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ABSTRACT: We report on the HLA typing of three brothers (A, B, C) with rheumatoid arthritis (RA) and their six sons. This family is interesting for the full concordance for RA between parents. The aim of this study was the discovery of genetic and/or enviromental cofactors determining this absolute concordance.
Recenti progressi in medicina 07/2012; 103(7-8):279-83.
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ABSTRACT: Tocilizumab is a monoclonal humanized anti-IL-6-receptor antibody used for the treatment of rheumatoid arthritis. The safety of tocilizumab in HCV patients is an open question. We report on safety and efficacy of tocilizumab in a 71-year-old female with rheumatoid arthritis and chronic hepatitis C. Monotherapy with tocilizumab (8 mg/kg every 4 weeks, i.v.) was prescribed after the discontinuation, determined by clinical inefficacy, of anti-TNF-alfa agents (adalimumab and, subsequently, etanercept). We have registered an optimal and rapid clinical response to tocilizumab with early remission (SDAI <3.3 since 4 weeks). The safety was good with no adverse events and maintenance, during a six-month followup, of normal liver enzymes. These data suggest a good safety profile of tocilizumab in patients with rheumatoid arthritis and chronic hepatitis C virus pathology.
Case Reports in Medicine 01/2012; 2012:212381.
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ABSTRACT: Environmental factors can be triggers for the clinical appearance of rheumatoid arthritis in subjects with genetic susceptibility. Genetic factors account for 60% of disease susceptibility. This review is focused on the genetic and environmental basis of the susceptibility to arthritis.
Recenti progressi in medicina 04/2011; 102(4):175-82.
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Emanuela Balestrieri,
Sandro Grelli,
Claudia Matteucci,
Antonella Minutolo,
Gabriella d'Ettorre,
Fiorella Di Sora, Francesco Montella,
Vincenzo Vullo,
Stefano Vella,
Cartesio Favalli,
Beatrice Macchi,
Antonio Mastino
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ABSTRACT: The simultaneous expression of 19 apoptosis-related genes was analyzed by RNA-protection assay in peripheral blood mononuclear cells of HIV-infected patients before and during successful antiretroviral therapy (ART). After 12 months of therapy, the expression of the pro-apoptotic genes FAS, FAS-L, FAF-1, FADD, CASPASE-8, DR3, TRAIL, TNFR-1, TRADD, and BAX was significantly downregulated with respect to time 0, while that of BCL-2, BCL-XL, and MCL-1 was significantly upregulated. The data suggest that inhibition of cell death in HIV-positive patients under successful therapy is the result of a complex network of multifactor signaling, correlated with both death and survival of lymphocytes.
Journal of Medical Virology 03/2007; 79(2):111-7. · 2.82 Impact Factor
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Benedetta Longo,
Annalisa Pantosti,
Ida Luzzi,
Agapito Tarasi,
Fiorella Di Sora,
Stella Gallo,
Paola Placanica,
Monica Monaco,
Anna Maria Dionisi,
Italo Volpe, Francesco Montella,
Antonio Cassone,
Giovanni Rezza
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ABSTRACT: We investigated an outbreak of Acinetobacter baumannii in the intensive care unit (ICU) of a hospital in Rome, Italy. The outbreak involved 14 patients whose isolates were most frequently recovered from bronchoalveolar lavage. All isolates were multidrug-resistant and showed diminished susceptibility or resistance to carbapenems. A. baumannii strains with a similar antibiotic susceptibility pattern were isolated from the environment. Pulsed-field gel electrophoresis identified a single clone from both the patients' and environmental isolates. Because of the lack of a single source of infection, the eradication of the epidemic required a broad approach, including contact isolation and cohorting, aggressive environmental disinfection, and close monitoring of the ward staff's performance. Infected patients were successfully treated with combined therapy. Although considered of low virulence, A. baumannii can be particularly aggressive and difficult to treat in ICU patients.
