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1. Personalised management of patients with hepatocellular carcinoma: a multiparametric therapeutic hierarchy concept

Author

Vitale, A, Cabibbo, G, Iavarone, M, Vigano, L, Pinato, D, Ponziani, F, Lai, Q, Casadei-Gardini, A, Celsa, C, Galati, G, Gambato, M, Crocetti, L, Renzulli, M, Giannini, E, Farinati, F, Trevisani, F, Cillo, U, Baccarani, U, Brancaccio, G, Cozzolongo, R, Cucchetti, A, De Matthaeis, N, Di Sandro, S, Famularo, S, Finotti, M, Foschi, F, Ghinolfi, D, Guarracino, M, Gruttadauria, S, Guarino, M, Kostandini, A, Lenci, I, Levi Sandri, G, Manzia, T, Marasco, G, Masarone, M, Mazzarelli, C, Melandro, F, Miele, L, Morisco, F, Nicolini, D, Pagano, D, Pelizzaro, F, Pieri, G, Piscaglia, F, Plaz Torres, M, Pravisani, R, Rendina, M, Romano, F, Russo, F, Sacco, R, Sangiovanni, A, Sposito, C, Tortora, R, Tovoli, F, Vigano, M, Violi, P, Vitale A., Cabibbo G., Iavarone M., Vigano L., Pinato D. J., Ponziani F. R., Lai Q., Casadei-Gardini A., Celsa C., Galati G., Gambato M., Crocetti L., Renzulli M., Giannini E. G., Farinati F., Trevisani F., Cillo U., Baccarani U., Brancaccio G., Cozzolongo R., Cucchetti A., De Matthaeis N., Di Sandro S., Famularo S., Finotti M., Foschi F. G., Ghinolfi D., Guarracino M., Gruttadauria S., Guarino M., Kostandini A., Lenci I., Levi Sandri G. B., Manzia T. M., Marasco G., Masarone M., Mazzarelli C., Melandro F., Miele L., Morisco F., Nicolini D., Pagano D., Pelizzaro F., Pieri G., Piscaglia F., Plaz Torres M. C., Pravisani R., Rendina M., Romano F., Russo F. P., Sacco R., Sangiovanni A., Sposito C., Tortora R., Tovoli F., Vigano M., Violi P., Vitale, A, Cabibbo, G, Iavarone, M, Vigano, L, Pinato, D, Ponziani, F, Lai, Q, Casadei-Gardini, A, Celsa, C, Galati, G, Gambato, M, Crocetti, L, Renzulli, M, Giannini, E, Farinati, F, Trevisani, F, Cillo, U, Baccarani, U, Brancaccio, G, Cozzolongo, R, Cucchetti, A, De Matthaeis, N, Di Sandro, S, Famularo, S, Finotti, M, Foschi, F, Ghinolfi, D, Guarracino, M, Gruttadauria, S, Guarino, M, Kostandini, A, Lenci, I, Levi Sandri, G, Manzia, T, Marasco, G, Masarone, M, Mazzarelli, C, Melandro, F, Miele, L, Morisco, F, Nicolini, D, Pagano, D, Pelizzaro, F, Pieri, G, Piscaglia, F, Plaz Torres, M, Pravisani, R, Rendina, M, Romano, F, Russo, F, Sacco, R, Sangiovanni, A, Sposito, C, Tortora, R, Tovoli, F, Vigano, M, Violi, P, Vitale A., Cabibbo G., Iavarone M., Vigano L., Pinato D. J., Ponziani F. R., Lai Q., Casadei-Gardini A., Celsa C., Galati G., Gambato M., Crocetti L., Renzulli M., Giannini E. G., Farinati F., Trevisani F., Cillo U., Baccarani U., Brancaccio G., Cozzolongo R., Cucchetti A., De Matthaeis N., Di Sandro S., Famularo S., Finotti M., Foschi F. G., Ghinolfi D., Guarracino M., Gruttadauria S., Guarino M., Kostandini A., Lenci I., Levi Sandri G. B., Manzia T. M., Marasco G., Masarone M., Mazzarelli C., Melandro F., Miele L., Morisco F., Nicolini D., Pagano D., Pelizzaro F., Pieri G., Piscaglia F., Plaz Torres M. C., Pravisani R., Rendina M., Romano F., Russo F. P., Sacco R., Sangiovanni A., Sposito C., Tortora R., Tovoli F., Vigano M., and Violi P.

Abstract

Advances in the surgical and systemic therapeutic landscape of hepatocellular carcinoma have increased the complexity of patient management. A dynamic adaptation of the available staging-based algorithms is required to allow flexible therapeutic allocation. In particular, real-world hepatocellular carcinoma management increasingly relies on factors independent of oncological staging, including patients’ frailty, comorbid burden, critical tumour location, multiple liver functional parameters, and specific technical contraindications impacting the delivery of treatment and resource availability. In this Policy Review we critically appraise how treatment allocation strictly based on pretreatment staging features has shifted towards a more personalised treatment approach, in which expert tumour boards assume a central role. We propose an evidence-based framework for hepatocellular carcinoma treatment based on the novel concept of multiparametric therapeutic hierarchy, in which different therapeutic options are ordered according to their survival benefit (ie, from surgery to systemic therapy). Moreover, we introduce the concept of converse therapeutic hierarchy, in which therapies are ordered according to their conversion abilities or adjuvant abilities (ie, from systemic therapy to surgery).

Published
2023

3. Predictors of serious adverse events and non-response in cirrhotic patients with primary biliary cholangitis treated with obeticholic acid

Author

De Vincentis, A, D'Amato, D, Cristoferi, L, Gerussi, A, Malinverno, F, Lleo, A, Colapietro, F, Marra, F, Galli, A, Fiorini, C, Coco, B, Brunetto, M, Niro, G, Cotugno, R, Saitta, C, Cozzolongo, R, Losito, F, Giannini, E, Labanca, S, Marzioni, M, Marconi, G, Morgando, A, Pellicano, R, Vanni, E, Cazzagon, N, Floreani, A, Chessa, L, Morelli, O, Muratori, L, Pellicelli, A, Pompili, M, Ponziani, F, Tortora, A, Rosina, F, Russello, M, Cannavo, M, Simone, L, Storato, S, Vigano, M, Abenavoli, L, D'Anto, M, De Gasperi, E, Distefano, M, Scifo, G, Zolfino, T, Calvaruso, V, Cuccorese, G, Palitti, V, Sacco, R, Bertino, G, Frazzetto, E, Alvaro, D, Mulinacci, G, Palermo, A, Scaravaglio, M, Terracciani, F, Galati, G, Ronca, V, Zuin, M, Claar, E, Izzi, A, Picardi, A, Invernizzi, P, Vespasiani-Gentilucci, U, Carbone, M, Feletti, V, Mussetto, A, Venere, R, Bernaccioni, G, Graciella Pigozzi, M, Fagiuoli, S, Terreni, N, Pozzoni, P, Baiocchi, L, Grassi, G, Vinci, M, Bellia, V, Boldizzoni, R, Casella, S, Omazzi, B, Poggi, G, De Vincentis A., D'Amato D., Cristoferi L., Gerussi A., Malinverno F., Lleo A., Colapietro F., Marra F., Galli A., Fiorini C., Coco B., Brunetto M., Niro G. A., Cotugno R., Saitta C., Cozzolongo R., Losito F., Giannini E. G., Labanca S., Marzioni M., Marconi G., Morgando A., Pellicano R., Vanni E., Cazzagon N., Floreani A., Chessa L., Morelli O., Muratori L., Pellicelli A., Pompili M., Ponziani F., Tortora A., Rosina F., Russello M., Cannavo M., Simone L., Storato S., Vigano M., Abenavoli L., D'Anto M., De Gasperi E., Distefano M., Scifo G., Zolfino T., Calvaruso V., Cuccorese G., Palitti V. P., Sacco R., Bertino G., Frazzetto E., Alvaro D., Mulinacci G., Palermo A., Scaravaglio M., Terracciani F., Galati G., Ronca V., Zuin M., Claar E., Izzi A., Picardi A., Invernizzi P., Vespasiani-Gentilucci U., Carbone M., Feletti V., Mussetto A., Venere R., Bernaccioni G., Graciella Pigozzi M., Fagiuoli S., Terreni N., Pozzoni P., Baiocchi L., Grassi G., Vinci M., Bellia V., Boldizzoni R., Casella S., Omazzi B., Poggi G., De Vincentis, A, D'Amato, D, Cristoferi, L, Gerussi, A, Malinverno, F, Lleo, A, Colapietro, F, Marra, F, Galli, A, Fiorini, C, Coco, B, Brunetto, M, Niro, G, Cotugno, R, Saitta, C, Cozzolongo, R, Losito, F, Giannini, E, Labanca, S, Marzioni, M, Marconi, G, Morgando, A, Pellicano, R, Vanni, E, Cazzagon, N, Floreani, A, Chessa, L, Morelli, O, Muratori, L, Pellicelli, A, Pompili, M, Ponziani, F, Tortora, A, Rosina, F, Russello, M, Cannavo, M, Simone, L, Storato, S, Vigano, M, Abenavoli, L, D'Anto, M, De Gasperi, E, Distefano, M, Scifo, G, Zolfino, T, Calvaruso, V, Cuccorese, G, Palitti, V, Sacco, R, Bertino, G, Frazzetto, E, Alvaro, D, Mulinacci, G, Palermo, A, Scaravaglio, M, Terracciani, F, Galati, G, Ronca, V, Zuin, M, Claar, E, Izzi, A, Picardi, A, Invernizzi, P, Vespasiani-Gentilucci, U, Carbone, M, Feletti, V, Mussetto, A, Venere, R, Bernaccioni, G, Graciella Pigozzi, M, Fagiuoli, S, Terreni, N, Pozzoni, P, Baiocchi, L, Grassi, G, Vinci, M, Bellia, V, Boldizzoni, R, Casella, S, Omazzi, B, Poggi, G, De Vincentis A., D'Amato D., Cristoferi L., Gerussi A., Malinverno F., Lleo A., Colapietro F., Marra F., Galli A., Fiorini C., Coco B., Brunetto M., Niro G. A., Cotugno R., Saitta C., Cozzolongo R., Losito F., Giannini E. G., Labanca S., Marzioni M., Marconi G., Morgando A., Pellicano R., Vanni E., Cazzagon N., Floreani A., Chessa L., Morelli O., Muratori L., Pellicelli A., Pompili M., Ponziani F., Tortora A., Rosina F., Russello M., Cannavo M., Simone L., Storato S., Vigano M., Abenavoli L., D'Anto M., De Gasperi E., Distefano M., Scifo G., Zolfino T., Calvaruso V., Cuccorese G., Palitti V. P., Sacco R., Bertino G., Frazzetto E., Alvaro D., Mulinacci G., Palermo A., Scaravaglio M., Terracciani F., Galati G., Ronca V., Zuin M., Claar E., Izzi A., Picardi A., Invernizzi P., Vespasiani-Gentilucci U., Carbone M., Feletti V., Mussetto A., Venere R., Bernaccioni G., Graciella Pigozzi M., Fagiuoli S., Terreni N., Pozzoni P., Baiocchi L., Grassi G., Vinci M., Bellia V., Boldizzoni R., Casella S., Omazzi B., and Poggi G.

