One special question to start with: can HIF/NFkB be a target in inflammation?

Hypoxia and Inflammation are strictly interconnected with important consequences at clinical and therapeutic level. While cell and tissue damage due to acute hypoxia mostly leads to cell necrosis, in chronic hypoxia, cells that are located closer to vessels are able to survive adapting their phenotype through the expression of a number of genes, including proinflammatory receptors for alarmins. These receptors are activated by alarmins released by necrotic cells and generate signals for master transcription factors such as NFkB, AP1, etc. which control hundreds of genes for innate immunity and damage repair. Clinical consequences of chronic inflammatory reparative response activation include cell and tissue remodeling, damage in the primary site and, the systemic involvement of distant organs and tissues. Thus every time a tissue environment becomes stably hypoxic, inflammation can be activated followed by chronic damage and cell death or repair with vessel proliferation and fibrosis. This pathway can occur in cancer, myocardial infarction and stroke, diabetes, obesity, neurodegenerative diseases, chronic and autoimmune diseases and age-related diseases. Interestingly, proinflammatory gene expression can be observed earlier in hypoxic tissue cells and, in addition, in activated resident or recruited leukocytes. Herewith, the reciprocal relationships between hypoxia and inflammation will be shortly reviewed to underline the possible therapeutic targets to control hypoxia-related inflammation in a number of epidemiologically important human diseases and conditions

Infertility in Fabry's disease: role of hypoxia and inflammation in determining testicular damage

Fabry’s disease (FD) is a genetic X-linked systemic and progressive rare disease, which is characterized by the accumulation of glycolipid bodies (GB) into the lysosomes of almost all cell types and consequently by a multiform clinical picture. Here we studied testicular biopsies of a 42 ys old FD patient, presenting infertility with a reduced number of spermatozoa and preserved sexual activity. Testicular biopsies have been analyzed by optical microscopy (OM) and transmission electron microscopy (TEM). OM, showed a severe involvement of testis interstitium blood vessels with reduced or closed lumen, an increased of connective tissue, and a substantial thicketing of peritubular region. TEM, showed that GB were abundant in vessel wall cells and in myofibroblast of the peritubular region. In contrast with literature reports, Leydig cells were constantly unaffected by GB accumulation showing well-preserved ultrastructural organization. On the contrary, tubular cells, although not affected by GB accumulation, appeared severely damaged. These data led us to hypothesize that the diffusion of oxygen and nutrients from the blood to tubules could be impaired. To test this hypothesis we explored, by immunofluorescence (IF) and molecular biology (MB) coupled to laser capture microdissection (LCMD), the activation of HIF/NFkB pathway. IF showed increased signal for HIF1a in all stromal components, while it appeared almost absent in seminiferous tubules. On the contrary, NFkB fluorescence was evident in tubules. mRNA of tubular and interstitial tissue fractions, separately extracted by LCMD, confirms that HIF1a and hypoxic-related genes such as alarmin recepters (RAGE, TLR4) were overexpressed in the interstitial cells. At the same time, NFkB and a number of proinflammatory genes such as HMOX1, PTGES, SAA1-SAA2 were up-regulated in the tubule microenvironment. Taken together, these results suggest that the GB accumulation in the interstitium, reducing vessel lumen and increasing the distance between vessel and tubular cells, leads to chronic progressive hypoxia. Hypoxia has two effects: 1) Necrosis of cells more distant from vessels, especially germinative epithelium, and Sertoli cells, releasing alarmins; 2) Adaptation to low levels of O2, with activation of HIF1a. In both cases, strong activation of NFkB occurs that trigger a inflammatory response (IR). We suggest a role for the IR activation in determining intratubular cells damage and consequently, infertility in FD

Infertility in Fabry’s disease: role of hypoxia and inflammation in determining testicular damage