Annali dell'Istituto superiore di sanita 02/2007; 43(1):83-8. · 0.94 Impact Factor
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Sandro Grelli,
Emanuela Balestrieri,
Claudia Matteucci,
Antonella Minutolo,
Gabriella D'Ettorre,
Filippo Lauria, Francesco Montella,
Vincenzo Vullo,
Stefano Vella,
Cartesio Favalli,
Antonio Mastino,
Beatrice Macchi
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ABSTRACT: The impact of antiretroviral therapy (ART) on immune-reconstitution and its relationship with the complex scenario of multiple cell signaling associated with apoptosis in HIV infection has not yet been fully elucidated. Here we report the results of the analysis of the expression of 13 genes involved in the apoptotic pathway, simultaneously detected by RNA-protection assay in peripheral blood mononuclear cells (PBMCs) of 12 HIV-1-infected responder patients before and during successful ART. In particular, we calculated the correlations among apoptosis and viral load (VL) levels versus the quantitative expression of genes associated with death receptors or to Bcl-2 pathways. Nonparametric bivariate Spearman's analysis of significant correlations showed that apoptosis was directly correlated with mRNA levels for caspase-8, FasL, and TRAIL. Conversely, apoptosis levels were inversely correlated with mRNA levels for Bcl-xl, Bcl-2, and Mcl-1, respectively. In addition, while VL was directly correlated with the expression of caspase 8, it was inversely correlated with mRNA levels for Bcl-2 and Mcl-1. These results, although worthy of further investigation, show that variations of apoptosis levels in PBMCs of HIV-1+ patients during ART are strictly related to the modulation of a complex network of signaling involving both death and survival of lymphocytes.
Annals of the New York Academy of Sciences 01/2007; 1090:130-7. · 3.15 Impact Factor
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ABSTRACT: We report the complete sequence analysis of the provirus harbored in a long-term nonprogressor (patient SG1) 20 years after the first infection with a human immunodeficiency virus type 1 strain lacking nef. The sequencing showed large deletions in the nef-nef and nef-U3 regions. Except for vpu, all of the other accessory genes were intact. The gag and pol genes did not show significant alterations. We found large deletions in env, spanning the V1, V2, V3, V4, and V5 regions. We believe that, when down-regulation of the class 1 major histocompatibility complex molecules is inhibited by the lack of nef function, the cells containing Env-defective molecules evade cytotoxic T lymphocyte killing and accumulate progressively.
Journal of Virology 01/2007; 80(23):11892-6. · 5.40 Impact Factor
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Sandro Grelli,
Gabriella d'Ettorre,
Filippo Lauria, Francesco Montella,
Loide Di Traglia,
Miriam Lichtner,
Vincenzo Vullo,
Cartesio Favalli,
Stefano Vella,
Beatrice Macchi,
Antonio Mastino
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ABSTRACT: We have addressed the relationships between inhibition of CD4+ and CD8+ cell apoptosis and CD4+ cell recovery in HIV patients undergoing potent antiretroviral therapy (PART) by correlating apoptosis levels with virological and immunological parameters detected over a long-term period in HIV patients undergoing therapy.
Twenty-two HIV-1-infected patients undergoing PART were enrolled in a long-term, open longitudinal study. Data derived from 17 patients with successful response to therapy (TS; median time of follow-up 36 months, range 24-36 months) were used for correlation studies. Apoptosis was evaluated after short-term culture of peripheral blood lymphocytes by flow cytometry analysis of isolated nuclei or of annexin V/CD4, annexin V/CD8 double-stained cells.
Sustained, noticeable levels of apoptosis inhibition in peripheral blood mononuclear cells were measured, in the long-term, in 16 of the 17 TS patients. Levels of total cell apoptosis correlated with levels of CD8+ apoptotic cells more significantly than with levels of CD4+ apoptotic cells. In addition, CD4+ cell counts were correlated inversely with levels of CD8+ apoptotic cells in a highly significant fashion, but not with levels of CD4+ apoptotic cells.
Our data indicate that the increase of CD4+ lymphocytes in HIV patients, as a consequence of successful response to PART, may be related to changes in apoptosis level occurring in the CD8+, and not in the CD4+, cell compartment.
Journal of Antimicrobial Chemotherapy 04/2004; 53(3):494-500. · 5.07 Impact Factor
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ABSTRACT: We evaluated a procedure for identifying recent HIV infections, using sequential serum samples from 47 HIV-positive persons for whom the seroconversion date could be accurately estimated. Each serum sample was divided into two aliquots: one diluted with phosphate-buffered saline and the other diluted with 1 M guanidine. We assayed the aliquots with the automated AxSYM HIV1/2gO test (Abbott Diagnostics Division), without modifying the manufacturer's protocol. We then calculated the avidity index (AI): the ratio of the sample/cutoff value for the guanidine aliquot to that of the phosphate-buffered saline aliquot. We analyzed 216 serum samples: 34 samples were collected within 6 months of seroconversion (recent seroconversions), and 182 were collected after 6 months. The mean AIs, by time from seroconversion, were 0.68 +/- 0.16 (within 6 months) and 0.98 +/- 0.10 (after 6 months) (P < 0.0001). AI of <0.90 correctly identified 88.2% of recent infections but misclassified as recent infections 13.2% of serum samples collected afterward. The probability of an infection being classified as recent and having AI of > or = 0.90 would be 0.7% in a population with 5% recent infections. AI can identify with a certain degree of accuracy recent HIV infections, and being a quantitative index, it provides different levels of sensitivity and specificity, depending on the selected cutoff value. The standard assay procedure is not modified. This test is simple and inexpensive and could be used for surveillance, decision-making in treatment, and prevention.
