRT-PCR. Bone marrow Ph+ CML CD34+/CD38- LSCs were found to specifically co-express CD26 (dipeptidylpeptidase-IV). We explored feasibility of detecting and quantifying CD26+ LSCs by flow cytometry in peripheral blood (PB). Over 400 CML patients (at diagnosis and during/after therapy) entered this cross-sectional study in which CD26 expression was evaluated by a standardized multiparametric flow cytometry analysis on PB CD45+/CD34+/CD38- stem cell population. All 120 CP-CML patients at diagnosis showed measurable PB CD26+ LSCs (median 19.20/μL, range 0.27-698.6). PB CD26+ LSCs were also detectable in 169/236 (71.6%) CP-CML patients in first-line TKI treatment (median 0.014 cells/μL; range 0.0012-0.66) and in 74/112 (66%), additional patients studied on treatment-free remission (TFR) (median 0.015/μL; range 0.006-0.76). Notably, no correlation between BCR-ABL/ABLIS ratio and number of residual LSCs was found both in patients on or off TKIs. This is the first evidence that "circulating" CML LSCs persist in the majority of CML patients in molecular response while on TKI treatment and even after TKI discontinuation. Prospective studies evaluating the dynamics of PB CD26+ LSCs during TKI treatment and the role of a "stem cell response" threshold to achieve and maintain TFR are ongoing.
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Affiliation(s)
- Monica Bocchia
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Anna Sicuranza
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Alessandra Iurlo
- IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Santina Sirianni
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Sara Galimberti
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Lara Aprile
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Bruno Martino
- Hematology Unit Bianchi Melacrino Morelli Hospital, Reggio Calabria, Italy
| | - Patrizia Pregno
- Hematology Division, Azienda Ospedaliera Città della Salute e della Scienza, Torino, Italy
| | - Federica Sorà
- Fondazione Policlinico Universitario A Gemelli IRCSS Università Cattolica Sacro Cuore, Rome, Italy
| | | | - Carmen Fava
- Hematology Division, Ospedale Mauriziano, Torino, Italy
| | - Fausto Castagnetti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology and Medical Oncology "L. & A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Luca Puccetti
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Massimo Breccia
- Hematology, Biotecnologie Cellulari ed Ematologia, University "La Sapienza", Rome, Italy
| | - Daniele Cattaneo
- IRCCS Ca' Granda - Maggiore Policlinico Hospital Foundation, Milan, Italy
| | - Marzia Defina
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Olga Mulas
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Claudia Baratè
- Department of Hematology, Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giovanni Caocci
- Hematology Unit, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
| | - Simona Sica
- Fondazione Policlinico Universitario A Gemelli IRCSS Università Cattolica Sacro Cuore, Rome, Italy
| | - Alessandro Gozzetti
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | | | - Monica Crugnola
- Hematology Unit, Maggiore Hospital University of Parma, Parma, Italy
| | | | - Mario Tiribelli
- Division of Hematology and BMT, Department of Medical and Morphological Researches, University of Udine, Udine, Italy
| | - Paola Pacelli
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
| | - Ilaria Ferrigno
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Emilio Usala
- Hematology Unit, Ospedale Oncologico A. Businco, Cagliari, Italy
| | - Nicola Sgherza
- Hematology Unit, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Italy
| | - Gianantonio Rosti
- Department of Experimental, Diagnostic and Specialty Medicine, Institute of Hematology and Medical Oncology "L. & A. Seràgnoli", University of Bologna, Bologna, Italy
| | - Alberto Bosi
- Department of Hematology, University of Firenze, Florence, Italy
| | - Donatella Raspadori
- Hematology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, University of Siena, Siena, Italy
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Bocchia M, Galimberti S, Aprile L, Sicuranza A, Gozzini A, Santilli F, Abruzzese E, Baratè C, Scappini B, Fontanelli G, Trawinska MM, Defina M, Gozzetti A, Bosi A, Petrini M, Puccetti L. Genetic predisposition and induced pro-inflammatory/pro-oxidative status may play a role in increased atherothrombotic events in nilotinib treated chronic myeloid leukemia patients. Oncotarget 2018; 7:72311-72321. [PMID: 27527867 PMCID: PMC5342164 DOI: 10.18632/oncotarget.11100] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/1969] [Accepted: 07/18/2016] [Indexed: 12/18/2022] Open
Abstract
Several reports described an increased risk of cardiovascular (CV) events, mainly atherothrombotic, in Chronic Myeloid Leukemia (CML) patients receiving nilotinib. However, the underlying mechanism remains elusive. The objective of the current cross-sectional retrospective study is to address a potential correlation between Tyrosine Kinase Inhibitors (TKIs) treatment and CV events. One hundred and 10 chronic phase CML patients in complete cytogenetic response during nilotinib or imatinib, were screened for CV events and evaluated for: traditional CV risk factors, pro/anti-inflammatory biochemical parameters and detrimental ORL1 gene polymorphisms (encoding for altered oxidized LDL receptor-1). Multivariate analysis of the whole cohort showed that the cluster of co-existing nilotinib treatment, dyslipidaemia and G allele of LOX-1 polymorphism was the only significant finding associated with CV events. Furthermore, multivariate analysis according to TKI treatment confirmed IVS4-14 G/G LOX-1 polymorphism as the strongest predictive factor for a higher incidence of CV events in nilotinib patients. Biochemical assessment showed an unbalanced pro-inflammatory cytokines network in nilotinib vs imatinib patients. Surprisingly, pre-existing traditional CV risk factors were not always predictive of CV events. We believe that in nilotinib patients an induced “inflammatory/oxidative status”, together with a genetic pro-atherothrombotic predisposition, may favour the increased incidence of CV events. Prospective studies focused on this issue are ongoing.
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Affiliation(s)
- Monica Bocchia
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Sara Galimberti
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Lara Aprile
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Anna Sicuranza
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Antonella Gozzini
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | | | | | - Claudia Baratè
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Barbara Scappini
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | - Giulia Fontanelli
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | | | - Marzia Defina
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alessandro Gozzetti
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Alberto Bosi
- Functional Unit of Hematology, University of Florence, Florence, Italy
| | - Mario Petrini
- Department of Clinical and Experimental Medicine, U.O. Hematology, University of Pisa, Pisa, Italy
| | - Luca Puccetti
- Department of Hematology, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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Damås JK, Puccetti L, Aukrust P. Early anti-thrombotic and anti-inflammatory actions of statins and fibrates – time for adjuvant therapy in acute coronary syndromes? Thromb Haemost 2017; 94:1-3. [PMID: 16113777 DOI: 10.1160/th05-05-0317] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Mumoli N, Vitale J, Giorgi-Pierfranceschi M, Sabatini S, Tulino R, Cei M, Bucherini E, Bova C, Mastroiacovo D, Camaiti A, Palmiero G, Puccetti L, Dentali F. General Practitioner-Performed Compression Ultrasonography for Diagnosis of Deep Vein Thrombosis of the Leg: A Multicenter, Prospective Cohort Study. Ann Fam Med 2017; 15:535-539. [PMID: 29133492 PMCID: PMC5683865 DOI: 10.1370/afm.2109] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/30/2017] [Accepted: 04/24/2017] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Patients with suspected deep vein thrombosis (DVT) of the lower limb represent a diagnostic dilemma for general practitioners. Compression ultrasonography (US) is universally recognized as the best test of choice. We assessed the diagnostic accuracy of compression US performed by general practitioners given short training in the management of symptomatic proximal DVT. METHODS From May 2014 to May 2016, we evaluated in a multicenter, prospective cohort study all consecutive outpatients with suspected DVT; bilateral proximal lower limb compression US was performed by general practitioners and by physicians expert in vascular US, each group blinded to the other's findings. In all examinations with a negative or nondiagnostic result, compression US was repeated by the same operator after 5 to 7 days. Inter-observer agreement and accuracy were calculated. RESULTS We enrolled a total of 1,107 patients. The expert physicians diagnosed DVT in 200 patients, corresponding to an overall prevalence of 18.1% (95% CI, 15.8%-20.3%). The agreement between the trained general practitioners and the experts was excellent (Cohen κ = 0.86; 95% CI, 0.84-0.88). Compression US performed by general practitioners had a sensitivity of 90.0% (95% CI, 88.2%-91.8%) and a specificity of 97.1% (95% CI, 96.2%-98.1%) with a diagnostic accuracy for DVT of 95.8% (95% CI, 94.7%-97.0%). CONCLUSIONS Our results suggest that, even in hands of physicians not expert in vascular US, compression US can be a reliable tool in the diagnosis of DVT. We found that the sensitivity achieved by general practitioners appeared suboptimal, however, so future studies should evaluate the implementation of proper training strategies to maximize skill.