Abstract

Background & Aims: Obeticholic acid (OCA) has recently been restricted in patients with primary biliary cholangitis (PBC) with “advanced cirrhosis” because of its narrow therapeutic index. We aimed to better define the predicting factors of hepatic serious adverse events (SAEs) and non-response in cirrhotic patients undergoing OCA therapy. Methods: Safety and efficacy of treatment were evaluated in a cohort of consecutive PBC cirrhotic patients started with OCA. OCA response was evaluated according to the Poise criteria. Risk factors for hepatic SAEs and non-response were reported as risk ratios (RR) with 95% confidence intervals (CIs). Results: One hundred PBC cirrhotics were included, 97 Child-Pugh class A and 3 class B. Thirty-one had oesophageal varices and 5 had a history of ascites. Thirty-three per cent and 32% of patients achieved a biochemical response at 6 and 12 months respectively. Male sex (adjusted-RR 1.75, 95%CI 1.42–2.12), INR (1.37, 1.00–1.87), Child-Pugh score (1.79, 1.28–2.50), MELD (1.17, 1.04–1.30) and bilirubin (1.83, 1.11–3.01) were independently associated with non-response to OCA. Twenty-two patients discontinued OCA within 12 months: 10 for pruritus, 9 for hepatic SAEs (5 for jaundice and/or ascitic decompensation; 4 for upper digestive bleeding). INR (adjusted-RR 1.91, 95%CI 1.10–3.36), lower albumin levels (0.18, 0.06–0.51), Child-Pugh score (2.43, 1.50–4.04), history of ascites (3.5, 1.85–6.5) and bilirubin (1.30, 1.05–1.56), were associated with hepatic SAEs. A total bilirubin≥1.4 mg/dl at baseline was the most accurate biochemical predictor of hepatic SAEs under OCA. Conclusions: An accurate baseline assessment is crucial to select cirrhotic patients who can benefit from OCA. Although OCA is effective in one third of cirrhotics, bilirubin level ≥1.4 mg/dl should discourage from its use.

Published
2022

5. Factors Influencing Microbiota in Modulating Vaccine Immune Response: A Long Way to Go

Author

Ponziani, Francesca Romana, Coppola, Gaetano, Rio, Pierluigi, Caldarelli, M., Borriello, Raffaele, Gambassi, Giovanni, Gasbarrini, Antonio, Cianci, Rossella, Ponziani F. R. (ORCID:0000-0002-5924-6238), Coppola G., Rio P., Borriello R., Gambassi G. (ORCID:0000-0002-7030-9359), Gasbarrini A. (ORCID:0000-0002-7278-4823), Cianci R. (ORCID:0000-0001-5378-8442), Ponziani, Francesca Romana, Coppola, Gaetano, Rio, Pierluigi, Caldarelli, M., Borriello, Raffaele, Gambassi, Giovanni, Gasbarrini, Antonio, Cianci, Rossella, Ponziani F. R. (ORCID:0000-0002-5924-6238), Coppola G., Rio P., Borriello R., Gambassi G. (ORCID:0000-0002-7030-9359), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Cianci R. (ORCID:0000-0001-5378-8442)

Abstract

Vaccine immunogenicity still represents an unmet need in specific populations, such as people from developing countries and “edge populations”. Both intrinsic and extrinsic factors, such as the environment, age, and dietary habits, influence cellular and humoral immune responses. The human microbiota represents a potential key to understanding how these factors impact the immune response to vaccination, with its modulation being a potential step to address vaccine immunogenicity. The aim of this narrative review is to explore the intricate interactions between the microbiota and the immune system in response to vaccines, highlighting the state of the art in gut microbiota modulation as a novel therapeutic approach to enhancing vaccine immunogenicity and laying the foundation for future, more solid data for its translation to the clinical practice.

Published
2023

7. The role of antiplatelet therapies on incidence and mortality of hepatocellular carcinoma

Author

Lai, Q., De Matthaeis, N., Finotti, M., Galati, G., Marrone, G., Melandro, F., Morisco, F., Nicolini, D., Pravisani, R., Giannini, E. G., Aglitti, A., Aliberti, C., Baccarani, U., Bhoori, S., Borzio, M., Brancaccio, G., Burra, P., Cabibbo, G., Casadei Gardini, A., Carrai, P., Cillo, U., Conti, F., Cucchetti, A., D'Ambrosio, R., Dell'Unto, C., Di Costanzo, G. G., Di Sandro, S., Foschi, F. G., Fucilli, F., Gambato, M., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttaduria, S., Guarino, M., Kostandini, A., Iavarone, M., Lenci, I., Levi Sandri, G. B., Losito, F., Lupo, L. G., Manzia, T. M., Mazzocato, S., Mescoli, C., Miele, L., Muley, M., Persico, M., Plaz Torres, M. C., Pompili, M., Ponziani, F. R., Rapaccini, G. L., Rendina, M., Renzulli, M., Rossi, M., Rreka, E., Russo, F. P., Sacco, R., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Trevisani, F., Vigano, L., Vigano, M., Villa, E., Vincenzi, V., Violi, P., and Vitale, A.

Subjects
clopidogrel, aspirin, Clinical Biochemistry, incidence, occurrence, survival, General Medicine, Biochemistry, Settore MED/18
Abstract

To evaluate the impact of antiplatelet therapy (APT)on the incidence of hepatocellular carcinoma (HCC) and mortality following its treatment.A systematic literature search was performed using PubMed and Cochrane Central Register of Controlled Trials Databases. Two HCC clinical settings were explored: (i) incidence, and (ii) death after any HCC treatment. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated to compare the pooled data between patients who received or did not receive APT.A total of 20 studies were identified, of whom 15 focused on HCC incidence, including 2,685,009 patients, and five on post-treatment death, including 3281 patients. APT was associated with an overall reduced risk of HCC incidence (OR: 0.63; 95%CI = 0.51-0.79; p 0.001) as well as of post-treatment mortality (OR: 0.54; 95%CI = 0.35-0.83; p = 0.006).Current data suggest that APT correlated with higher HCC incidence and poor overall survival following tumour treatment.

Published
2023

8. Overview of prognostic systems for hepatocellular carcinoma and ITA.LI.CA external validation of MESH and CNLC classifications

Author

Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., Zoli M., Vitale, A, Farinati, F, Finotti, M, Di Renzo, C, Brancaccio, G, Piscaglia, F, Cabibbo, G, Caturelli, E, Missale, G, Marra, F, Sacco, R, Giannini, E, Trevisani, F, Cillo, U, Bhoori, S, Borzio, M, Burra, P, Casadei Gardini, A, Carrai, P, Conti, F, Cozzolongo, R, Cucchetti, A, D'Ambrosio, R, Dell'Unto, C, De Matthaeis, N, Di Costanzo, G, Di Sandro, S, Famularo, S, Foschi, F, Fucilli, F, Galati, G, Gambato, M, Gasbarrini, A, Giuliante, F, Ghinolfi, D, Grieco, A, Gruttadauria, S, Guarino, M, Iavarone, M, Kostandini, A, Lai, Q, Lenci, I, Levi Sandri, G, Losito, F, Lupo, L, Marasco, G, Manzia, T, Mazzocato, S, Masarone, M, Melandro, F, Mescoli, C, Miele, L, Morisco, F, Muley, M, Nicolini, D, Pagano, D, Persico, M, Pompili, M, Ponziani, F, Pravisani, R, Rapaccini, G, Rendina, M, Renzulli, M, Romano, F, Rossi, M, Rreka, E, Russo, F, Sangiovanni, A, Sessa, A, Simonetti, N, Sposito, C, Tortora, R, Vigano, L, Vigano, M, Villa, E, Vincenzi, V, Violi, P, Azzaroli, F, Brunetto, M, Di Marco, A, Masotto, A, Mega, A, Nardone, G, Oliveri, F, Raimondo, G, Svegliati Baroni, G, Vidili, G, Zoli, M, Vitale A., Farinati F., Finotti M., Di Renzo C., Brancaccio G., Piscaglia F., Cabibbo G., Caturelli E., Missale G., Marra F., Sacco R., Giannini E. G., Trevisani F., Cillo U., Bhoori S., Borzio M., Burra P., Casadei Gardini A., Carrai P., Conti F., Cozzolongo R., Cucchetti A., D'ambrosio R., Dell'unto C., De Matthaeis N., Di Costanzo G. G., Di Sandro S., Famularo S., Foschi F. G., Fucilli F., Galati G., Gambato M., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttadauria S., Guarino M., Iavarone M., Kostandini A., Lai Q., Lenci I., Levi Sandri G. V., Losito F., Lupo L. G., Marasco G., Manzia T. M., Mazzocato S., Masarone M., Melandro F., Mescoli C., Miele L., Morisco F., Muley M., Nicolini D., Pagano D., Persico M., Pompili M., Ponziani F. R., Pravisani R., Rapaccini G. L., Rendina M., Renzulli M., Romano F., Rossi M., Rreka E., Russo F. P., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Vigano L., Vigano M., Villa E., Vincenzi V., Violi P., Azzaroli F., Brunetto M. R., Di Marco A., Masotto A., Mega A., Nardone G., Oliveri F., Raimondo G., Svegliati Baroni G., Vidili G., and Zoli M.

Abstract

Prognostic assessment in patients with HCC remains an extremely difficult clinical task due to the complexity of this cancer where tumour characteristics interact with degree of liver dysfunction, patient general health status, and a large span of available treatment options. Several prognostic systems have been proposed in the last three decades, both from the Asian and European/North American countries. Prognostic scores, such as the CLIP score and the recent MESH score, have been generated on a solid statistical basis from real life population data, while staging systems, such as the BCLC scheme and the recent CNLC classification, have been created by experts according to recent HCC prognostic evidences from the literature. A third category includes combined prognostic systems that can be used both as prognostic scores and staging systems. A recent example is the ITA.LI.CA prognostic system including either a prognostic score and a simplified staging system. This review focuses first on an overview of the main prognostic systems for HCC classified according to the above three categories, and, second, on a comprehensive description of the methodology required for a correct comparison between different systems in terms of prognostic performance. In this second section the main studies in the literature comparing different prognostic systems are described in detail. Lastly, a formal comparison between the last prognostic systems proposed for each of the above three categories is performed using a large Italian database including 6882 HCC patients in order to concretely apply the comparison rules previously described.

Published
2021

9. Intestinal barrier in human health and disease

Author

Di Tommaso, N., Gasbarrini, A., Ponziani, F. R., Di Tommaso N., Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), Di Tommaso, N., Gasbarrini, A., Ponziani, F. R., Di Tommaso N., Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

The intestinal mucosa provides a selective permeable barrier for nutrient absorption and protection from external factors. It consists of epithelial cells, immune cells and their secretions. The gut microbiota participates in regulating the integrity and function of the intestinal barrier in a homeostatic balance. Pathogens, xenobiotics and food can disrupt the intestinal barrier, promoting systemic inflammation and tissue damage. Genetic and immune factors predispose individuals to gut barrier dysfunction, and changes in the composition and function of the gut microbiota are central to this process. The progressive identification of these changes has led to the development of the concept of ‘leaky gut syndrome’ and ‘gut dysbiosis’, which underlie the relationship between intestinal barrier impairment, metabolic diseases and autoimmunity. Understanding the mechanisms underlying this process is an intriguing subject of research for the diagnosis and treatment of various intestinal and extraintestinal diseases.

Published
2021

10. Letter to the Editor: Restructuring the Gut Microbiota of Patients with Cirrhosis After HCV Eradication: A Matter of Time?