Fabry’s disease (FD) is a genetic X-linked systemic and progressive rare disease, which is characterized by the accumulation of glycolipid bodies (GB) into the lys- osomes of almost all cell types and consequently by a multiform clinical picture. Here we studied testicular biopsies of a 42 ys old FD patient, presenting infertility with reduced number of spermatozoa and preserved sexual activity. Testicular biopsies have been analyzed by optical microscopy (OM) and transmis- sion electron microscopy (TEM). OM, showed a severe involvement of testis inter- stitium blood vessels with reduced or closed lumen, an increased of connective tis- sue and a substantial thicketing of peritubular region. TEM, showed that GB were abundant in vessel wall cells and in myofibroblast of peritubular region. In contrast with literature reports, Leydig cells were constantly unaffected by GB accumulation showing well preserved ultrastructural organization. On the contrary, tubular cells, although not affected by GB accumulation, appeared severely damaged. These data led us to hypothesize that diffusion of oxygen and nutrients from blood to tubules could be impaired. To test this hypothesis we explored, by immunofluorescence (IF) and molecular biology (MB) coupled to laser capture micro-dissection (LCMD), the activation of HIF/NFkB pathway. IF showed increased signal for HIF1a in all stromal components, while it appeared almost absent in seminipherous tubules. On the contrary, NFkB fluores- cence was evident in tubules. mRNA of tubular and interstitial tissue fractions, separately extracted by LCMD, confirms that HIF1a and hypoxic-related genes such as alarmin recepters (RAGE, TLR4) were overexpressed in the interstitial cells. At the same time, NFkB and a number of proinflammatory genes such as HMOX1, PTGES, SAA1-SAA2 were up- regulated in the tubule microenviroment. Taken together, these results suggest that the GB accumulation in interstitium, reducing vessel lumen and increasing the distance between vessel and tubular cells, leads to chronic progressive hypoxia. Hypoxia has two effects: 1)Necrosis of cells more distant from vessels, especially germinative epithelium and Sertoli cells, releas- ing alarmins; 2)Adaptation to low levels of O2, with activation of HIF1a. In both cas- es a strong activation of NFkB occurs that trigger a inflammatory response (IR). We suggest a role for the IR activation in determining intratubular cells damage and con- sequently, infertility in FD

Low grade endotoxemia and oxidative stress in offspring of patients with early myocardial infarction

Background and aims: Offspring of patients with early myocardial infarction are at higher cardiovascular risk, but the underlying physio-pathological mechanism is unclear. NADPH oxidase-type 2 (NOX-2) plays a pivotal role as mediator of oxidative stress and could be involved in activating platelets in these patients. Furthermore, altered intestinal permeability and serum lipopolysaccharide (LPS) could be a trigger to promote NOX-2 activation and platelet aggregation. This study aims to evaluate the behavior of low grade endotoxemia, oxidative stress and platelet activation in offspring of patients with early myocardial infarction. Methods: We enrolled, in a cross-sectional study, 46 offspring of patients with early myocardial infarction and 86 healthy subjects (HS). LPS levels and gut permeability (assessed by zonulin), oxidative stress (assessed by serum NOX-2-derived peptide (sNOX2-dp) release, hydrogen peroxide (H2O2) production and isoprostanes), serum nitric oxide (NO) bioavailability and platelet activation (by serum thromboxane B2 (TXB2) and soluble P-Selectin (sP-Selectin)) were analyzed. Results: Compared to HS, offspring of patients with early myocardial infarction had higher values of LPS, zonulin, serum isoprostanes, sNOX2-dp H2O2, TXB2, p-selectin and lower NO bioavailability. Logistic regression analysis showed that the variables associated with offspring of patients with early myocardial infarction were LPS, TXB2 and isoprostanes. The multiple linear regression analysis confirmed that serum NOX-2, isoprostanes, p-selectin and H2O2 levels were significantly associated to LPS. Furthermore, serum LPS, isoprostanes and TXB2 levels were significantly associated with sNOX-2-dp. Conclusions: Offspring of patients with early myocardial infarction have a low grade endotoxemia that could generate oxidative stress and platelet activation increasing their cardiovascular risk. Future studies are needed to understand the role of dysbiosis in this population

Multicenter Experience Using Total Lymphoid Irradiation and Antithymocyte Globulin as Conditioning for Allografting in Hematological Malignancies

A non myeloablative conditioning with total lymphoid irradiation (TLI) and antithymocyte globulin (ATG) was shown to protect against graft-versus-host disease (GVHD). To evaluate the effects of TLI-ATG in a multicenter study, 45 heavily pretreated patients, median age 51, with lymphoid (n = 38) and myeloid (n = 7) malignancies were enrolled at 9 centers. Twenty-eight patients (62%) received at least 3 lines of treatment before allografting, and 13 (29%) had refractory/relapsed disease at the time of transplantation. Peripheral blood hematopoietic cells were from HLA identical sibling (n = 30), HLA-matched (n = 9), or 1 antigen HLA-mismatched (n = 6) unrelated donors. A cumulative TLI dose of 8 Gy was administered from day −11 through −1 with ATG at the dose of 1.5 mg/kg/day (from day −11 through −7). GVHD prophylaxis consisted of cyclosporine and mycophenolate mofetil. Donor engraftment was reached in 95% of patients. Grade II to IV acute GVHD (aGVHD) developed in 6 patients (13.3%), and in 2 of these patients, it developed beyond day 100. Incidence of chronic GVHD (cGVHD) was 35.8%. One-year nonrelapse mortality was 9.1%. After a median follow-up of 28 months (range, 3-57 months) from transplantation, median overall survival was not reached, whereas median event-free survival was 20 months. This multicenter experience confirms that TLI-ATG protects against GVHD and maintains graft-vs-tumor effects