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Affiliation(s)
- Nicola Mumoli
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali).
| | - Josè Vitale
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Matteo Giorgi-Pierfranceschi
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Silvia Sabatini
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Renato Tulino
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Marco Cei
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Eugenio Bucherini
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Carlo Bova
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Daniela Mastroiacovo
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Alberto Camaiti
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Gerardo Palmiero
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Luca Puccetti
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
| | - Francesco Dentali
- Department of Internal Medicine, Ospedale Civile di Livorno, Livorno, Italy (Mumoli, Cei, Camaiti, Palmiero); Department of Internal Medicine, Ospedale Beata Vergine di Mendrisio, Ticino, Switzerland (Vitale); Emergency Department, Ospedale della Val d'Arda, Piacenza, Italy (Giorgi-Pierfranceschi); Primary Ambulatory Care, Livorno, Italy (Sabatini); Primary Care, Porto Santo Stefano, Grosseto, Italy (Tulino); Department of Vascular Medicine, ASL Di Romagna, Ravenna, Italy (Bucherini); Department of Internal Medicine, Azienda Ospedaliera, Cosenza, Italy (Bova); Angiology Unit, ASL 1 Avezzano Sulmona L'Aquila, Avezzano (AQ), Italy (Mastroiacovo); Primary Ambulatory Care, Pisa, Italy (Puccetti); Department of Internal Medicine, Ospedale di Circolo, Varese, Varese, Italy (Dentali)
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Fruschelli M, Fazio S, Capozzoli M, Chimenti G, Hadjistilianou T, Sicuranza A, Aprile L, Puccetti L. Incidence of retinal vein occlusions (RVO) in patients treated with oral anticoagulants or antiplatelet drugs for cardioembolic or atherothrombotic prevention. Acta Ophthalmol 2016. [DOI: 10.1111/j.1755-3768.2016.0542] [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: 11/30/2022]
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16
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Bruni F, Pasqui AL, Pastorelli M, Bova G, Cercignani M, Palazzuoli A, Sawamura T, Gioffre WR, Auteri A, Puccetti L. Different Effect of Statins on Platelet Oxidized-LDLReceptor (CD36 and LOX-1) Expressionin Hypercholesterolemic Subjects. Clin Appl Thromb Hemost 2016; 11:417-28. [PMID: 16244767 DOI: 10.1177/107602960501100408] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Hydroxymethyl-glutaryl-CoA-reductase inhibitors (statins) reduce cardiovascular mortality by decreasing cholesterol as well as by non-lipid-related actions. Oxidized low-density lipoproteins (ox-LDL) are pro-atherogenic molecules and potent platelet agonists. CD36 and lectin-like ox-LDL receptor-1 (LOX-1) are specific ox-LDL receptors also expressed in platelets. This study was planned to address whether treatment with atorvastatin 10 mg/day, pravastatin 40 mg/day or simvastatin 20 mg/day could affect platelet CD36 and LOX-1 expression. Twenty-four patients for each treatment were evaluated after 3, 6, and 9 days and at 6 weeks for complete lipid profile (chromogenic), ox-LDL (ELISA), platelet P-selectin (P-sel), CD36, LOX-1 (FACS), and intracellular citrullin recovery (iCit) (HPLC). Data show hyperactivated platelets (P-sel absolute values, percent variation in activated cells, all p < 0.001), and CD36 and LOX-1 overexpression (all p < 0.001) in patients at baseline. P-sel, CD36, and LOX-1 were significantly decreased by atorvastatin and simvastatin (all p < 0.01) and related with iCit increase (r = 0.58,p < 0.001) and platelet-associated ox-LDL (r = 0.51, p < 0.01) at 9 days. Pravastatin reduced LOX-1 and P-sel (p < 0.05) at 6 weeks in relation with decreased LDL and ox-LDL (r = 0.39, p < 0.01 and r = 0.37, p < 0.01, respectively). These data suggest that atorvastatin and simvastatin reduce platelet activity by exposure of CD36 and LOX-1 before significant LDL reduction, whereas pravastatin action is detected later and in relation with LDL and ox-LDL lowering. Rapid and consistent reduction of CD36 and LOX-1 could be considered a direct anti-atherothrombotic mechanism related to the role of ox-LDL in platelet activation, platelet-endothelium interactions, and NO synthase activity.