Author

Ponziani, F. R., Gasbarrini, A., Pompili, M., Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani, F. R., Gasbarrini, A., Pompili, M., Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

N/A

Published
2021

11. Correlation Between Liver Function Tests Abnormalities and Interleukin-6 Serum Levels in Patients With SARS-CoV-2 Infection

Author

Ponziani, F. R., Nesci, A., Del Zompo, F., Santopaolo, F., Pompili, M., Gasbarrini, A., Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Santopaolo F., Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani, F. R., Nesci, A., Del Zompo, F., Santopaolo, F., Pompili, M., Gasbarrini, A., Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Santopaolo F., Pompili M. (ORCID:0000-0001-6699-7980), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

N/A

Published
2021

12. Real-world experience with obeticholic acid in patients with primary biliary cholangitis

Author

D'Amato, D, De Vincentis, A, Malinverno, F, Vigano, M, Alvaro, D, Pompili, M, Picciotto, A, Palitti, V, Russello, M, Storato, S, Pigozzi, M, Calvaruso, V, De Gasperi, E, Lleo, A, Castellaneta, A, Pellicelli, A, Cazzagon, N, Floreani, A, Muratori, L, Fagiuoli, S, Niro, G, Feletti, V, Cozzolongo, R, Terreni, N, Marzioni, M, Pellicano, R, Pozzoni, P, Baiocchi, L, Chessa, L, Rosina, F, Bertino, G, Vinci, M, Morgando, A, Vanni, E, Scifo, G, Sacco, R, D'Anto, M, Bellia, V, Boldizzoni, R, Casella, S, Omazzi, B, Poggi, G, Cristoferi, L, Gerussi, A, Ronca, V, Venere, R, Ponziani, F, Cannavo, M, Mussetto, A, Fontana, R, Losito, F, Frazzetto, E, Distefano, M, Colapietro, F, Labanca, S, Marconi, G, Grassi, G, Galati, G, O'Donnell, S, Mancuso, C, Mulinacci, G, Palermo, A, Claar, E, Izzi, A, Picardi, A, Invernizzi, P, Carbone, M, Vespasiani-Gentilucci, U, D'Amato D., De Vincentis A., Malinverno F., Vigano M., Alvaro D., Pompili M., Picciotto A., Palitti V. P., Russello M., Storato S., Pigozzi M. G., Calvaruso V., De Gasperi E., Lleo A., Castellaneta A., Pellicelli A., Cazzagon N., Floreani A., Muratori L., Fagiuoli S., Niro G. A., Feletti V., Cozzolongo R., Terreni N., Marzioni M., Pellicano R., Pozzoni P., Baiocchi L., Chessa L., Rosina F., Bertino G., Vinci M., Morgando A., Vanni E., Scifo G., Sacco R., D'Anto M., Bellia V., Boldizzoni R., Casella S., Omazzi B., Poggi G., Cristoferi L., Gerussi A., Ronca V., Venere R., Ponziani F., Cannavo M., Mussetto A., Fontana R., Losito F., Frazzetto E., Distefano M., Colapietro F., Labanca S., Marconi G., Grassi G., Galati G., O'Donnell S. E., Mancuso C., Mulinacci G., Palermo A., Claar E., Izzi A., Picardi A., Invernizzi P., Carbone M., Vespasiani-Gentilucci U., D'Amato, D, De Vincentis, A, Malinverno, F, Vigano, M, Alvaro, D, Pompili, M, Picciotto, A, Palitti, V, Russello, M, Storato, S, Pigozzi, M, Calvaruso, V, De Gasperi, E, Lleo, A, Castellaneta, A, Pellicelli, A, Cazzagon, N, Floreani, A, Muratori, L, Fagiuoli, S, Niro, G, Feletti, V, Cozzolongo, R, Terreni, N, Marzioni, M, Pellicano, R, Pozzoni, P, Baiocchi, L, Chessa, L, Rosina, F, Bertino, G, Vinci, M, Morgando, A, Vanni, E, Scifo, G, Sacco, R, D'Anto, M, Bellia, V, Boldizzoni, R, Casella, S, Omazzi, B, Poggi, G, Cristoferi, L, Gerussi, A, Ronca, V, Venere, R, Ponziani, F, Cannavo, M, Mussetto, A, Fontana, R, Losito, F, Frazzetto, E, Distefano, M, Colapietro, F, Labanca, S, Marconi, G, Grassi, G, Galati, G, O'Donnell, S, Mancuso, C, Mulinacci, G, Palermo, A, Claar, E, Izzi, A, Picardi, A, Invernizzi, P, Carbone, M, Vespasiani-Gentilucci, U, D'Amato D., De Vincentis A., Malinverno F., Vigano M., Alvaro D., Pompili M., Picciotto A., Palitti V. P., Russello M., Storato S., Pigozzi M. G., Calvaruso V., De Gasperi E., Lleo A., Castellaneta A., Pellicelli A., Cazzagon N., Floreani A., Muratori L., Fagiuoli S., Niro G. A., Feletti V., Cozzolongo R., Terreni N., Marzioni M., Pellicano R., Pozzoni P., Baiocchi L., Chessa L., Rosina F., Bertino G., Vinci M., Morgando A., Vanni E., Scifo G., Sacco R., D'Anto M., Bellia V., Boldizzoni R., Casella S., Omazzi B., Poggi G., Cristoferi L., Gerussi A., Ronca V., Venere R., Ponziani F., Cannavo M., Mussetto A., Fontana R., Losito F., Frazzetto E., Distefano M., Colapietro F., Labanca S., Marconi G., Grassi G., Galati G., O'Donnell S. E., Mancuso C., Mulinacci G., Palermo A., Claar E., Izzi A., Picardi A., Invernizzi P., Carbone M., and Vespasiani-Gentilucci U.

Abstract

Background & aims: Obeticholic acid (OCA) is the second-line treatment approved for patients with primary biliary cholangitis (PBC) and an inadequate response or intolerance to ursodeoxycholic acid. We aimed to evaluate the effectiveness and safety of OCA under real-world conditions. Methods: Patients were recruited into the Italian PBC Registry, a multicentre, observational cohort study that monitors patients with PBC at national level. The primary endpoint was the biochemical response according to Poise criteria; the secondary endpoint was the biochemical response according to normal range criteria, defined as normal levels of bilirubin, alkaline phosphatase (ALP), and alanine aminotransferase (ALT) at 12 months. Safety and tolerability were also assessed. Results: We analysed 191 patients until at least 12 months of follow-up. Median age was 57 years, 94% female, 61 (32%) had cirrhosis, 28 (15%) had histologically proven overlap with autoimmune hepatitis (PBC-AIH). At 12 months, significant median reductions of ALP (-32.3%), ALT (-31.4%), and bilirubin (-11.2%) were observed. Response rates were 42.9% according to Poise criteria, and 11% by normal range criteria. Patients with cirrhosis had lower response than patients without cirrhosis (29.5% vs. 49.2%, p = 0.01), owing to a higher rate of OCA discontinuation (30% vs. 12%, p = 0.004), although with similar ALP reduction (29.4% vs. 34%, p = 0.53). Overlap PBC-AIH had a similar response to pure PBC (46.4% vs. 42.3%, p = 0.68), with higher ALT reduction at 6 months (-38% vs. -29%, p = 0.04). Thirty-three patients (17%) prematurely discontinued OCA because of adverse events, of whom 11 experienced serious adverse events. Treatment-induced pruritus was the leading cause of OCA discontinuation (67%). Conclusions: Effectiveness and safety of OCA under real-world conditions mirror those in the Poise trial. Patients with cirrhosis had lower tolerability. Overlap PBC-AIH showed higher ALT reduction at 6 months compare

Published
2021

13. Italian association for the study of the liver position statement on SARS-CoV2 vaccination

Author

Russo, F, Piano, S, Bruno, R, Burra, P, Puoti, M, Masarone, M, Montagnese, S, Ponziani, F, Petta, S, Aghemo, A, Russo F. P., Piano S., Bruno R., Burra P., Puoti M., Masarone M., Montagnese S., Ponziani F. R., Petta S., Aghemo A., Russo, F, Piano, S, Bruno, R, Burra, P, Puoti, M, Masarone, M, Montagnese, S, Ponziani, F, Petta, S, Aghemo, A, Russo F. P., Piano S., Bruno R., Burra P., Puoti M., Masarone M., Montagnese S., Ponziani F. R., Petta S., and Aghemo A.

Abstract

The vaccination campaign against Sars-CoV-2 commenced in Italy at the end of December 2020. The first ones to receive the immunization against the virus were the health workers and the residents of nursing homes, following which the vaccine would be available for the entire population, beginning with the most vulnerable individuals. SARS-CoV2 vaccines have been demonstrated to be safe for the general population, although no data for patients with liver diseases or those having undergone liver transplantation are available so far. The present position statement AISF is an attempt to suggest, based on the published data on the impact of Sars-Cov-2 infection in patients with chronic liver disease, a possible priority for vaccination for this category of patients.

Published
2021

15. Gut microbiota compositional and functional fingerprint in patients with alcohol use disorder and alcohol-associated liver disease

Author

Addolorato, G., Ponziani, F. R., Dionisi, T., Mosoni, C., Vassallo, G. A., Sestito, L., Petito, V., Picca, A., Marzetti, E., Tarli, C., Mirijello, A., Zocco, M. A., Lopetuso, L. R., Antonelli, M., Rando, M. M., Paroni Sterbini, F., Posteraro, B., Sanguinetti, M., Gasbarrini, A., Addolorato G. (ORCID:0000-0002-1522-9946), Ponziani F. R. (ORCID:0000-0002-5924-6238), Mosoni C., Sestito L., Petito V., Marzetti E. (ORCID:0000-0001-9567-6983), Tarli C., Mirijello A., Zocco M. A. (ORCID:0000-0002-0814-9542), Lopetuso L. R., Antonelli M. (ORCID:0000-0003-3007-1670), Rando M. M., Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), Addolorato, G., Ponziani, F. R., Dionisi, T., Mosoni, C., Vassallo, G. A., Sestito, L., Petito, V., Picca, A., Marzetti, E., Tarli, C., Mirijello, A., Zocco, M. A., Lopetuso, L. R., Antonelli, M., Rando, M. M., Paroni Sterbini, F., Posteraro, B., Sanguinetti, M., Gasbarrini, A., Addolorato G. (ORCID:0000-0002-1522-9946), Ponziani F. R. (ORCID:0000-0002-5924-6238), Mosoni C., Sestito L., Petito V., Marzetti E. (ORCID:0000-0001-9567-6983), Tarli C., Mirijello A., Zocco M. A. (ORCID:0000-0002-0814-9542), Lopetuso L. R., Antonelli M. (ORCID:0000-0003-3007-1670), Rando M. M., Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Background & aims: Alcohol use disorder (AUD) represents the most common cause of liver disease. The gut microbiota plays a critical role in the progression of alcohol-related liver damage. Aim of this study was to characterize the gut microbial composition and function in AUD patients with alcohol-associated liver disease (AALD). Methods: This study included 36 AUD patients (14 with cirrhosis) who were active drinkers and an equal number of matched controls. Stool microbial composition, serum levels of lipopolysaccharide, cytokines/chemokines and gut microbiota functional profile were assessed. Results: AUD patients had a decreased microbial alpha diversity as compared to controls (0.092 vs 0.130, P =.047) and a specific gut microbial signature. The reduction of Akkermansia and the increase in Bacteroides were able to identify AUD patients with an accuracy of 93.4%. Serum levels of lipopolysaccharide (4.91 vs 2.43, P =.009) and pro-inflammatory mediators (tumour necrosis factor alpha 60.85 vs 15.08, P =.001; interleukin [IL] 1beta 4.43 vs 1.72, P =.0001; monocyte chemoattractant protein 1 225.22 vs 16.43, P =.006; IL6 1.87 vs 1.23, P =.008) were significantly increased in AUD patients compared to controls and in cirrhotic patients compared to non-cirrhotic ones (IL6 3.74 vs 1.39, P =.019; IL8 57.60 vs 6.53, P =.004). The AUD-associated gut microbiota showed an increased expression of gamma-aminobutyric acid (GABA) metabolic pathways and energy metabolism. Conclusions: AUD patients present a specific gut microbial fingerprint, associated with increased endotoxaemia, systemic inflammatory status and functional alterations that may be involved in the progression of the AALD and in the pathogenesis of AUD.