JAIDS Journal of Acquired Immune Deficiency Syndromes 04/2003; 32(4):424-8. · 4.43 Impact Factor
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ABSTRACT: We evaluated the precision and accuracy of a procedure for detecting recent human immunodeficiency virus (HIV) infections, specifically, the avidity index (AI) calculated using a method based on an automated AxSYM HIV 1/2gO assay (Abbott). To evaluate precision, we performed multiple replicates on eight HIV-positive serum samples. To evaluate the accuracy in identifying recent infections (i.e., within 6 months of seroconversion), we used 216 serum samples from 47 persons whose dates of seroconversion were known. To evaluate the sensitivity and specificity of the procedure for different AI cutoff values, we performed receiver operating characteristic (ROC) analysis. To determine the effects of antiretroviral treatment, advanced stage of the disease (i.e., low CD4-cell count), and low HIV viral load on the AI, we analyzed 15 serum samples from 15 persons whose dates of seroconversion were unknown. The precision study showed that the procedure was robust (i.e., the total variance of the AI was lower than 10%). Regarding accuracy, the mean AI was significantly lower for samples collected within 6 months of seroconversion, compared to those collected afterwards (0.68 +/- 0.16 versus 0.99 +/- 0.10; P < 0.0001), with no overlap of the 95% confidence intervals. The ROC analysis revealed that an AI lower than 0.6 had a sensitivity of 33.3% and a specificity of 98.4%, compared to 87.9 and 86.3%, respectively, for an AI lower than 0.9. Antiretroviral treatment, low CD4-cell count, and low viral load had no apparent effect on the AI. In conclusion, this procedure is reproducible and accurate in identifying recent infections; it is automated, inexpensive, and easy to perform, and it provides a quantitative result with different levels of sensitivity and specificity depending on the selected cutoff.
Journal of Clinical Microbiology 11/2002; 40(11):4015-20. · 4.15 Impact Factor
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ABSTRACT: To assess the diagnostic value of early signs of ischaemic cerebral infarction detected by unenhanced CT in the first 6-10 hours.
We reviewed the CT examinations of 42 patients (mean age: 61 years, range: 35-79) with suspected ischaemic stroke. We assessed CT findings at 6-10 hours of the onset of stroke for hemilateral evidence of main cerebral artery hyperdensity, sulcal effacement, liquoral space asymmetry, hypodensity of grey matter. The CT scans were performed without contrast medium.
The topographic pattern of cerebral infarctions was: middle cerebral artery territory in 25 patients, anterior cerebral in 9, striatal lacunar infarction in 2, posterior junctional infarction in 5, anterior junctional infarction in 1. Early signs of infarction were present in 24 patients (57%). CT scans showed early signs in 20 cases (80%) of middle cerebral infarctions; 8 (32%) had middle cerebral artery hyperdensity; 3 (12%) had middle cerebral artery hyperdensity and sulcal effacement; 4 (16%) had sulcal effacement; 2 (8%) had liquoral space asymmetry; 3 (12%) had hypodensity of grey matter and liquoral space asymmetry. CT scans showed early signs in 4/9 (44%) of anterior cerebral infarctions. Sensitivity and specificity of early CT to cerebral infarction was 57% and 100%. The three cases with both hyperdense middle cerebral artery and sulcal effacement died of transtentorial herniation within the 10th day. The seven other deaths occurred in patients without early signs or particular patterns appearing in subsequent CT.
In the management of ischaemic stroke the aim of neuroradiologic methods is to provide exact direction to immediate therapy by early diagnosis. In such cases the use of CT scanning aims at detecting signs of two main alterations of infarction: vascular occlusion and brain oedema. Middle cerebral artery hyperdensity, showing steady correspondence to infarction site and frequent disappearance on the follow-up CT, is indicative of embolic occlusion. Signs of "mass effect" are evident from the early stages in relation to the substantial concomitance of various types of brain oedema. The semeiology discussed in this study is more clearly detectable in middle cerebral artery infarction because this territory is the main site of embolic occlusion, and its larger size increases the "mass effect" due to oedema. The sensitivity obtained in this study is among the lowest values reported, which likely relates to our choice to use short scan times.
La radiologia medica 103(1-2):84-90. · 1.44 Impact Factor