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Affiliation(s)
- Fulvio Bruni
- Department of Clinical Medicine and Immunological Sciences, Internal Medicine Division, Center for Atherosclerosis Research, University of Siena, Siena, Italy
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Fruschelli M, Capozzoli M, Scapellato C, Calzoni P, Puccetti L. New generation analysis of thrombin generation in retinal vein thrombosis. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.1496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Fruschelli
- Scienze Mediche Chirurgiche e Neuroscienze; University of Siena; Siena Italy
| | - M. Capozzoli
- Scuola di Specializzazione in Oftalmologia; University of Siena; Siena Italy
| | - C. Scapellato
- U.O.C. Laboratorio Patologia Clinica Aous; University of Siena; Siena Italy
| | - P. Calzoni
- U.O.C. Ematologia E Coagulazione Aous; University of Siena; Siena Italy
| | - L. Puccetti
- Scienze Mediche Chirurgiche e Neuroscienze; University of Siena; Siena Italy
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Fruschelli M, Capozzoli M, Scapellato C, Calzoni P, Puccetti L. New generation analysis of thrombin generation in retinal vein thrombosis. Acta Ophthalmol 2015. [DOI: 10.1111/j.1755-3768.2015.0496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- M. Fruschelli
- Scienze Mediche Chirurgiche e Neuroscienze; University of Siena; Siena Italy
| | - M. Capozzoli
- Scuola di Specializzazione in Oftalmologia; University of Siena; Siena Italy
| | - C. Scapellato
- U.O.C. Laboratorio Patologia Clinica AOUS; University of Siena; Siena Italy
| | - P. Calzoni
- U.O.C. Ematologia E Coagulazione AOUS; University of Siena; Siena Italy
| | - L. Puccetti
- Scienze Mediche Chirurgiche e Neuroscienze; University of Siena; Siena Italy
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Santilli F, Blardi P, Scapellato C, Bocchia M, Guazzi G, Terzuoli L, Tabucchi A, Silvietti A, Lucani B, Gioffrè WR, Scarpini F, Fazio F, Davì G, Puccetti L. Decreased plasma endogenous soluble RAGE, and enhanced adipokine secretion, oxidative stress and platelet/coagulative activation identify non-alcoholic fatty liver disease among patients with familial combined hyperlipidemia and/or metabolic syndrome. Vascul Pharmacol 2015; 72:16-24. [PMID: 26117210 DOI: 10.1016/j.vph.2015.04.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 12/05/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 01/07/2023]
Abstract
OBJECTIVE In patients with familial combined hyperlipidemia (FCHL), without metabolic syndrome (MS), occurrence of non-alcoholic fatty liver disease (NAFLD) is related to a specific pro-inflammatory profile, influenced by genetic traits, involved in oxidative stress and adipokine secretion. Among FCHL or MS patients, hyperactivity of the ligand-receptor for advanced glycation-end-products (RAGE) pathway, as reflected by inadequate protective response by the endogenous secretory (es)RAGE, in concert with genetic predisposition, may identify those with NAFLD even before and regardless of MS. METHODS We cross-sectionally compared 60 patients with vs. 50 without NAFLD. Each group included patients with FCHL alone, MS alone, and FCHL plus MS. RESULTS NAFLD patients had significantly lower plasma esRAGE, IL-10 and adiponectin, and higher CD40 ligand, endogenous thrombin potential and oxidized LDL. The effects of MS plus FCHL were additive. The genotypic cluster including LOX-1 IVS4-14A plus ADIPO 45GG and 256 GT/GG plus IL-10 10-1082G, together with higher esRAGE levels highly discriminate FCHL and MS patients not developing NAFLD. CONCLUSIONS Among FCHL or MS patients, noncarriers of the protective genotypic cluster, with lower esRAGE and higher degree of atherothrombotic abnormalities coincide with the diagnosis of NAFLD. This suggests an interplay between genotype, adipokine secretion, oxidative stress and platelet/coagulative activation, accelerating NAFLD occurrence as a proxy for cardiovascular disease.
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Affiliation(s)
| | | | - Carlo Scapellato
- Division of Clinical Pathology, University Teaching Hospital of Siena, Italy
| | | | - Gianni Guazzi
- Unit of Emergency Radiology, University Teaching Hospital of Siena, Italy
| | - Lucia Terzuoli
- Division of Clinical Pathology, University Teaching Hospital of Siena, Italy
| | - Antonella Tabucchi
- Division of Clinical Pathology, University Teaching Hospital of Siena, Italy
| | - Antonella Silvietti
- Division of Clinical Pathology, University Teaching Hospital of Siena, Italy
| | | | | | | | - Francesca Fazio
- Department of Medicine and Aging, University of Chieti, Italy
| | - Giovanni Davì
- Department of Medicine and Aging, University of Chieti, Italy
| | - Luca Puccetti
- Division of Hematology, University of Siena, Italy; Atherothrombosis Centre, University of Siena, Italy.
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Navarri R, Lunghetti S, Cameli M, Mondillo S, Favilli R, Scarpini F, Puccetti L. Neurohumoral improvement and torsional dynamics in patients with heart failure after treatment with levosimendan. Int J Cardiol Heart Vasc 2014; 7:153-157. [PMID: 28785666 PMCID: PMC5497181 DOI: 10.1016/j.ijcha.2014.10.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 08/05/2014] [Accepted: 10/26/2014] [Indexed: 11/30/2022]
Abstract
Background Levosimendan improves clinical and hemodynamic parameters exerting an anti-inflammatory and antiapoptotic effect in decompensated heart failure. The aim of this study was to evaluate the effects of levosimendan on LV torsion, plasma levels of NT-proBNP and on the balance between pro-inflammatory (TNF-α, IL-6) and anti-inflammatory cytokines (IL-10). Methods We enrolled 24 patients (age 62 ± 7 years) with acute HF, NYHA class IV and severe LV dysfunction. All patients underwent transthoracic echocardiography using two-dimensional speckle tracking analysis to detect LV twist angle (LVTA), at baseline and 1 week after treatment with levosimendan infusion. Biochemical parameters (pro-BNP, IL-6, IL-10, TNF-α) were determined by enzyme-linked immunosorbent (ELISA). Results After one week, we observed an improvement in LV function especially in LVTA (4.15 ± 2.54 vs 2.9 ± 2.1 p < 0.01), in LV ejection fraction (27.3 ± 8.04 vs 21.6 ± 6.8 p = 0.03) and also a significant reduction in BNP levels (1844 ± 560 vs 4713 ± 1050, p = 0.03). The multiple linear regression analysis showed a significant relation between a reduction of TNF α/IL-10 ratio (Δ > 20%) and BNP (Δ > 40%), LVEF (Δ > 10%) and LVTA (Δ > 20%) (O.R. 1.77, 95% C.I. 1.11–2.83; O.R. 1.49, 95% C.I. 1.08–2.67; O.R. 1.66, 95% C.I. 1.10–2.74, respectively, confirmed p, all < 0.01 by Hosmer–Lemeshov confirmation and the formal test for interaction). Conclusions Levosimendan exerts a hemodynamic effect by improving EF and LV torsion in patients with acute HF in association with a positive effect on the balance between pro and anti-inflammatory cytokines.
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Affiliation(s)
- Romina Navarri
- Department of Cardiology, University Teaching Hospital of Siena, Italy
| | - Stefano Lunghetti
- Department of Cardiology, University Teaching Hospital of Siena, Italy
| | - Matteo Cameli
- Department of Cardiology, University Teaching Hospital of Siena, Italy
| | - Sergio Mondillo
- Department of Cardiology, University Teaching Hospital of Siena, Italy
| | - Roberto Favilli
- Department of Cardiology, University Teaching Hospital of Siena, Italy
| | | | - Luca Puccetti
- Centre for Atherosclerosis Research, University of Siena, Italy
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Monti M, Solito R, Puccetti L, Pasotti L, Roggeri R, Monzani E, Casella L, Morbidelli L. Protective effects of novel metal-nonoates on the cellular components of the vascular system. J Pharmacol Exp Ther 2014; 351:500-9. [PMID: 25238748 DOI: 10.1124/jpet.114.218404] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
At the cardiovascular level, nitric oxide (NO) controls smooth muscle functions, maintains vascular integrity, and exerts an antihypertensive effect. Metal-nonoates are a recently discovered class of NO donors, with NO release modulated through the complexation of the N-aminoethylpiperazine N-diazeniumdiolate ligand to metal ions, and thus representing a significant innovation with respect to the drugs traditionally used. In this study, we characterized the vascular protective effects of the most effective compound of this class, Ni(PipNONO)Cl, compared with the commercial N-diazeniumdiolate group derivate, diethylenetriamine/nitric oxide (DETA/NO). Ni(PipNONO)Cl induced a concentration-dependent relaxation of precontracted rat aortic rings. The ED50 was 0.67 µM, compared with 4.3 µM obtained with DETA/NO. When tested on cultured microvascular endothelial cells, Ni(PipNONO)Cl exerted a protective effect on the endothelium, promoting cell proliferation and survival in the picomolar range. The administration of Ni(PipNONO)Cl to vascular smooth muscle cells reduced the cell number, promoting their apoptosis at a high concentration (10 µM). Inhibition of smooth muscle cell migration, a hallmark of atherosclerosis, was accompanied by cytoskeletal rearrangement and loss of lamellipodia. When added to isolated platelets, Ni(PipNONO)Cl significantly reduced ADP-induced aggregation. Since atherosclerosis is accompanied by an inflammatory environment, cultured endothelial cells were exposed to interleukin (IL)-1β. In the presence of IL-1β, Ni(PipNONO)Cl inhibited cyclooxygenase-2 and inducible nitric oxide synthase upregulation, and reduced endothelial permeability and the platelet and monocyte adhesion markers CD31 and CD40 at the plasma membrane. Overall, these data indicate that Ni(PipNONO)Cl exerts vascular protective effects relevant for vascular dysfunction and prevention of atherosclerosis and thrombosis.