Published
2020

16. Gut Dysbiosis and Fecal Calprotectin Predict Response to Immune Checkpoint Inhibitors in Patients With Hepatocellular Carcinoma

Author

Ponziani, Francesca Romana, De Luca, A., Picca, A., Marzetti, Emanuele, Petito, Valentina, Del Chierico, F., Reddel, S., Paroni Sterbini, F., Sanguinetti, Maurizio, Putignani, Lorenza, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Marzetti E. (ORCID:0000-0001-9567-6983), Petito V., Sanguinetti M. (ORCID:0000-0002-9780-7059), Putignani L., Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani, Francesca Romana, De Luca, A., Picca, A., Marzetti, Emanuele, Petito, Valentina, Del Chierico, F., Reddel, S., Paroni Sterbini, F., Sanguinetti, Maurizio, Putignani, Lorenza, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Marzetti E. (ORCID:0000-0001-9567-6983), Petito V., Sanguinetti M. (ORCID:0000-0002-9780-7059), Putignani L., Gasbarrini A. (ORCID:0000-0002-7278-4823), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

The gut microbiota is a well-known prognostic factor and a modulator of treatment sensitivity in patients with cancers treated with immune checkpoint inhibitors. However, data on hepatocellular carcinoma (HCC) are lacking. This study aimed to evaluate the prognostic role of the gut microbiota and changes produced by immunotherapy on the intestinal environment in patients with cirrhosis and HCC. Eleven patients treated with Tremelimumab and/or Durvalumab were included in the analysis. All study participants underwent gut microbiota profiling, quantification of fecal calprotectin, serum levels of zonulin-1, lipopolysaccharide binding protein (LBP), and programmed death-ligand 1 (PD-L1) at baseline and at each treatment cycle until the third cycle, then every three cycles until treatment discontinuation or last visit. The 6 patients who achieved disease control (DC) showed lower pretreatment fecal calprotectin (median, 12.5; interquartile range [IQR], 5-29 vs. median, 116; IQR, 59-129 µg/g; P = 0.047) and PD-L1 serum levels (median, 0.08; IQR, 0.07-0.09 vs. median, 1.04; IQR, 0.17-1.95 ng/mL; P = 0.02) than nonresponders. The relative abundance of Akkermansia (log2 fold change [FC], 2.72; adjusted P [Padj] = 0.012) was increased, whereas that of Enterobacteriaceae (log2 FC, −2.34; Padj = 0.04) was reduced in the DC group. During treatment, fecal calprotectin showed a temporal evolution opposite to the Akkermansia to Enterobacteriaceae ratio and gut microbiota alpha diversity, but similar to zonulin-1 and LBP. Bifidobacterium had a stable behavior in patients with a long follow-up, while Akkermansia was more variable. Akkermansia and Bifidobacterium showed similar temporal patterns and causative relationships with Prevotella, Veillonella, Ruminococcus, Roseburia, Lachnospira, Faecalibacterium, and Clostridium. Conclusion: A favorable composition of the gut microbiota and low intestinal inflammation are associated with ac

Published
2022

17. Diet-Induced Alterations in Gut Microbiota Composition and Function

Author

Rinninella, Emanuele, Cintoni, Marco, Raoul, Pauline Celine, Ianiro, Gianluca, Laterza, Lucrezia, Ponziani, Francesca Romana, Pulcini, Gabriele, Gasbarrini, Antonio, Mele, Maria Cristina, Rinninella E. (ORCID:0000-0002-9165-2367), Cintoni M. (ORCID:0000-0002-9610-0748), Raoul P., Ianiro G. (ORCID:0000-0002-8318-0515), Laterza L., Ponziani F. R. (ORCID:0000-0002-5924-6238), Pulcini G., Gasbarrini A. (ORCID:0000-0002-7278-4823), Mele M. C. (ORCID:0000-0003-0153-5819), Rinninella, Emanuele, Cintoni, Marco, Raoul, Pauline Celine, Ianiro, Gianluca, Laterza, Lucrezia, Ponziani, Francesca Romana, Pulcini, Gabriele, Gasbarrini, Antonio, Mele, Maria Cristina, Rinninella E. (ORCID:0000-0002-9165-2367), Cintoni M. (ORCID:0000-0002-9610-0748), Raoul P., Ianiro G. (ORCID:0000-0002-8318-0515), Laterza L., Ponziani F. R. (ORCID:0000-0002-5924-6238), Pulcini G., Gasbarrini A. (ORCID:0000-0002-7278-4823), and Mele M. C. (ORCID:0000-0003-0153-5819)

Abstract

Gut microbiota plays a fundamental role within human health, and exerts key functions within the human body. Diet is one of the most powerful modulators of gut microbiota functions and composition. This complex interplay involves also the immune system and the intestinal barrier, highlighting the central role of diet in the pathogenesis and treatment of multiple diseases. In this review article we will paint the landscape of the effects of specific dietary nutrients, and of the detrimental or beneficial outcomes of different dietary patterns, on the composition of human gut microbiota. Moreover, we will discuss the potential application of diet as a therapeutic modulator of gut microbiota, including cutting-edge ways of exploitation, including the use of dietary components as adjuvants to promote microbial engraftment after fecal microbiota transplantation, or personalized nutritional approaches, targeted to the patient microbiome.

Published
2022

18. High prevalence of lower limb atherosclerosis is linked with the gut–liver axis in patients with primary biliary cholangitis

Author

Ponziani, Francesca Romana, Nesci, Antonio, Caputo, C., Salvatore, L., Picca, A., Del Chierico, F., Paroni Sterbini, F., Marzetti, Emanuele, Di Giorgio, Angela, Santoro, Luca, Putignani, Lorenza, Gasbarrini, Antonio, Santoliquido, Angelo, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Marzetti E. (ORCID:0000-0001-9567-6983), Di Giorgio A., Santoro L., Putignani L., Gasbarrini A. (ORCID:0000-0002-7278-4823), Santoliquido A. (ORCID:0000-0003-1539-4017), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani, Francesca Romana, Nesci, Antonio, Caputo, C., Salvatore, L., Picca, A., Del Chierico, F., Paroni Sterbini, F., Marzetti, Emanuele, Di Giorgio, Angela, Santoro, Luca, Putignani, Lorenza, Gasbarrini, Antonio, Santoliquido, Angelo, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Marzetti E. (ORCID:0000-0001-9567-6983), Di Giorgio A., Santoro L., Putignani L., Gasbarrini A. (ORCID:0000-0002-7278-4823), Santoliquido A. (ORCID:0000-0003-1539-4017), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

Background and Aims Hypercholesterolemia is frequent in people with primary biliary cholangitis (PBC); however, it does not seem to confer an increased risk of cardiovascular disease. We aimed to evaluate the prevalence of peripheral arterial disease in PBC women and its association with the gut-liver axis and systemic inflammation. Methods Thirty patients affected by PBC and hypercholesterolemia were enrolled, with equal-sized groups of women with non-alcoholic fatty liver disease (NAFLD) and healthy controls (CTRL). All patients underwent Doppler ultrasound examination of peripheral arteries, assessment of flow-mediated dilation, quantification of circulating cytokines and vasoactive mediators and characterization of the gut microbiota. Results PBC patients had a higher prevalence of lower extremity arterial disease (LEAD) defined as atherosclerotic plaques in any of femoral, popliteal and/or tibial arteries compared with both NAFLD and CTRL women (83.3% vs. 53.3% and 50%, respectively; p = .01). Factors associated with LEAD at univariate analysis were VCAM-1 (p = .002), ICAM-1 (p = .003), and TNF-alpha (p = .04) serum levels, but only VCAM-1 (OR 1.1, 95% CI 1.0-1.1; p = .04) and TNF-alpha (OR 1.12, 95% CI 0.99-1.26; p = .04) were confirmed as independent predictors in the multivariate model. Gut microbiota analysis revealed that Acidaminococcus (FDR = 0.0008), Bifidobacterium (FDR = 0.001) and Oscillospira (FDR = 0.03) were differentially expressed among groups. Acidaminococcus, which was increased in PBC, was positively correlated with TNF-alpha serum levels. Down-regulation of metabolic pathways linked to fatty acid and butyrate metabolism, glyoxylate metabolism and branched-chain amino acids degradation was found in the functional gut metagenome of PBC women. Conclusions LEAD is common in patients affected by PBC and is associated with inflammatory markers and alterations in the gut-liver axis.

Published
2022

19. Risk factors for portal vein thrombosis or venous thromboembolism in a large cohort of hospitalized cirrhotic patients

Author

Faccia, M., Santopaolo, Francesco, Gasbarrini, Antonio, Pompili, Maurizio, Zocco, Maria Assunta, Ponziani, Francesca Romana, Santopaolo F., Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Zocco M. A. (ORCID:0000-0002-0814-9542), Ponziani F. R. (ORCID:0000-0002-5924-6238), Faccia, M., Santopaolo, Francesco, Gasbarrini, Antonio, Pompili, Maurizio, Zocco, Maria Assunta, Ponziani, Francesca Romana, Santopaolo F., Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Zocco M. A. (ORCID:0000-0002-0814-9542), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Background: Portal vein thrombosis (PVT) and venous thromboembolism (VTE) are fearsome complications of liver cirrhosis. Objectives: To assess the prevalence and the main risk factors for venous thrombotic complications in hospitalized cirrhotic patients. Patients/methods: We retrospectively reviewed electronic administrative discharge data of 19461 cirrhotic patients hospitalized over a 35-year period; univariate and multivariate logistic regression was used to asses risk factors for PVT or VTE and their impact on hospital stay and mortality. Results: 382 out of 7445 patients (5.1%) were diagnosed with PVT and 95 (1.3%) with VTE. Liver cirrhosis complications were observed in 45% of patients. Hepatic encephalopathy (HE) (OR 13.88 [10.76–17.98] p < 0.0001), endoscopic signs of portal hypertension (OR 1.33 [1.02–1.75] p = 0.02), hepatocellular carcinoma (HCC) (OR 4.59 [3.6–5.84] p < 0.0001), diabetes (OR 1.68 [1.27–2.22] p = 0.0001), abdominal surgery/invasive procedures (OR 2.03 [1.56–2.64] p < 0.0001) emerged as independent predictors of PVT. Higher risk of VTE was observed in patients with HE (OR 3.21 [1.78–5.79] p < 0.0001), HCC (OR 1.98 [1.23–3.19] p = 0.002) or other tumors (OR 2.48 [1.42–4.32] p = 0.001), acute illnesses (infections OR 3.01 [1.84–5.05] p = 0.0001; cardiac/respiratory insufficiency OR 2.4 [1.27–4.53] p = 0.003; acute myocardial infarction/stroke OR 7.86 [1.76–35.12] p = 0.003). VTE was the only independent predictor of in-hospital mortality (OR 4.45 [1.05–18.81] p = 0.042). Conclusions: Liver disease complications related to portal hypertension, HCC or other tumors, diabetes, acute illnesses (i.e. infections, cardiac/pulmonary insufficiency, acute myocardial infarction/stroke) and abdominal interventions are associated with increased risk of PVT or VTE in hospitalized cirrhotic patients, and should be considered to define personalized preemptive approaches.