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

Background: Mechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated. Objectives: To develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD. Methods: From the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD. Results: Among the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23. Conclusions: Integrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations. Clinical trial registration: NCT02737982

Serum Albumin Is Inversely Associated With Portal Vein Thrombosis in Cirrhosis

We analyzed whether serum albumin is independently associated with portal vein thrombosis (PVT) in liver cirrhosis (LC) and if a biologic plausibility exists. This study was divided into three parts. In part 1 (retrospective analysis), 753 consecutive patients with LC with ultrasound-detected PVT were retrospectively analyzed. In part 2, 112 patients with LC and 56 matched controls were entered in the cross-sectional study. In part 3, 5 patients with cirrhosis were entered in the in vivo study and 4 healthy subjects (HSs) were entered in the in vitro study to explore if albumin may affect platelet activation by modulating oxidative stress. In the 753 patients with LC, the prevalence of PVT was 16.7%; logistic analysis showed that only age (odds ratio [OR], 1.024; P = 0.012) and serum albumin (OR, -0.422; P = 0.0001) significantly predicted patients with PVT. Analyzing the 112 patients with LC and controls, soluble clusters of differentiation (CD)40-ligand (P = 0.0238), soluble Nox2-derived peptide (sNox2-dp; P < 0.0001), and urinary excretion of isoprostanes (P = 0.0078) were higher in patients with LC. In LC, albumin was correlated with sCD4OL (Spearman's rank correlation coefficient [r(s)], -0.33; P < 0.001), sNox2-dp (r(s), -0.57; P < 0.0001), and urinary excretion of isoprostanes (r(s), -0.48; P < 0.0001) levels. The in vivo study showed a progressive decrease in platelet aggregation, sNox2-dp, and urinary 8-iso prostaglandin F2 alpha-III formation 2 hours and 3 days after albumin infusion. Finally, platelet aggregation, sNox2-dp, and isoprostane formation significantly decreased in platelets from HSs incubated with scalar concentrations of albumin. Conclusion: Low serum albumin in LC is associated with PVT, suggesting that albumin could be a modulator of the hemostatic system through interference with mechanisms regulating platelet activation

The Sex-Specific Detrimental Effect of Diabetes and Gender-Related Factors on Pre-admission Medication Adherence Among Patients Hospitalized for Ischemic Heart Disease: Insights From EVA Study

Background: Sex and gender-related factors have been under-investigated as relevant determinants of health outcomes across non-communicable chronic diseases. Poor medication adherence results in adverse clinical outcomes and sex differences have been reported among patients at high cardiovascular risk, such as diabetics. The effect of diabetes and gender-related factors on medication adherence among women and men at high risk for ischemic heart disease (IHD) has not yet been fully investigated.Aim: To explore the role of sex, gender-related factors, and diabetes in pre-admission medication adherence among patients hospitalized for IHD.Materials and Methods: Data were obtained from the Endocrine Vascular disease Approach (EVA) (ClinicalTrials.gov Identifier: NCT02737982), a prospective cohort of patients admitted for IHD. We selected patients with baseline information regarding the presence of diabetes, cardiovascular risk factors, and gender-related variables (i.e., gender identity, gender role, gender relations, institutionalized gender). Our primary outcome was the proportion of pre-admission medication adherence defined through a self-reported questionnaire. We performed a sex-stratified analysis of clinical and gender-related factors associated with pre-admission medication adherence.Results: Two-hundred eighty patients admitted for IHD (35% women, mean age 70), were included. Around one-fourth of the patients were low-adherent to therapy before hospitalization, regardless of sex. Low-adherent patients were more likely diabetic (40%) and employed (40%). Sex-stratified analysis showed that low-adherent men were more likely to be employed (58 vs. 33%) and not primary earners (73 vs. 54%), with more masculine traits of personality, as compared with medium-high adherent men. Interestingly, women reporting medication low-adherence were similar for clinical and gender-related factors to those with medium-high adherence, except for diabetes (42 vs. 20%, p = 0.004). In a multivariate adjusted model only employed status was associated with poor medication adherence (OR 0.55, 95%CI 0.31–0.97). However, in the sex-stratified analysis, diabetes was independently associated with medication adherence only in women (OR 0.36; 95%CI 0.13–0.96), whereas a higher masculine BSRI was the only factor associated with medication adherence in men (OR 0.59, 95%CI 0.35–0.99).Conclusion: Pre-admission medication adherence is common in patients hospitalized for IHD, regardless of sex. However, patient-related factors such as diabetes, employment, and personality traits are associated with adherence in a sex-specific manner

Modeling of mixing and drying processes in pasta production

Dottorato di Ricerca in: Ambiente, Salute e Processi Ecosostenibili, Ciclo XXVII, a.a. 2014Università della Calabri