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Affiliation(s)
- Martina Monti
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Raffaella Solito
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Luca Puccetti
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Luca Pasotti
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Riccardo Roggeri
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Enrico Monzani
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Luigi Casella
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
| | - Lucia Morbidelli
- Department of Life Sciences (M.M., R.S., L.M.) and Division of Hematology, Atherothrombosis Center (L.Pu.), University of Siena, Siena, Italy; Department of Chemistry, University of Pavia, Pavia, Italy (L.Pa., E.M., L.C.); and Noxamet Ltd., Milan, Italy (M.M., L.Pa., R.R., E.M., L.C., L.M.)
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Nucci EM, Lisi M, Cameli M, Baldi L, Puccetti L, Mondillo S, Favilli R, Lunghetti S. The role of 3D and speckle tracking echocardiography in cardiac amyloidosis: a case report. Eur Rev Med Pharmacol Sci 2014; 18:74-77. [PMID: 24452946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Cardiac amyloidosis (CA) is a disorder characterized by amyloid fibrils deposition in cardiac interstitium; it results in a restrictive cardiomyopathy with heart failure (HF) and conduction abnormalities. The "gold standard" for diagnosis of CA is myocardial biopsy but possible sampling errors and procedural risks, limit it's use. Magnetic resonance (RMN) offers more information than traditional echocardiography and allows diagnosis of CA but often it's impossible to perform. We report the case of a man with HF and symptomatic bradyarrhythmia that required an urgent pacemaker implant. Echocardiography was strongly suggestive of CA but wasn't impossible to perform an RMN to confirm this hypothesis because the patient was implanted with a definitive pacemaker. So was performed a Speckle Tracking Echocardiography (STE) and a 3D echocardiography: STE allows to differentiate CA from others hypertrophic cardiomyopathy by longitudinal strain value < 12% and 3D echocardiography shows regional left ventricular dyssynchrony with a characteristic temporal pattern of dispersion of regional volume systolic change. On the basis of these results, finally was performed an endomyocardial biopsy that confirmed the diagnosis of CA. This case underlines the importance of news, noninvasive techniques such as eco 3D and STE for early diagnosis of CA, especially when RMN cannot be performed.
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Affiliation(s)
- E M Nucci
- Department of Cardiology, Azienda Ospedaliera Universitaria Senese, Siena, Italy.
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Vazzana N, Ganci A, Cefalu' AB, Lattanzio S, Noto D, Santoro N, Saggini R, Puccetti L, Averna M, Davi' G. Enhanced lipid peroxidation and platelet activation as potential contributors to increased cardiovascular risk in the low-HDL phenotype. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht310.p5499] [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: 11/14/2022] Open
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Vazzana N, Ganci A, Cefalù AB, Lattanzio S, Noto D, Santoro N, Saggini R, Puccetti L, Averna M, Davì G. Enhanced lipid peroxidation and platelet activation as potential contributors to increased cardiovascular risk in the low-HDL phenotype. J Am Heart Assoc 2013; 2:e000063. [PMID: 23557750 PMCID: PMC3647282 DOI: 10.1161/jaha.113.000063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Low high‐density lipoprotein (HDL) levels are major predictors of cardiovascular (CV) events, even in patients on statin treatment with low‐density lipoprotein (LDL) at target. In animal models HDLs protect LDL from oxidation and blunt platelet activation. Our study aimed to examine whether HDL levels are related to in vivo oxidative stress and platelet activation, as determinants of atherothrombosis. Methods and Results Urinary 8‐iso‐PGF2α and 11‐dehydro‐TXB2, in vivo markers of oxidative stress and platelet activation, respectively, were measured in 65 coronary heart disease (CHD) normocholesterolemic patients with HDL ≤35 mg/dL, and in 47 CHD patients with HDL >35 mg/dL. The 2 eicosanoids were also measured before and after an intensive exercise program in sedentary people (n=18) and before and after fenofibrate treatment in otherwise healthy subjects with low HDL (n=10). Patients with HDL ≤35 mg/dL showed significantly higher urinary 8‐iso‐PGF2α (median [25th to 75th percentiles]: 289 [189 to 380] versus 216 [171 to 321] pg/mg creatinine, P=0.019) and 11‐dehydro‐TXB2 (563 [421 to 767] versus 372 [249 to 465] pg/mg creatinine, P=0.0001) than patients with higher HDL. A direct correlation was found between urinary 8‐iso‐PGF2α and 11‐dehydro‐TXB2 in the entire group of patients (ρ=0.77, P<0.0001). HDL levels were inversely related to both 8‐iso‐PGF2α (ρ=−0.32, P=0.001) and 11‐dehydro‐TXB2 (ρ=−0.52, P<0.0001). On multiple regression, only 8‐iso‐PGF2α (β=0.68, P<0.0001) and HDL level (β=−0.29, P<0.0001) were associated with urinary 11‐dehydro‐TXB2 excretion, independent of sex, age, smoking, hypertension, diabetes, previous myocardial infarction, total cholesterol, LDL, and triglycerides. Both intensive exercise and fenofibrate treatment significantly reduced the 2 eicosanoids in healthy subjects, in parallel with an HDL increase. Conclusions A low HDL phenotype, both in CHD patients and in healthy subjects, is associated with increased lipid peroxidation and platelet activation. These data provide novel insight into the mechanisms linking low HDL with increased CV risk.
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Affiliation(s)
- Natale Vazzana
- Department of Internal Medicine and Center of Excellence on Aging, G. d'Annunzio University of Chieti, Chieti, Italy
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Scarpini F, Cappellone R, Auteri A, Puccetti L. Role of genetic factors in statins side-effects. Cardiovasc Hematol Disord Drug Targets 2012; 12:35-43. [PMID: 22524173 DOI: 10.2174/187152912801823138] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 03/30/2012] [Accepted: 04/02/2012] [Indexed: 05/31/2023]
Abstract
Statins are relevant drugs involved in the reduction of cardiovascular events both in primary and secondary prevention. Related muscular side-effects are the most common cause of withdrawal and statins discontinuation could induce a negative rebound effect in terms of vascular events. Among factors in association with statins side-effects the combination with other drugs and the female sex are established conditions. However recent data suggest a specific genetic influence in intolerance development, at least for some statins. Indeed a genome-wide study in patients treated with simvastatin found an impressive association between single-nucleotide polymorphisms (SNPs) located within SLCO1B1 gene on chromosome 12 and established myopathy. Furthermore, the association between the SLCO1B1*5 variant and side-effects was found also in patients treated with atorvastatin but not, apparently, with pravastatin and categorized as carriers of mild-myopathy. Recently a similar evidence has been suggested in type 2 diabetic patients treated mainly with simvastatin. However another relevant issue is that, apart from genetic influence in liver transporters influencing drug levels, the complexity of mechanisms involved in the muscular side effects of statins has been addressed by the evidence of other influencing pathways such as the variant within the COQ2 gene involved in Coenzyme Q(10) mild-asymptomatic deficiency and skeletal muscle drug transporters expression. In conclusion, the picture of putative pharmacogenetic modulation of statins safety is reaching a growing body of evidence for translation into clinical practice but more specific studies for each single statin, in different clinical settings, both from genome-wide or competitive candidate genes evaluation, are needed before describing a definitive class-risk profile.