Published
2022

20. Project for interventional Oncology LArge-database in liveR Hepatocellular carcinoma - Preliminary CT-based radiomic analysis (POLAR Liver 1.1)

Author

Iezzi, Roberto, Casà, C, Posa, Alessandro, Cornacchione, Patrizia, Carchesio, F, Boldrini, Luca, Tanzilli, A, Cerrito, Lucia, Fionda, B, Longo, V, Miele, Luca, Lancellotta, V, Cellini, Francesco, Tran, H E, Ponziani, Francesca Romana, Giuliante, Felice, Rapaccini, Gian Ludovico, Grieco, Antonio, Pompili, Maurizio, Gasbarrini, Antonio, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Manfredi, Riccardo, Iezzi, R (ORCID:0000-0002-2791-481X), Posa, A, Cornacchione, P, Boldrini, L, Cerrito, L, Miele, L (ORCID:0000-0003-3464-0068), Cellini, F (ORCID:0000-0002-2145-2300), Ponziani, F R (ORCID:0000-0002-5924-6238), Giuliante, F (ORCID:0000-0001-9517-8220), Rapaccini, G L (ORCID:0000-0002-6467-857X), Grieco, A (ORCID:0000-0002-0544-8993), Pompili, M (ORCID:0000-0001-6699-7980), Gasbarrini, A (ORCID:0000-0002-7278-4823), Valentini, V (ORCID:0000-0003-4637-6487), Gambacorta, M A (ORCID:0000-0001-5455-8737), Tagliaferri, L (ORCID:0000-0003-2308-0982), Manfredi, R (ORCID:0000-0002-4972-9500), Iezzi, Roberto, Casà, C, Posa, Alessandro, Cornacchione, Patrizia, Carchesio, F, Boldrini, Luca, Tanzilli, A, Cerrito, Lucia, Fionda, B, Longo, V, Miele, Luca, Lancellotta, V, Cellini, Francesco, Tran, H E, Ponziani, Francesca Romana, Giuliante, Felice, Rapaccini, Gian Ludovico, Grieco, Antonio, Pompili, Maurizio, Gasbarrini, Antonio, Valentini, Vincenzo, Gambacorta, Maria Antonietta, Tagliaferri, Luca, Manfredi, Riccardo, Iezzi, R (ORCID:0000-0002-2791-481X), Posa, A, Cornacchione, P, Boldrini, L, Cerrito, L, Miele, L (ORCID:0000-0003-3464-0068), Cellini, F (ORCID:0000-0002-2145-2300), Ponziani, F R (ORCID:0000-0002-5924-6238), Giuliante, F (ORCID:0000-0001-9517-8220), Rapaccini, G L (ORCID:0000-0002-6467-857X), Grieco, A (ORCID:0000-0002-0544-8993), Pompili, M (ORCID:0000-0001-6699-7980), Gasbarrini, A (ORCID:0000-0002-7278-4823), Valentini, V (ORCID:0000-0003-4637-6487), Gambacorta, M A (ORCID:0000-0001-5455-8737), Tagliaferri, L (ORCID:0000-0003-2308-0982), and Manfredi, R (ORCID:0000-0002-4972-9500)

Abstract

N/A

Published
2022

21. Durvalumab: an investigational agent for unresectable hepatocellular carcinoma

Author

Maestri, Marta, Pallozzi, Maria, Santopaolo, Francesco, Cerrito, Lucia, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Maestri M., Pallozzi M., Santopaolo F., Cerrito L., Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), Maestri, Marta, Pallozzi, Maria, Santopaolo, Francesco, Cerrito, Lucia, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Maestri M., Pallozzi M., Santopaolo F., Cerrito L., Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Introduction: Programmed death 1 (PD1), programmed death ligand 1 (PD-L1), and cytotoxic T lymphocyte associated protein 4 (CTLA-4) are proteins involved in the modulation of immune response, which are upregulated in hepatocellular carcinoma (HCC) tumor microenvironment (TME). Immune checkpoint inhibitors (ICIs) are a new class of drugs that counteract immunological tolerance to cancer cells. Despite the aggressiveness of HCC and its poor prognosis, only a few tyrosine kinase inhibitors (TKIs) and ICIs have been approved for patients with advanced disease. Areas Covered: We analyze the current knowledge on Durvalumab, a human antibody against PD-L1 its pharmacodynamics, and pharmacokinetics. We provide a description of its application in HCC, illustrating clinical trials that have demonstrated the safety and efficacy in this setting, either as monotherapy or in combination with other ICIs or TKIs, or as adjuvant treatment. Expert Opinion: Durvalumab is a promising drug that could extend the landscape of approved treatments for HCC. The clinical safety profile of Durvalumab was well manageable and comparable to other ICIs, with a low incidence of severe immune-related adverse events (irAEs). The importance of personalized therapy according to tumor characteristics is emerging, but very little is known about factors that could influence the efficacy of ICIs.

Published
2022

22. Predictors of Serious Adverse Event and Non-response in Cirrhotic Patients With Primary Biliary Cholangitis under Obeticholic Acid

Author

De Vincentis, A., primary, D'Amato, D., additional, Cristoferi, L., additional, Gerussi, A., additional, Malinverno, F., additional, Lleo, A., additional, Colapietro, F., additional, Marra, F., additional, Galli, A., additional, Fiorini, C., additional, Coco, B., additional, Brunetto, M., additional, Niro, G.A., additional, Cotugno, R., additional, Saitta, C., additional, Cozzolongo, R., additional, Losito, F., additional, Giannini, E.G., additional, Labanca, S., additional, Marzioni, M., additional, Marconi, G., additional, Morgando, A., additional, Pellicano, R., additional, Vanni, E., additional, Cazzagon, N., additional, Floreani, A., additional, Chessa, L., additional, Morelli, O., additional, Muratori, L., additional, Pellicelli, A., additional, Pompili, M., additional, Ponziani, F., additional, Rosina, F., additional, Russello, M., additional, Cannavò, M., additional, Simone, L., additional, Storato, S., additional, Viganò, M., additional, Abenavoli, L., additional, D'Antò, M., additional, De Gasperi, E., additional, Distefano, M., additional, Scifo, G., additional, Zolfino, T., additional, Calvaruso, V., additional, Cuccorese, G., additional, Pace Palitti, V., additional, Sacco, R., additional, Bertino, G., additional, Frazzetto, E., additional, Alvaro, D., additional, Mulinacci, G., additional, Palermo, A., additional, Galati, G., additional, Ronca, V., additional, Zuin, M., additional, Claar, E., additional, Izzi, A., additional, Picardi, A., additional, Invernizzi, P., additional, Vespasiani-Gentilucci, U., additional, and Carbone, M., additional

Published
2022
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24. List of Contributors

Author

Akbar, R., primary, Al Bitar, A., additional, Anagnostopoulos, V., additional, Barrett, B., additional, Berg, A., additional, Berni, N., additional, Brocca, L., additional, Chaparro, D., additional, Ciabatta, L., additional, Dai, Q., additional, Das, N., additional, De Witte, E., additional, Dwyer, E., additional, Entekhabi, D., additional, Gerard, F., additional, Ghilain, N., additional, Griffiths, H., additional, Gruber, A., additional, Gupta, D.K., additional, Gupta, M., additional, Han, D., additional, Hodges, C., additional, Holzman, M., additional, Ireland, G., additional, Islam, T., additional, Jiménez-Muñoz, J.C., additional, Kalivas, D., additional, Kerr, Y.H., additional, Mattar, C., additional, Mialon, A., additional, Mironov, V., additional, Moghaddam, M., additional, Moramarco, T., additional, Muñoz-Sabater, J., additional, Pandey, V., additional, Petrie, A., additional, Petropoulos, G.P., additional, Piles, M., additional, Ponziani, F., additional, Prasad, R., additional, Pratola, C., additional, Rahimzadeh-Bajgiran, P., additional, Rivas, R., additional, Santamaría-Artigas, A., additional, Savin, I., additional, Singh, S.K., additional, Sánchez, N., additional, Sobrino, J.A., additional, Srivastava, P.K., additional, Suman, S., additional, Tebbs, E., additional, Vall-llossera, M., additional, Wagner, W., additional, Wan Jaafar, W.Z., additional, Wigneron, J.-P., additional, and Zhuo, L., additional

Published
2016
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25. Bariatric surgery and liver disease: General considerations and role of the gut–liver axis

Author

Cerreto, M., Santopaolo, Francesco, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, Santopaolo F., Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerreto, M., Santopaolo, Francesco, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, Santopaolo F., Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Weight loss is a therapeutic solution for many metabolic disorders, such as obesity and its complications. Bariatric surgery aims to achieve lasting weight loss in all patients who have failed after multiple dietary attempts. Among its many benefits, it has been associated with the regression of non-alcoholic fatty liver disease (NAFLD), which is often associated with obesity, with evidence of substantial improvement in tissue inflammation and fibrosis. These benefits are mediated not only by weight loss, but also by favorable changes in systemic inflammation and in the composition of the gut microbiota. Changes in microbial metabolites such as short-chain fatty acids (SCFAs), capable of acting as endocrine mediators, and bile acids (BAs) as well as modifications of the gut-brain axis, are among the involved mechanisms. However, not all bariatric surgeries show beneficial effects on the liver; those leading to malabsorption can cause liver failure or a marked worsening of fibrosis and the development of cirrhosis. Nevertheless, there are still many unclear aspects, includ-ing the extent of the benefits and the magnitude of the risks of bariatric surgery in cirrhotic patients. In addition, the usefulness and the safety of these procedures in patients who are candidates to or who have undergone liver transplant need solid supporting evidence. This paper aims to review literature data on the use of bariatric surgery in the setting of chronic liver disease.

