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Knowledge about the balance between heritable and nonheritable risk in multiple sclerosis (MS) is based on twin studies in high-prevalence areas. In a study that avoided ascertainment limitations and directly compared continental Italy (medium-prevalence) and Sardinia (high-prevalence), we ascertained 216 pairs from 34,549 patients. This gives a twinning rate of 0.62% among MS patients, significantly less than that of the general population. In continental Italy, probandwise concordance was 14.5% (95% confidence interval, 5.1-23.8) for monozygotic and 4.0% (95% confidence interval, 0.8-7.1) for dizygotic twins. Results in Sardinia resemble those in northern populations but in limited numbers. Monozygotic concordance was 22.2% (95% confidence interval, 0-49.3) probandwise, but no concordant dizygotic pairs were identified. A questionnaire on 80 items possibly related to disease cause was administered to 70 twin pairs, 135 sporadic patients, and 135 healthy volunteers. Variables positively (7) or negatively (2) associated with predisposition and concordance in twins largely overlapped and were mainly linked to infection. If compared with previous studies, our data demonstrate that penetrance in twins appears to correlate with MS prevalence. They highlight the relevance of nonheritable variables in Mediterranean areas. The apparent underrepresentation of MS among Italian twins draws attention to protective factors, shared by twins, that may influence susceptibility.

Background To our knowledge the most complete study of vascular manifestations of APS was published in 2002 (1), using the Sapporo criteria. There are no recent papers on arterial manifestations of APS using the Miyakis 2006 criteria (2). High risk of recurrence is reported in triple positivity for aPL. (3). Objectives To evaluate immunological, neurological, cardiological and laboratory findings in patients with aAPS. Methods Multidisciplinary evaluation of 28 consecutive patients diagnosed with APS (Miyakis criteria), with at least one arterial manifestation proved with imaging studies. Results 19 women and 9 men (mean age 45, range 27-70) were diagnosed with APS according to Miyakis criteria, with total of 43 vascular events. 9 of them had isolated APS, 12 associated with SLE/UCTD and 7 with other autoimmune diseases. Clinical and laboratory features are shown in the following Table: All patients presented cardiovascular risk factors (smoking, arterial hypertension, hypercolesterolemia, obesity, family history for Coronary Artery Disease), more factors being present in male patients. Thrombophilia study resulted negative in 18, positive for heterozygosity of the factor II in 3, hyperhomocysteinemia in 1 and elevated factor VIII level in 1 case. The neurological evaluation revealed 17 cases of headache, 8 of depression, 7 of cognitive deficit and 3 of seizures. Livedo reticularis was present in 8 patients, all with cerebrovascular events and alterations in magnetic resonance imaging. The echocardiographic study revealed preserved ejection fraction (60-70%) in all cases. Females presented severe valvulopathies in 2, moderate mitralic regurgitation in 3 and mild aortic and mitralic regurgitation in 2 cases. Pulmonary artery pressure was elevated in 2 (45 and 49 mm Hg) and the diastolic function was altered in 2 patients. Male patients showed signs of accelerated atherosclerosis. 3 female patients had both vascular and obstetric morbidity; 16 with only vascular manifestations had uneventful pregnancies with good neonatal outcome. Conclusions Stroke is the most frequent arterial event in APS. All aAPS patients present cardiovascular risk factors. Ecocardiographic study is advisable in aAPS patients in order to exclude silent valvulopathies. Recurrences correlate with triple antiphospholipid positivity.Female aAPS patients do not seem to experience pregnancy morbidity. References Miyakis et al. J Thromb Haemost 2006;4:295-306. Cervera et al. Arthritis Rheum 2002;46:1019-27. Pengo et al. J Thromb Haemost 2010;8:237-42 Disclosure of Interest None Declared

The expression of gene sequences related to PDGF A and B chains and of PDGF B-type receptor in human glioma biopsies was analyzed. The major part of astrocytic gliomas expressed transcripts for these genes at higher levels than found in peritumoral and in normal nervous tissue specimens. Our results are in agreement with the hypothesis of an autocrine growth stimulation in astrocytic gliomas, mediated by PDGF and PDGF receptors. Moreover, PDGF may be involved in paracrine mechanisms responsible for endothelial hyperplasias in malignant gliomas.