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Affiliation(s)
- Francesca Scarpini
- Department of Clinical Medicine and Immunological Sciences, Internal Medicine Division, Centre for Atherosclerosis Research, University of Siena, Italy
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Puccetti L, Scarpini F, Cappellone R, Auteri A. Safety of long-term simvastatin discontinuation. Lancet 2012; 379:1704; author reply 1704. [PMID: 22559898 DOI: 10.1016/s0140-6736(12)60719-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Puccetti L, Pasqui AL, Scarpini F, Cappellone R, Ghezzi A, Ceccatelli L, Auteri A. Statins discontinuation in compliant chronic users induces atherothrombotic profile despite baseline clinical setting and treatments. Int J Cardiol 2011; 153:328-9. [PMID: 22000266 DOI: 10.1016/j.ijcard.2011.09.042] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 09/17/2011] [Indexed: 11/19/2022]
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Pastorelli M, Puccetti L, Di Pietra N, Bruni F, Acampa M, Costa A, Beermann U, Bocchi V, Donati V, Auteri A, Cerase A. Cranial osteolytic metastases as the only recurrence of gastric carcinoma. Eur Rev Med Pharmacol Sci 2011; 15:580-582. [PMID: 21744757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The purpose of this case report is to increase the knowledge about bone metastatic pattern in gastric cancer. A 59-year-old man presented with headache three years after a total gastrectomy for signet-ring cell carcinoma. Head computed tomography and magnetic resonance imaging showed multiple osteolytic lesions of the cranial vault and base, consistent with metastatic or haematological disease. Bone scintigraphy confirmed areas of accumulation only in the skull. An extensive search didn't show any other tumor. Bone biopsy revealed metastatic signet-ring cell carcinoma. In gastric cancer, bone metastases are generally associated with metastases in lymph nodes, liver, and lung, and have a higher frequency in the thoracolumbar spine. However, cranial bone metastases presenting with headache may be the only manifestation of gastric cancer recurrence.
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Affiliation(s)
- M Pastorelli
- Division of Internal Medicine, Department of Clinical Medicine and Immunological Sciences, University of Siena, Italy.
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Giordano N, Puccetti L, Papakostas P, Di Pietra N, Bruni F, Pasqui AL, Acampa M, Bocchi V, Donati V, Voglino M, Fioravanti A, Montella A, Auteri A, Nuti R, Pastorelli M. Bosentan treatment for Raynauds phenomenon and skin fibrosis in patients with Systemic Sclerosis and pulmonary arterial hypertension: an open-label, observational, retrospective study. Int J Immunopathol Pharmacol 2011; 23:1185-94. [PMID: 21244767 DOI: 10.1177/039463201002300422] [Citation(s) in RCA: 19] [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: 11/15/2022] Open
Abstract
Raynaud?s phenomenon (RP) and cutaneous fibrosis are the distinctive manifestations of scleroderma, in which Endothelin-1 plays a fundamental pathogenetic role. Bosentan, an Endothelin-1 receptor antagonist used for the treatment of pulmonary arterial hypertension, retards the beginning of new sclerodermic digital ulcers (DU). This open-label, observational, retrospective study verified the effect of Bosentan on RP and skin fibrosis in sclerodermic outpatients affected by pulmonary arterial hypertension without DU. Fourteen subjects (13 women, 1 man; mean age 60 ± 7.5 years; ten with limited and four with diffuse scleroderma) were observed at baseline (T0) and after four (T1), twelve (T2), twenty-four (T3) and forty-eight (T4) weeks during treatment with Bosentan. They were evaluated for daily quantity and duration of RP attacks and skin thickness (using modified Rodnan total skin score, MRSS). Videocapillaroscopic evaluation was performed at T0 and T4. Bosentan decreased significantly the number and duration of RP attacks, beginning at T2 (p<0.05). Videocapillaroscopy showed significant improvement of microcirculatory patterns at T4 (p<0.05). MRSS decreased throughout the study, reaching the statistical significance at T3 and T4 (p<0.01) in the whole cohort. The present data suggest that Bosentan is effective in stabilizing the microcirculation involvement and in improving skin fibrosis irrespective of scleroderma patterns.
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Affiliation(s)
- N Giordano
- Department of Internal Medicine, Endocrine-Metabolic Sciences and Biochemistry, University of Siena, Italy.
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Puccetti L, Scarpini F, Auteri A, Ciani F. Genetics of the coenzyme Q10 pathway and rosuvastatin-induced muscle effects. J Pediatr 2011; 158:520-1. [PMID: 21276592 DOI: 10.1016/j.jpeds.2010.11.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 11/30/2010] [Indexed: 11/16/2022]
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Puccetti L, Santilli F, Pasqui AL, Lattanzio S, Liani R, Ciani F, Ferrante E, Ciabattoni G, Scarpini F, Ghezzi A, Auteri A, Davì G. Effects of atorvastatin and rosuvastatin on thromboxane-dependent platelet activation and oxidative stress in hypercholesterolemia. Atherosclerosis 2010; 214:122-8. [PMID: 21056418 DOI: 10.1016/j.atherosclerosis.2010.10.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/10/2010] [Accepted: 10/02/2010] [Indexed: 12/17/2022]
Abstract
OBJECTIVES We examined the time-dependent effects of atorvastatin and rosuvastatin on in vivo oxidative stress and platelet activation, to assess whether these phenomena are related to any pleiotropic effect of any statin or to their LDL-lowering effect. We also asked whether the presence of specific allele frequencies in carriers of the 3'UTR/lectin-like oxidized LDL receptor-1 (LOX-1) polymorphism may influence the effect of either statin. METHODS We included 60 hypercholesterolemic subjects, previously screened for LOX-1 3'UTR polymorphism, randomized, according to genetic profile (15 T and 15 C carriers for each arm), to atorvastatin 20mg/day or rosuvastatin 10mg/day. RESULTS After 8 weeks, atorvastatin and rosuvastatin were associated with comparable, significant reductions in LDL cholesterol (40.8% and 43.6%, respectively), plasma hs-CRP (9.5% vs. 13.8%), urinary 11-dehydro-thromboxane (TX) B(2) (38.9% vs. 27.1%) and 8-iso-prostaglandin (PG) F(2α) (39.4% vs. 19.4%). The impact of rosuvastatin or atorvastatin on CRP, 8-iso-PGF(2α), and 11-dehydro-TXB(2) did not differ according to the LOX-1 haplotype. On multiple regression analyses, only CRP and LDL were independent predictors of 11-dehydro-TXB(2), and only LDL was a significant predictor of 8-iso-PGF(2α). CONCLUSIONS Both atorvastatin and rosuvastatin cause comparable reductions of thromboxane-dependent platelet activation, lipid peroxidation and inflammation. The presence of 3'UTR/LOX-1 polymorphism does not affect the changes induced by either statin.