Published
2021

26. Low seroprevalence of SARS-CoV-2 antibodies in cirrhotic patients

Author

Del Zompo, F., De Maio, Flavio, Santopaolo, Francesco, Ricci, Riccardo, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, De Maio F., Santopaolo F., Ricci R. (ORCID:0000-0002-9089-5084), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani F. R. (ORCID:0000-0002-5924-6238), Del Zompo, F., De Maio, Flavio, Santopaolo, Francesco, Ricci, Riccardo, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, De Maio F., Santopaolo F., Ricci R. (ORCID:0000-0002-9089-5084), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

N/A

Published
2021

27. Missed linkage to care for patients who screened positive for Hepatitis C in a tertiary care centre: Results of the Telepass project

Author

Ponziani, Francesca Romana, Santopaolo, Francesco, Siciliano, Massimo, De Belvis, A. G., Tortora, Annalisa, Mora, Vincenzina, Fanali, Chiara, Morsella, Alisha, Balducci, Federica, Vetrugno, Giuseppe, D'Alfonso, Maria Elena, Cambieri, Andrea, Cauda, Roberto, Bellantone, Rocco Domenico Alfonso, Sanguinetti, Maurizio, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Santopaolo F., Siciliano M., Tortora A., Mora V., Fanali C., Morsella A., Balducci F., Vetrugno G. (ORCID:0000-0003-0181-2855), D'Alfonso M. E., Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Bellantone R. (ORCID:0000-0002-0844-3469), Sanguinetti M. (ORCID:0000-0002-9780-7059), Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani, Francesca Romana, Santopaolo, Francesco, Siciliano, Massimo, De Belvis, A. G., Tortora, Annalisa, Mora, Vincenzina, Fanali, Chiara, Morsella, Alisha, Balducci, Federica, Vetrugno, Giuseppe, D'Alfonso, Maria Elena, Cambieri, Andrea, Cauda, Roberto, Bellantone, Rocco Domenico Alfonso, Sanguinetti, Maurizio, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Santopaolo F., Siciliano M., Tortora A., Mora V., Fanali C., Morsella A., Balducci F., Vetrugno G. (ORCID:0000-0003-0181-2855), D'Alfonso M. E., Cambieri A., Cauda R. (ORCID:0000-0002-1498-4229), Bellantone R. (ORCID:0000-0002-0844-3469), Sanguinetti M. (ORCID:0000-0002-9780-7059), Pompili M. (ORCID:0000-0001-6699-7980), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Italy is one of the countries on track with the WHO’s agenda to eliminate hepatitis C virus (HCV) by 2030. Healthcare facilities play a crucial role in seeking patients who are infected but have not yet been treated. We assessed the effectiveness of a recall strategy, named ‘Telepass’ project, for patients exposed to HCV infection who have not yet been linked to care in a large tertiary care centre. The ‘Telepass’ project was structured in two phases: (a) a retrospective analysis first identified all anti–HCV-positive subjects among patients who underwent pre-operative assessment in the facility in the course of one year; (b) a following prospective phase, aimed to recall patients in need either of further diagnostic tests (ie HCV-RNA) or treatment. A total of 12246 records of patients tested for HCV antibodies were reviewed. The overall prevalence of anti–HCV-positive subjects was 1.83% (224/12246) with a male/female ratio of 2.07. Out of the 224 anti–HCV-positive patients, 123 (54.91%) did not have documented HCV-RNA tests and were therefore selected for recall. Of these, 123 were reachable and 26 (21.13%) were successfully linked to care. Ten patients (38.46%) tested HCV-RNA positive and initiated treatment with direct-acting antivirals (DAAs). The Telepass study highlights that a recall strategy starting from internal hospital databases can help identify patients with chronic HCV infection who have not yet been linked to care, and provides an epidemiological insight into the prevalence of HCV infection in Italy in the late DAAs era.

Published
2021

28. Fecal microbiota transplantation in patients with hbv infection or other chronic liver diseases: Update on current knowledge and future perspectives

Author

Paratore, Mattia, Santopaolo, Francesco, Cammarota, Giovanni, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Paratore M., Santopaolo F., Cammarota G. (ORCID:0000-0002-3626-6148), Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), Paratore, Mattia, Santopaolo, Francesco, Cammarota, Giovanni, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Paratore M., Santopaolo F., Cammarota G. (ORCID:0000-0002-3626-6148), Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Liver disease and gut dysbiosis are strictly associated, and the pathophysiology of this bidirectional relationship has recently been the subject of several investigations. Growing evidence highlights the link between gut microbiota composition, impairment of the gut-liver axis, and the development or progression of liver disease. Therefore, the modulation of gut microbiota to maintain homeostasis of the gut-liver axis could represent a potential instrument to halt liver damage, modify the course of liver disease, and improve clinical outcomes. Among all the methods available to achieve this purpose, fecal microbiota transplantation (FMT) is one of the most promising, being able to directly reshape the recipient’s gut microbial communities. In this review, we report the main characteristics of gut dysbiosis and its pathogenetic consequences in cirrhotic patients, discussing the emerging data on the application of FMT for liver disease in different clinical settings.

Published
2021

29. Advances in pharmacotherapeutics for hepatocellular carcinoma

Author

Cerrito, Lucia, Santopaolo, Francesco, Monti, Francesca, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Cerrito L., Santopaolo F., Monti F., Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerrito, Lucia, Santopaolo, Francesco, Monti, Francesca, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, Cerrito L., Santopaolo F., Monti F., Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Introduction: Although hepatocellular carcinoma (HCC) is the most frequent primary liver cancer, there are limited therapeutic options for the advanced stages. Sorafenib was the first tyrosine-kinase inhibitor (TKI) approved for unresectable HCC and remained the only effective choice for a decade. The horizon of systemic treatments drastically expanded in the latest years, opening new interesting possibilities. Areas covered: In this manuscript, the authors have analysed the recent advances in pharmacotherapy for HCC, discussing their mechanisms of action, the clinical efficacy and the safety profile of currently available first, second-and third-line treatments. The authors have also analysed the role of immune system modulators, in particular immune checkpoints inhibitors (ICIs), based on the limited data published so far. Expert opinion: The emergence of new targeted therapies, such as lenvatinib, have changed the landscape of HCC therapy. Tumor extension, differences in objective response rates and adverse events profiles should be considered to tailor the choice of the first-line agent. Sorafenib remains the most studied drug, with much real-world data available. The efficacy of second line therapies has only been proven in non-responder or sorafenib-intolerant patients. Unfortunately, studies directly comparing the second-line agents regorafenib, ramucirumab and cabozantinib are still lacking.

Published
2021

30. Improved gut microbiota features after the resolution of SARS‐CoV‐2 infection

Author

De Maio, Flavio, Ianiro, Gianluca, Coppola, Gaetano, Santopaolo, Francesco, Abbate, Valeria, Bianco, D. M., Del Zompo, F., De Matteis, Giuseppe, Leo, Maria Laura, Nesci, Antonio, Nicoletti, Alberto, Pompili, Maurizio, Cammarota, Giovanni, Posteraro, Brunella, Sanguinetti, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, De Maio F., Ianiro G. (ORCID:0000-0002-8318-0515), Coppola G., Santopaolo F., Abbate V., De Matteis G., Leo M., Nesci A., Nicoletti A., Pompili M. (ORCID:0000-0001-6699-7980), Cammarota G. (ORCID:0000-0002-3626-6148), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), De Maio, Flavio, Ianiro, Gianluca, Coppola, Gaetano, Santopaolo, Francesco, Abbate, Valeria, Bianco, D. M., Del Zompo, F., De Matteis, Giuseppe, Leo, Maria Laura, Nesci, Antonio, Nicoletti, Alberto, Pompili, Maurizio, Cammarota, Giovanni, Posteraro, Brunella, Sanguinetti, Maurizio, Gasbarrini, Antonio, Ponziani, Francesca Romana, De Maio F., Ianiro G. (ORCID:0000-0002-8318-0515), Coppola G., Santopaolo F., Abbate V., De Matteis G., Leo M., Nesci A., Nicoletti A., Pompili M. (ORCID:0000-0001-6699-7980), Cammarota G. (ORCID:0000-0002-3626-6148), Posteraro B. (ORCID:0000-0002-1663-7546), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has a tropism for the gastrointestinal tract and several studies have shown an alteration of the gut microbiota in hospitalized infected patients. However, long-term data on microbiota changes after recovery are lacking. Methods: We enrolled 30 patients hospitalized for SARS‐CoV‐2-related pneumonia. Their gut microbiota was analyzed within 48 h from the admission and compared with (1) that of other patients admitted for suspected bacterial pneumonia (control group) (2) that obtained from the same subject 6 months after nasopharyngeal swab negativization. Results: Gut microbiota alpha-diversity increased 6 months after the resolution of SARS-CoV-2 infection. Bacteroidetes relative abundance was higher (≈ 36.8%) in patients with SARS-CoV-2, and declined to 18.7% when SARS-CoV-2 infection resolved (p = 0.004). Conversely, Firmicutes were prevalent (≈ 75%) in controls and in samples collected after SARS-CoV-2 infection resolution (p = 0.001). Ruminococcaceae, Lachnospiraceae and Blautia increased after SARS-CoV-2 infection resolution, rebalancing the gut microbiota composition. Conclusion: SARS-CoV-2 infection is associated with changes in the gut microbiome, which tend to be reversed in long-term period.

Published
2021

31. Prevalence of liver injury and correlation with clinical outcomes in patients with COVID-19: Systematic review with meta-analysis

Author

DEL ZOMPO, F., De Siena, Martina, Ianiro, Gianluca, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, DE SIENA M., IANIRO G. (ORCID:0000-0002-8318-0515), GASBARRINI A. (ORCID:0000-0002-7278-4823), POMPILI M. (ORCID:0000-0001-6699-7980), PONZIANI F. R. (ORCID:0000-0002-5924-6238), DEL ZOMPO, F., De Siena, Martina, Ianiro, Gianluca, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani, Francesca Romana, DE SIENA M., IANIRO G. (ORCID:0000-0002-8318-0515), GASBARRINI A. (ORCID:0000-0002-7278-4823), POMPILI M. (ORCID:0000-0001-6699-7980), and PONZIANI F. R. (ORCID:0000-0002-5924-6238)

Abstract

OBJECTIVE: Liver involvement of SARS-CoV-2 infection has been reported in several papers, but without homogeneous findings. We aimed to systematically review the prevalence of liver involvement in patients with SARS-CoV-2 infection at their hospital admission, and its correlation with disease severity and clinical outcomes in patients with or without pre-existing chronic liver disease. MATERIALS AND METHODS: We systematically searched PubMed, Embase, Web of Science, Medline, PMC, clinical trial registries, and other Coronavirus family publications for studies reporting data on SARS-CoV-2 infection or COVID-19 and liver function tests (LFTs) alterations, as well as clinical course of patients with chronic liver disease or cirrhosis. Case reports, preprints, editorials, reviews were excluded. We also revised literature to describe the background of liver involvement during SARS-CoV-2 infection. RESULTS: 36 studies, including 20724 patients with SARS-CoV-2 infection, were included. The pooled prevalence of LFTs abnormalities at admission was 46.9% (AST 26.5%, ALT 22.8%, GGT 22.5%, ALP 5.7%, tBIL 8.0%). ALT, AST, tBIL were independent predictors of disease severity (ALT OR 1.54, 95% CI 1.17-2.03; AST OR 3.17, 95% CI 2.10- 4.77; tBIL OR 2.32, 95% CI 1.18-4.58) and in-hospital mortality (ALT OR 1.48, 95% CI 1.12-1.96; AST OR 4.39, 95% CI 2.68-7.18; tBIL OR 7.75, 95% CI 2.28- 26.40). Heterogeneity among studies was high. The few available data also reported that COVID-19 was associated with increased risk of liver decompensation and mortality in patients with liver cirrhosis. CONCLUSIONS: LFTs alterations were reported in up to 47% of unselected patients with COVID-19 and were associated with severe disease or in-hospital mortality. In cirrhotic patients, COVID-19 was associated with high risk of liver decompensation or mortality.