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Affiliation(s)
- Luca Puccetti
- Center for Atherosclerosis Research, University of Siena, v.le Bracci, 53100 Siena, Italy.
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Cianchi F, Vinci MC, Supuran CT, Peruzzi B, De Giuli P, Fasolis G, Perigli G, Pastorekova S, Papucci L, Pini A, Masini E, Puccetti L. Selective Inhibition of Carbonic Anhydrase IX Decreases Cell Proliferation and Induces Ceramide-Mediated Apoptosis in Human Cancer Cells. J Pharmacol Exp Ther 2010; 334:710-9. [DOI: 10.1124/jpet.110.167270] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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Acampa M, Franchi M, Guideri F, Lamberti I, Bruni F, Pastorelli M, Bova G, Pasqui AL, Puccetti L, Auteri A. Cardiac dysautonomia and arterial distensibility in essential hypertensives. Auton Neurosci 2009; 146:102-5. [PMID: 19121608 DOI: 10.1016/j.autneu.2008.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 10/07/2008] [Accepted: 11/13/2008] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The central nervous system plays an important role in the regulation of blood pressure: the sympathetic nervous system may be a primary contributor to the development of some forms of essential hypertension. Hypertension is also associated with reduced distensibility of large arteries. The aim of our study is the evaluation of a correlation between cardiac dysautonomia (evaluated by means of heart rate variability [HRV]) and altered artery distensibility (evaluated by means of measurement of the time interval from the onset of the QRS wave and the detection of the last Korotkoff sound [QKD interval]). MATERIALS AND METHODS HRV and QKD interval were evaluated in 23 patients (60.9+/-8.7 years) with untreated hypertension and in 20 control subjects (53.2+/-16.8 years). QKD interval and QKD(100-60) (that is QKD for a 100 mm Hg systolic blood pressure and 60 bpm heart rate) were measured during a 24-hours blood pressure monitoring. HRV was evaluated by means of a spectral method. Three main spectral components were distinguished: very low frequency (VLF), low frequency (LF) and high frequency (HF) component. RESULTS Patients with reduced QKD(100-60) interval show reduced total power and spectral components values, with higher LF/HF ratio in basal conditions in comparison with control group. In patients with hypertension, QKD(100-60) values correlated significantly with LF/HF ratio (Spearman r=-0.551; p=0.006), HF spectral component (Spearman r=0.630; p=0.001) and total power (Spearman r=0.426; p=0.004). CONCLUSIONS Our results suggest that sympathetic overactivity may be the contributor of reduced arterial distensibility observed in patients with essential hypertension.
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Affiliation(s)
- Maurizio Acampa
- Department of Clinical Medicine and Immunological Sciences, Section of Internal Medicine, University of Siena, Siena, Italy.
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Maffei S, Di Renzo M, Santoro S, Puccetti L, Pasqui AL. Refractory Takayasu arteritis successfully treated with infliximab. Eur Rev Med Pharmacol Sci 2009; 13:63-65. [PMID: 19364087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Takayasu arteritis (TA) is a chronic inflammatory disease of large arteries which progressively develop stenosis, occlusion or aneurismal degeneration. Proinflammatory cytokines and, among these, tumor necrosis factor-alpha (TNF-alpha) are increased and play a pathogenetic role in the development of disease. Conventional therapy often fails to determine clinical remission and, in these cases, pathogenetic strategies with anti-TNF-alpha drugs have been proposed. Infliximab is a human-murine chimeric monoclonal antibody that specifically binds to and neutralizes soluble TNF-alpha. It is an effective treatment for rheumatoid arthritis, spondyloarthritis, Crohn's disease and ulcerative colitis and it has been recently proposed for the treatment of TA in patients refractory to conventional therapy. Here we report the case of a patient affected by Takayasu arteritis unresponsive to conventional therapy who was then treated with infliximab and obtained a clinical remission of the disease.
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Affiliation(s)
- S Maffei
- Department of Cardiology, Policlinico Le Scotte, University of Siena, Italy
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Tripodi SA, Del Vecchio MT, Supuran CT, Scozzafava A, Gabrielli MG, Pastorekova S, Rossie R, Fasolis G, Puccetti L. Redox State and Carbonic Anhydrase Isozyme IX Expression in Human Renal Cell Carcinoma: Biochemical and Morphological Investigations. J Enzyme Inhib Med Chem 2008; 19:287-91. [PMID: 15500003 DOI: 10.1080/14756360410001689531] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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: 02/01/2023] Open
Abstract
Clear renal cell carcinomas (RCC) frequently express carbonic anydrase IX (CA IX) because of non-functional mutation of von Hippel Lindau (VHL) tumor suppressor gene. CA IX is a tumor-associated transmembrane antigen, which catalyzes the extracellular, reversible hydration of carbon dioxide to bicarbonate and proton and thereby contributes to acidification of extracellular milieu. Extracellular acidic pH facilitates tumor growth and progression. CA IX expression is upregulated by Hypoxia Inducible Factor-1 (HIF-1), which is negatively controlled by oxygen via wild type VHL protein and is also regulated by the cell redox state. We investigated the immunohistochemical pattern of distribution of CA IX in a small series (14 cases) of RCCs. CA IX expression was matched with the redox state of RCC, stratifying our series in relation to clinical and histopathological parameters, such as Fuhrman grade, staging, proliferation markers expression, and particularly, the presence of necrosis. Our results show for the first time the existence of a perivascular pattern of CA IX distribution in RCC. We also found a significant relationship between CA IX expression and the presence of necrosis. Tumors with higher CA IX expression exhibited higher degree of necrosis (p < 0.05). Notably, an almost significant relationship between the redox state and CA IX expression was detected in RCC patients with 5 years disease-free survival, most of them showing organ-confined disease. Tumors with lower redox state showed an algebraically higher degree of CA IX expression. On the contrary, tumors with higher redox state exhibited an algebraically lower CA IX expression (p = 0.057). The observed relationship of CA IX expression and necrosis suggests a role for CA IX in RCC. Further investigations are necessary to further establish the role of the redox state in regulation of CA IX expression in RCC.
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Affiliation(s)
- Sergio A Tripodi
- Department of Pathology and Oncology, University of Siena, Siena, Italy.