Published
2021

32. Characterization of the gut-liver-muscle axis in cirrhotic patients with sarcopenia

Author

Ponziani, Francesca Romana, Picca, A., Marzetti, Emanuele, Calvani, Riccardo, Conta, G., Del Chierico, F., Capuani, G., Faccia, M., Fianchi, Francesca, Funaro, B., Jose Coelho-Junior, H., Petito, Valentina, Rinninella, Emanuele, Paroni Sterbini, F., Reddel, S., Vernocchi, P., Cristina Mele, M., Miccheli, A., Putignani, Lorenza, Sanguinetti, Maurizio, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Marzetti E. (ORCID:0000-0001-9567-6983), Calvani R. (ORCID:0000-0001-5472-2365), Fianchi F., Petito V., Rinninella E. (ORCID:0000-0002-9165-2367), Putignani L., Sanguinetti M. (ORCID:0000-0002-9780-7059), Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani, Francesca Romana, Picca, A., Marzetti, Emanuele, Calvani, Riccardo, Conta, G., Del Chierico, F., Capuani, G., Faccia, M., Fianchi, Francesca, Funaro, B., Jose Coelho-Junior, H., Petito, Valentina, Rinninella, Emanuele, Paroni Sterbini, F., Reddel, S., Vernocchi, P., Cristina Mele, M., Miccheli, A., Putignani, Lorenza, Sanguinetti, Maurizio, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Marzetti E. (ORCID:0000-0001-9567-6983), Calvani R. (ORCID:0000-0001-5472-2365), Fianchi F., Petito V., Rinninella E. (ORCID:0000-0002-9165-2367), Putignani L., Sanguinetti M. (ORCID:0000-0002-9780-7059), Pompili M. (ORCID:0000-0001-6699-7980), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Background & Aim: Sarcopenia is frequent in cirrhosis and is associated with unfavourable outcomes. The role of the gut-liver-muscle axis in this setting has been poorly investigated. The aim of this study was to identify gut microbiota, metabolic and inflammatory signatures associated with sarcopenia in cirrhotic patients. Methods: Fifty cirrhotic patients assessed for the presence of sarcopenia by the quantification of muscle mass and strength were compared with age- and sex-matched controls. A multiomic analysis, including gut microbiota composition and metabolomics, serum myokines and systemic and intestinal inflammatory mediators, was performed. Results: The gut microbiota of sarcopenic cirrhotic patients was poor in bacteria associated with physical function (Methanobrevibacter, Prevotella and Akkermansia), and was enriched in Eggerthella, a gut microbial marker of frailty. The abundance of potentially pathogenic bacteria, such as Klebsiella, was also increased, to the detriment of autochthonous ones. Sarcopenia was associated with elevated serum levels of pro-inflammatory mediators and of fibroblast growth factor 21 (FGF21) in cirrhotic patients. Gut microbiota metabolic pathways involved in amino acid, protein and branched-chain amino acid metabolism were up-regulated, in addition to ethanol, trimethylamine and dimethylamine production. Correlation networks and clusters of variables associated with sarcopenia were identified, including one centred on Klebsiella/ethanol/FGF21/Eggerthella/Prevotella. Conclusions: Alterations in the gut-liver-muscle axis are associated with sarcopenia in patients with cirrhosis. Detrimental but also compensatory functions are involved in this complex network.

Published
2021

34. Platelets and hepatocellular cancer: Bridging the bench to the clinics

Author

Lai, aEmail Author, Q., Vitale, bEmail Author, A., Manzia, cEmail Author, T. M., Foschi, dEmail Author, F. G., Sandri, eEmail Author, G. B. L., Gambato, bEmail Author, M., Melandro, fEmail Author, F., Russo, bEmail Author, F. P., Miele, gEmail Author, L., Viganò, hEmail Author, L., Burra, bEmail Author, P., Giannini, iEmail Author, E. G., Aliberti, C., Baccarani, U., Bhoori, S., Borzio, M., Brancaccio, G., Cabibbo, G., Casadei, Gardini, Carrai, A., Cillo, P., Conti, U., Cucchetti, F., D’Ambrosio, A., Dell’Unto, R., Dematthaeis, C., Costanzo, Di, G. G., Di Sandro, S., Fucilli, F., Galati, G., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttaduria, S., Guarino, M., Kostandini, A., Iavarone, M., Lenci, I., Losito, F., Lupo, L. G., Mazzocato, S., Mescoli, C., Miele, L., Morisco, F., Muley, M., Nicolini, D., Persico, M., Pompili, M., Ponziani, F. R., Pravisani, R., Rapaccini, G. L., Rendina, M., Renzulli, M., Rossi, M., Rreka, E., Sacco, R., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Trevisani, F., Viganò, M., Villa, E., Vincenzi, V., Violi, P., Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest Group, Lai, Q., aEmail Author, Vitale, A., bEmail Author, Manzia, T. M., cEmail Author, Foschi, F. G., dEmail Author, Sandri, G. B. L., eEmail Author, Gambato, M., bEmail Author, Melandro, F., fEmail Author, Russo, F. P., bEmail Author, Miele, L., gEmail Author, Viganò, L., hEmail Author, Burra, P., bEmail Author, Giannini, E. G., iEmail Author, Aliberti, C., Baccarani, U., Bhoori, S., Borzio, M., Brancaccio, G., Cabibbo, G., Casadei, Gardini, A., Carrai, P., Cillo, U., Conti, F., Cucchetti, A., D’Ambrosio, R., Dell’Unto, C., Dematthaei, Di, Costanzo, G., G., Di Sandro, S., Fucilli, F., Galati, G., Gasbarrini, A., Giuliante, F., Ghinolfi, D., Grieco, A., Gruttaduria, S., Guarino, M., Kostandini, A., Iavarone, M., Lenci, I., Losito, F., Lupo, L. G., Mazzocato, S., Mescoli, C., Miele, L., Morisco, F., Muley, M., Nicolini, D., Persico, M., Pompili, M., Ponziani, F. R., Pravisani, R., Rapaccini, G. L., Rendina, M., Renzulli, M., Rossi, M., Rreka, E., Sacco, R., Sangiovanni, A., Sessa, A., Simonetti, N., Sposito, C., Tortora, R., Trevisani, F., Viganò, M., Villa, E., Vincenzi, V., Violi, P., Associazione Italiana per lo Studio del Fegato (AISF) HCC Special Interest, Group, Lai Q., Vitale A., Manzia T.M., Foschi F.G., Sandri G.B.L., Gambato M., Melandro F., Russo F.P., Miele L., Vigano L., Burra P., Giannini E.G., Aglitti A., Aliberti C., Baccarani U., Bhoori S., Borzio M., Brancaccio G., Cabibbo G., Casadei Gardini A., Carrai P., Cillo U., Conti F., Cucchetti A., D'ambrosio R., Dell'unto C., Dematthaeis N., Di Costanzo G.G., Di Sandro S., Fucilli F., Galati G., Gasbarrini A., Giuliante F., Ghinolfi D., Grieco A., Gruttaduria S., Guarino M., Kostandini A., Iavarone M., Lenci I., Losito F., Lupo L.G., Mazzocato S., Mescoli C., Morisco F., Muley M., Nicolini D., Persico M., Pompili M., Ponziani F.R., Pravisani R., Rapaccini G.L., Rendina M., Renzulli M., Rossi M., Rreka E., Sacco R., Sangiovanni A., Sessa A., Simonetti N., Sposito C., Tortora R., Trevisani F., Vigano M., Villa E., Vincenzi V., Violi P., Lai, Q., Vitale, A., Manzia, T. M., Foschi, F. G., Sandri, G. B. L., Gambato, M., Melandro, F., Russo, F. P., Vigano, L., Burra, P., Giannini, E. G., Casadei Gardini, A., Carrai, P., Cillo, U., Conti, F., Cucchetti, A., D'Ambrosio, R., Dell'Unto, C., Dematthaeis, N., Di Costanzo, G. G., and Vigano, M.

Subjects
Cancer Research, Integrins, Platelet-derived growth factor, Endothelium, Settore MED/12 - GASTROENTEROLOGIA, medicine.medical_treatment, Integrin, Review, lcsh:RC254-282, 03 medical and health sciences, chemistry.chemical_compound, 0302 clinical medicine, Platelet-to-lymphocyte ratio, Selectins, Vascular endothelial growth factor, medicine, Platelet, Selectin, business.industry, Growth factor, lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens, Extravasation, Settore MED/01, medicine.anatomical_structure, Oncology, chemistry, Tumor progression, 030220 oncology & carcinogenesis, Cancer research, 030211 gastroenterology & hepatology, business
Abstract

Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells' extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet-tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC. Growing interest is recently being focused on the role played by the platelets in favoring hepatocellular cancer (HCC) growth and dissemination. The present review reports in detail both the experimental and clinical evidence published on this topic. Several growth factors and angiogenic molecules specifically secreted by platelets are directly connected with tumor progression and neo-angiogenesis. Among them, we can list the platelet-derived growth factor, the vascular endothelial growth factor, the endothelial growth factor, and serotonin. Platelets are also involved in tumor spread, favoring endothelium permeabilization and tumor cells’ extravasation and survival in the bloodstream. From the bench to the clinics, all of these aspects were also investigated in clinical series, showing an evident correlation between platelet count and size of HCC, tumor biological behavior, metastatic spread, and overall survival rates. Moreover, a better understanding of the mechanisms involved in the platelet–tumor axis represents a paramount aspect for optimizing both current tumor treatment and development of new therapeutic strategies against HCC.

Published
2019

35. Gut microbiome composition in lean patients with NASH is associated with liver damage independent of caloric intake: A prospective pilot study

Author

Duarte, S. M. B., Stefano, J. T., Miele, L., Ponziani, F. R., Souza-Basqueira, M., Okada, L. S. R. R., de Barros Costa, F. G., Toda, K., Mazo, D. F. C., Sabino, E. C., Carrilho, F. J., Gasbarrini, A., Oliveira, C. P., Miele, L. (ORCID:0000-0003-3464-0068), Ponziani, F. R. (ORCID:0000-0002-5924-6238), Gasbarrini, A. (ORCID:0000-0002-7278-4823), Duarte, S. M. B., Stefano, J. T., Miele, L., Ponziani, F. R., Souza-Basqueira, M., Okada, L. S. R. R., de Barros Costa, F. G., Toda, K., Mazo, D. F. C., Sabino, E. C., Carrilho, F. J., Gasbarrini, A., Oliveira, C. P., Miele, L. (ORCID:0000-0003-3464-0068), Ponziani, F. R. (ORCID:0000-0002-5924-6238), and Gasbarrini, A. (ORCID:0000-0002-7278-4823)

Abstract

Background and Aim: The aim of the study was to compare the gut microbiomes from obese and lean patients with or without NASH to outline phenotypic differences. Methods and Results: We performed a cross-sectional pilot study comprising biopsy-proven NASH patients grouped according to BMI. Microbiome DNA was extracted from stool samples, and PCR amplification was performed using primers for the V4 region of the 16S rRNA gene. The amplicons were sequenced using the Ion PGM Torrent platform, and data were analyzed using QIIME software. Macronutrient consumption was analyzed by a 7-day food record. Liver fibrosis ≥ F2 was associated with increased abundance of Lactobacilli (p = 0.0007). NASH patients showed differences in Faecalibacterium, Ruminococcus, Lactobacillus and Bifidobacterium abundance compared with the control group. Lean NASH patients had a 3-fold lower abundance of Faecalibacterium and Ruminococcus (p = 0.004), obese NASH patients were enriched in Lactobacilli (p = 0.002), and overweight NASH patients had reduced Bifidobacterium (p = 0.018). Moreover, lean NASH patients showed a deficiency in Lactobacillus compared with overweight and obese NASH patients. This group also appeared similar to the control group with regard to gut microbiome alpha diversity. Although there were qualitative differences between lean NASH and overweight/obese NASH, they were not statistically significant (p = 0.618). The study limitations included a small sample size, a food questionnaire that collected only qualitative and semi-quantitative data, and variations in group gender composition that may influence differences in FXR signaling, bile acids metabolism and the composition of gut microbiota. Conclusion: Our preliminary finding of a different pathogenetic process in lean NASH patients needs to be confirmed by larger studies, including those with patient populations stratified by sex and dietary habits.