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Puccetti L, Capati E, Auteri A. Genetic modulation of anti-inflammatory effects of atorvastatin; probably a multi-gene condition. Atherosclerosis 2008; 197:469-70; author reply 67-8. [DOI: 10.1016/j.atherosclerosis.2007.10.039] [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] [Received: 08/19/2007] [Accepted: 10/12/2007] [Indexed: 10/22/2022]
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Pasqui AL, Di Renzo M, Bova G, Maffei S, Pompella G, Auteri A, Puccetti L. Pro-inflammatory/anti-inflammatory cytokine imbalance in acute coronary syndromes. Clin Exp Med 2008; 6:38-44. [PMID: 16550343 DOI: 10.1007/s10238-006-0092-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2005] [Accepted: 12/23/2005] [Indexed: 10/24/2022]
Abstract
The aim of this study was to evaluate the presence of an imbalance between proinflammatory and anti-inflammatory mediators in patients affected by acute coronary syndromes (ACS). We considered two groups of 26 and 28 patients with acute myocardial infarction (AMI) and unstable angina (UA) respectively, compared with a group of 30 patients with stable angina and 30 healthy volunteers. We evaluated the production in cultured and stimulated lymphomonocytes of interferon (IFN)gamma and tumour necrosis factor (TNF)alpha, which are well known to possess proinflammatory effects, and of interleukin (IL)10, which has been shown to have a protective anti-inflammatory activity. We also assessed the clinical characteristics of groups and, particularly, we evaluated the circulating levels of C-reactive protein (hs-CRP). We found a significant increase of IFNgamma and TNFalpha production (P<0.01) and a significant decrease of IL10 production (P<0.05) in cultures of lymphomonocytes taken from patients with AMI and UA compared with SA patients and controls. No significant changes where found between AMI and UA patients and SA patients and controls. Circulating levels of hs-CRP were significantly increased (P<0.01) in patients with ACS compared with the other control groups. Our data showed an increased production of proinflammatory mediators in ACS that may be detectable both in circulating blood and in cell cultures where it is possible to evaluate in a better way the functional state of cells; this finding was associated with a reduced production of the antiinflammatory cytokine IL10. In conclusion, a relevant imbalance is present in ACS and this fact could contribute to plaque instability and clinical manifestations.
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Affiliation(s)
- A L Pasqui
- Dip Medicina Clinica e Scienze Immunologiche, Sezione di Medicina Interna, Policlinico Le Scotte, I-53100, Siena, Italy.
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Puccetti L, Bruni F, Pasqui AL, Pastorelli M, Ciani F, Palazzuoli A, Acampa M, Auteri A. Genetic influence in antithrombotic actions of atorvastatin in hypercholesterolaemia. Eur J Clin Invest 2008; 38:11-6. [PMID: 18173546 DOI: 10.1111/j.1365-2362.2007.01891.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent data indicate that statins could offer coronary artery disease (CAD) benefit even by mechanisms beyond lipid lowering. Genetic influence has been shown for some antithrombotic actions of statins via oxidized-low-density lipoprotein cholesterol (ox-LDL) receptors and nitric oxide synthase (NOS) activity modulation. The present study was designed to evaluate the influence of ox-LDL lectin-like receptor-1 (LOX-1) and NOS polymorphisms in the incidence of cardiovascular events in pure hypercholesterolaemic subjects during statin treatment. MATERIALS AND METHODS A prospective 4-year study involving 1039 event-free subjects (643 males, 396 females) treated with atorvastatin (10-40 mg day(-1)) to reach the appropriate Adult Treatment Panel-III LDL target of 3.36 mmol L(-1). Enrolled subjects were evaluated every 6 months or at a clinical event. LOX-1 3'UTR/T-C and NOS G894T polymorphisms were detected by allelic discrimination assays (polymerase chain reaction), lipid profile by enzymatic-colorimetric method, ox-LDL by enzyme linked immunosorbent assay, platelet activation by P-selectin (P-sel) expression (FACScan), NOS activity (by intracellular citrullin recovery) and homocysteine (high performance liquid chromatography), C-reactive protein (CRP) by sensitive nephelometric technique. RESULTS LOX-1 3'UTR/T showed the strongest association with events in the whole cohort with respect to each other variable including LDL reduction and NOS G894T (OR 4.90, 95% CI 3.19-6.98, P < 0.00001). Smoking influenced events in LDL-targeted subjects (P < 0.0001). Ox-LDL and P-sel were better indicators than LDL or other variables according to 3'UTR/C genotype regardless of the magnitude of LDL reduction (OR 4.21, 95% CI 2.29-6.70 P < 0.0001). CONCLUSIONS LOX-1 polymorphisms could influence statin effectiveness in CAD prevention by induction of sensitivity to antithrombotic mechanisms such as antiplatelet activity.
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Affiliation(s)
- L Puccetti
- Department of Clinical Medicine and Immunology, Internal Medicine Division, Centre for Atherosclerosis Research, University of Siena, Siena, Italy.
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Pasqui AL, Di Renzo M, Auteri A, Federico G, Puccetti L. Increased TNF-alpha production by peripheral blood mononuclear cells in patients with Krabbe's disease: effect of psychosine. Eur J Clin Invest 2007; 37:742-5. [PMID: 17696965 DOI: 10.1111/j.1365-2362.2007.01850.x] [Citation(s) in RCA: 10] [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] [Indexed: 12/01/2022]
Abstract
BACKGROUND Inflammatory and/or immune activation occurs both in animal models (twitcher mice) and in the brain of patients with Globoid cell leukodystrophy (GLD) or Krabbe's disease (KD). In this study we evaluated in vitro the cytokine profile of KD patients and the effect of psychosine, the toxic metabolite which plays a role in the demyelination process in these patients. MATERIALS AND METHODS We studied cytokine production by peripheral blood mononuclear cells (PBMCs) isolated from four KD patients, diagnosed on the basis of clinical criteria. Cells were cultured and stimulated with appropriate agents and the supernatants collected before and after the addition of psychosine. Tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) and monocyte chemoattractant factor (MCP)-1) production was evaluated (ELISA method) and compared with a group of 10 normal subjects. RESULTS We found a significant increase of TNF-alpha release by PBMCs of KD patients compared with healthy subjects; TNF-alpha production was significantly increased after LPS addition. Psychosine was able to induce a further significant increase (P < 0.05) only in cells obtained from KD patients and not from control subjects. No changes were found in IL-8 and MCP-1 production. CONCLUSIONS The increased TNF-alpha production permits us to confirm the presence of an inflammatory-immune stimulus in KD patients, which may be induced and potentiated by the pathogenetic metabolite psychosine.
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Puccetti L, Pasqui AL, Bruni F, Pastorelli M, Ciani F, Palazzuoli A, Pontani A, Ghezzi A, Auteri A. Lectin-like oxidized-LDL receptor-1 (LOX-1) polymorphisms influence cardiovascular events rate during statin treatment. Int J Cardiol 2007; 119:41-7. [PMID: 17050011 DOI: 10.1016/j.ijcard.2006.07.045] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [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: 02/22/2006] [Revised: 06/01/2006] [Accepted: 07/09/2006] [Indexed: 12/01/2022]
Abstract
BACKGROUND Oxidized-LDL (ox-LDL) are involved in atherothrombosis by induction of endothelial dysfunction and thrombosis. The specific receptor lectin-like oxidized-LDL receptor-1 (LOX-1) is expressed in endothelial cells, monocytes and platelets. LOX-1 gene allelic variants (3'UTR/T) have been related with cardiovascular events and reduced anti-platelet activity induced by statins. OBJECTIVES To detect whether LOX-1 polymorphisms could affect statins effectiveness in cardiovascular prevention. PATIENTS/METHODS The present was a retrospective study performed in 751 white hypercholesterolemic subjects treated with increasing doses of atorvastatin (n=382, 247 male, 135 female) or simvastatin (n=369, 244 male, 125 female) up to 4 years, whose LDL target was 3.36 mmol/L according to the National Cholesterol Education Program, Adult Treatment Panel III (NCEP-ATPIII). Single nucleotide polymorphism were evaluated by allelic discrimination assays (PCR), lipid profile by enzymatic-colorimetric methods and C-reactive protein (CRP) by a nephelometric technique. RESULTS Twenty-three non-ST elevation (NSTEMI) and eleven ST-elevation myocardial infarction (STEMI) were encountered in the observational period without differences between treatments (p=0.175) and sex (p=0.139). Each symptomatic subject (10 reaching the appropriate LDL target and 24 with still undesirable LDL) had the 3'UTR/T allelic variant (adjusted O.R. 4.63, 95% C.I. 3.46-6.70, p<0.0001). Among patients not reaching LDL target the C allele resulted protective with respect to T carriers (p<0.00001). Also, similar changes of CRP resulted in different event rate between T and C carriers (p<0.001) in the whole cohort. CONCLUSIONS In the studied population LOX-1 genetic variants influence cardiovascular risk reduction induced by statins also in patients not reaching the LDL target. The previously described LOX-1-related antithrombotic actions of both statins employed could have a specific role in what observed, suggesting a genetic influence in statins LDL-lowering partially related actions.
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Affiliation(s)
- L Puccetti
- Department of Clinical Medicine and Immunology, Internal Medicine Division, Center for Atherosclerosis Research, Policlinico Le Scotte, University of Siena, V.le Bracci, 53100, Siena, Italy.
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Pasqui A, Maffei S, Capati E, Bova G, DiRenzo M, Puccetti L, Auteri A. PO9-232 THE ROLE OF CYTOKINES IN LEFT VENTRICULAR REMODELING AFTER MYOCARDIAL INFARCTION. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71242-4] [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: 10/23/2022]
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Capati E, Bruni F, Pasqui A, Pastorelli M, Ciani F, Palazzuoli A, Auteri A, Puccetti L. YI-797 LECTIN-LIKE OXIDIZED-LDL RECEPTOR-1 (LOX-1) AND NITRIC OXIDE SINTHASE (NOS) POLYMORPHISMS INFLUENCES ATORVASTATIN ANTITHROMBOTIC ACTION AND CARDIOVASCULAR EVENT RATE. ATHEROSCLEROSIS SUPP 2007. [DOI: 10.1016/s1567-5688(07)71807-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Palazzuoli A, Deckers J, Calabrò A, Campagna MS, Nuti R, Pastorelli M, Pasqui AL, Bruni F, Auteri A, Puccetti L. Brain natriuretic peptide and other risk markers for outcome assessment in patients with non-ST-elevation coronary syndromes and preserved systolic function. Am J Cardiol 2006; 98:1322-8. [PMID: 17134622 DOI: 10.1016/j.amjcard.2006.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2006] [Revised: 06/13/2006] [Accepted: 06/13/2006] [Indexed: 10/24/2022]
Abstract
Several emerging cardiac markers constitute strong predictors among patients with coronary artery disease. In particular, brain natriuretic peptide (BNP), troponin T (TnT), and C-reactive protein (CRP) are related to increased risk of recurrent ischemic events and death. However, little is known about the utility of these biomarkers in combination. This study examined risk assessment in patients with coronary artery disease and preserved systolic function. We studied 208 consecutive patients (138 men, 70 women) with stable angina, unstable angina, and non-Q-wave myocardial infarction whose plasma BNP, TnT, and CRP levels were measured at hospital admission. All recruited patients underwent echocardiographic examination, and selective coronary angiography was performed. After adjusting for clinical presentation, age, gender, and common risk factors, BNP was demonstrated as a strong predictor of heart failure (6 months, odds ratio [OR] 2.03, 95% confidence interval [CI] 1.24 to 2.9, p <0.01; 12 months, OR 2.65, 95% CI 1.69 to 3.5, p <0.001) and mortality at 3, 6, and 12 months (p <0.001). BNP was also significantly related to extent of coronary artery disease and left anterior descending artery involvement (p <0.01). Patients with a BNP level >80 pg/ml in all 3 groups had a significantly poorer prognosis with increased incidence of heart failure and death. CRP was related to recurrent ischemic events (infarct or recurrent angina, OR 1.4, 95% CI 1.14 to 2.08, p <0.01) and was associated with major cardiac revascularization at 12 months (OR 1.51, 95% CI 1.29 to 1.73, p <0.001). TnT demonstrated a mild correlation with recurrent infarct or angina at 12 months (OR 1.1, 95% CI 0.96 to 1.22, p <0.05) but appeared related to multivessel coronary artery disease (OR 1.47, 95% CI 1.05 to 1.99, p <0.01). In conclusion, BNP appears to be associated with a long-term increased risk of mortality and heart failure in patients with apparently mild risk. BNP is also associated with a larger extent and greater severity of myocardial ischemia. Early BNP measurement could provide incremental information to TnT and CRP, and it may be the strongest independent predictor of cardiac outcome in subjects without left ventricular dysfunction or enlargement.
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Affiliation(s)
- Alberto Palazzuoli
- Department of Internal Medicine and Metabolic Diseases, Section of Cardiology, University of Siena, Siena, Italy.
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Parkkila S, Vullo D, Puccetti L, Parkkila AK, Scozzafava A, Supuran CT. Carbonic anhydrase activators: Activation of isozyme XIII with amino acids and amines. Bioorg Med Chem Lett 2006; 16:3955-9. [PMID: 16730978 DOI: 10.1016/j.bmcl.2006.05.023] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2006] [Revised: 05/05/2006] [Accepted: 05/05/2006] [Indexed: 11/16/2022]
Abstract
The first activation study of isoform XIII of carbonic anhydrase (CA, EC 4.2.1.1) is reported. A series of amino acids and amines incorporating protonatable moieties of the primary/heterocyclic amine type were included in the study. As for CA I and II, CA XIII activators enhance kcat and show no effect on KM, for the physiologic reaction catalyzed by this isoform. Excellent CA XIII activating properties were shown by D-amino acids (His, Phe, DOPA, and Trp), serotonin, and 4-(2-aminoethyl)-morpholine, whereas the corresponding L-amino acids, dopamine, histamine, and 1-(2-aminoethyl)-piperazine, were weaker activators.
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Affiliation(s)
- Seppo Parkkila
- Institute of Medical Technology, University of Tampere, Tampere University Hospital, Biokatu 6, 33520 Tampere, Finland
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Maffei S, Di Renzo M, Puccetti L, Bova G, Pastorelli M, Pasqui A, Auteri A. Mo-P2:180 Cytokines imbalance in acute coronary syndromes. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80315-6] [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: 11/29/2022]
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Todiere G, Bruni F, Pasqui A, Pastorelli M, Ciani F, Palazzuoli A, Auteri A, Puccetti L. We-W44:3 Lectin-like oxidized-LDL receptor-1 (LOX-1) polymorphism is associated with increased rate of cardiovascular events during statin treatment. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)81325-5] [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: 10/23/2022]
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Martino M, Pasqui A, Bruni F, Pastorelli M, Ciani F, Palazzuoli A, Auteri A, Puccetti L. Mo-P6:460 3UTR/T polymorphism of lectin-like oxidized-LDL receptor-1 (LOX-1) influences antiplatelet activity of atorvastatin in hypercholesterolemic subjects. ATHEROSCLEROSIS SUPP 2006. [DOI: 10.1016/s1567-5688(06)80590-8] [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: 10/23/2022]
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