Published
2018

36. P-57 Atezolizumab in combination with bevacizumab in patients with unresectable HCC previously untreated with systemic therapy: Interim analysis results from phase IIIb Italian AMETHISTA trial

Author

Martinelli, E., Masi, G., Piscaglia, F., Cabibbo, G., Di Maio, M., Gasbarrini, A., Iavarone, M., Pellegrini, E., Mazzaferro, V., Ballestrero, A., Garufi, C., Bergamo, F., Celsa, C., Marino, D., Tovoli, F., Ponziani, F., Pressiani, T., Astolfi, C., Ciardiello, F., Daniele, B., and Rimassa, L.

Published
2023
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37. Letter: liver involvement and mortality in COVID-19 patients – authors' reply

Author

Ponziani, Francesca Romana, Del Zompo, F., Nesci, Antonio, Santopaolo, Francesco, Ianiro, Gianluca, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Santopaolo F., Ianiro G. (ORCID:0000-0002-8318-0515), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani, Francesca Romana, Del Zompo, F., Nesci, Antonio, Santopaolo, Francesco, Ianiro, Gianluca, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A., Santopaolo F., Ianiro G. (ORCID:0000-0002-8318-0515), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

N/A

Published
2020

38. Increased Faecalibacterium abundance is associated with clinical improvement in patients receiving rifaximin treatment

Author

Ponziani, Francesca Romana, Scaldaferri, Franco, De Siena, Martina, Mangiola, Francesca, Matteo, Maria Valeria, Pecere, Silvia, Petito, Valentina, Paroni Sterbini, F., Lopetuso, Loris Riccardo, Masucci, Luca, Cammarota, Giovanni, Sanguinetti, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Scaldaferri F. (ORCID:0000-0001-8334-7541), de Siena M., Mangiola F., Matteo M. V., Pecere S., Petito V., Lopetuso L. R., Masucci L. (ORCID:0000-0002-8358-6726), Cammarota G. (ORCID:0000-0002-3626-6148), Sanguinetti M. (ORCID:0000-0002-9780-7059), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani, Francesca Romana, Scaldaferri, Franco, De Siena, Martina, Mangiola, Francesca, Matteo, Maria Valeria, Pecere, Silvia, Petito, Valentina, Paroni Sterbini, F., Lopetuso, Loris Riccardo, Masucci, Luca, Cammarota, Giovanni, Sanguinetti, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Scaldaferri F. (ORCID:0000-0001-8334-7541), de Siena M., Mangiola F., Matteo M. V., Pecere S., Petito V., Lopetuso L. R., Masucci L. (ORCID:0000-0002-8358-6726), Cammarota G. (ORCID:0000-0002-3626-6148), Sanguinetti M. (ORCID:0000-0002-9780-7059), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Compositional and functional alterations of the gut microbiota are involved in the pathogenesis of several gastrointestinal diseases. Rifaximin is often used to induce disease remission due to its eubiotic effects on the gut microbiota. To investigate the correlation between changes in the gut microbiota composition and symptoms improvement in patients who present a clinical response to rifaximin treatment. Patients with ulcerative colitis (UC), Crohn’s disease (CD), irritable bowel syndrome (IBS) and diverticular disease (DD) undergoing rifaximin treatment for clinical indication were enrolled in the study. Rifaximin was administered at the dose of 1,200 mg/day for 10 days. Faecal samples were collected at baseline and at the end of treatment; clinical improvement was assessed by Mayo score for UC, CD Activity Index (CDAI) for CD, IBS severity scoring system (IBS-SSS) for IBS and global symptomatic score (GSS) for DD. Twenty-five patients were included in the analysis and a clinical improvement was recorded for 10/25 (40%) of them. Microbial alpha diversity showed a slight increase in clinical responders (P=0.271), while it decreased in patients who did not improved (P=0.05). A significant post-treatment increase in Faecalibacterium abundance was observed in patients with a positive response (log2FC 1.959, P=0.042). Roseburia abundance decreased in both groups, whereas Ruminococcus decreased only in patients who clinically improved. Clinical improvement consequent to rifaximin treatment is associated with an increase in Faecalibacterium abundance. Achieving a positive shift in the gut microbiota composition seems a key event to obtain a clinical benefit from treatment.

Published
2020

39. NAFLD or comorbidities, that is the question

Author

Ponziani, Francesca Romana, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), Pompili M. (ORCID:0000-0001-6699-7980), Ponziani, Francesca Romana, Gasbarrini, Antonio, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

N/a

Published
2020

40. Biliary tract microbiota: A new kid on the block of liver diseases?

Author

Nicoletti, Alberto, Ponziani, Francesca Romana, Nardella, E., Ianiro, Gianluca, Gasbarrini, Antonio, Dal Verme, L. Z., Nicoletti A., Ponziani F. R. (ORCID:0000-0002-5924-6238), Ianiro G. (ORCID:0000-0002-8318-0515), Gasbarrini A. (ORCID:0000-0002-7278-4823), Nicoletti, Alberto, Ponziani, Francesca Romana, Nardella, E., Ianiro, Gianluca, Gasbarrini, Antonio, Dal Verme, L. Z., Nicoletti A., Ponziani F. R. (ORCID:0000-0002-5924-6238), Ianiro G. (ORCID:0000-0002-8318-0515), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

– The microbiome plays a crucial role in maintaining the homeostasis of the organism. Recent evidence has provided novel insights for understanding the interaction between the microbiota and the host. However, the vast majority of such studies have analyzed the interactions taking place in the intestinal tract. The biliary tree has traditionally been considered sterile under normal conditions. However, the advent of metagenomic techniques has revealed an unexpectedly rich bacterial community in the biliary tract. Associations between specific microbiological patterns and inflammatory biliary diseases and cancer have been recently described. Hence, biliary dysbiosis may be a primary trigger in the pathogenesis of biliary diseases. In particular, recent studies have suggested that microorganisms could play a significant role in the development of gallstones, pathogenesis of autoimmune cholangiopathies and biliary carcinogenesis. Moreover, the intimate connection between the biliary tract, liver and pancreas, could reveal hidden influences on the development of diseases of these organs. Further studies are needed to deepen the comprehension of the influence of the biliary microbiota in human pathology. This knowledge could lead to the formulation of strategies for modulating the biliary microbiota in order to treat and prevent these pathological conditions.

Published
2020

41. Liver involvement is not associated with mortality: results from a large cohort of SARS-CoV-2-positive patients

Author

Ponziani, Francesca Romana, Del Zompo, F., Nesci, Domenico Arturo, Santopaolo, F., Ianiro, Gianluca, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A. (ORCID:0000-0001-9466-1755), Ianiro G. (ORCID:0000-0002-8318-0515), Pompili M. (ORCID:0000-0001-6699-7980), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani, Francesca Romana, Del Zompo, F., Nesci, Domenico Arturo, Santopaolo, F., Ianiro, Gianluca, Pompili, Maurizio, Gasbarrini, Antonio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Nesci A. (ORCID:0000-0001-9466-1755), Ianiro G. (ORCID:0000-0002-8318-0515), Pompili M. (ORCID:0000-0001-6699-7980), and Gasbarrini A. (ORCID:0000-0002-7278-4823)

Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is frequently associated with liver test abnormalities. Aims: To describe the evolution of liver involvement during SARS-CoV-2 infection and its effect on clinical course and mortality. Methods: Data of 515 SARS-CoV-2-positive patients were collected at baseline and during follow-up, last evaluation or death. Stratification based on need for hospitalisation, severe disease and admission to intensive care unit (ICU) was performed. The association between liver test abnormalities (baseline and peak values) and ICU admission or death was also explored. Results: Liver test abnormalities were found in 161 (31.3%) patients. Aspartate aminotransferase (AST), alanine aminotransferase (ALT) and gamma glutamyl transferase (GGT) were increased in 20.4%, 19% and 13.6% of patients, respectively. Baseline liver test abnormalities were associated with increased risk of ICU admission (OR 2.19 [95% CI 1.24-3.89], P = 0.007) but not with mortality (OR 0.84 [95% CI 0.49-1.41], P = 0.51). Alkaline phosphatase (ALP) peak values were correlated with risk of death (OR 1.007 [95% CI 1.002-1.01], P = 0.005) along with age, multiple comorbidities, acute respiratory distress syndrome, ICU admission and C-reactive protein. Alterations of liver tests worsened within 15 days of hospitalisation; however, in patients with the longest median follow-up, the prevalence of liver test alterations decreased over time, returning to around baseline levels. Conclusions: In SARS-CoV-2-positive patients without pre-existing severe chronic liver disease, baseline liver test abnormalities are associated with the risk of ICU admission and tend to normalise over time. The ALP peak value may be predictive of a worse prognosis.

Published
2020

42. Nasopharyngeal Microbiota Profiling of SARS-CoV-2 Infected Patients

Author

De Maio, Flavio, Posteraro, Brunella, Ponziani, Francesca Romana, Cattani Franchi, Paola, Gasbarrini, Antonio, Sanguinetti, Maurizio, De Maio F., Posteraro B. (ORCID:0000-0002-1663-7546), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cattani P. (ORCID:0000-0003-4678-4763), Gasbarrini A. (ORCID:0000-0002-7278-4823), Sanguinetti M. (ORCID:0000-0002-9780-7059), De Maio, Flavio, Posteraro, Brunella, Ponziani, Francesca Romana, Cattani Franchi, Paola, Gasbarrini, Antonio, Sanguinetti, Maurizio, De Maio F., Posteraro B. (ORCID:0000-0002-1663-7546), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cattani P. (ORCID:0000-0003-4678-4763), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Sanguinetti M. (ORCID:0000-0002-9780-7059)

Abstract

We analyzed the bacterial communities of the nasopharynx in 40 SARS-CoV-2 infected and uninfected patients. All infected patients had a mild COVID-19 disease. We did not find statistically significant differences in either bacterial richness and diversity or composition. These findings suggest a nasopharyngeal microbiota at least early resilient to SARS-CoV-2 infection.

Published
2020

43. Gut microbiota during dietary restrictions: New insights in non-communicable diseases

Author

Rinninella, Emanuele, Cintoni, M., Raoul, P., Ianiro, Gianluca, Laterza, Lucrezia, Lopetuso, Loris Riccardo, Ponziani, Francesca Romana, Gasbarrini, Antonio, Mele, Maria Cristina, Rinninella E. (ORCID:0000-0002-9165-2367), Ianiro G. (ORCID:0000-0002-8318-0515), Laterza L., Lopetuso L. R., Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), Mele M. C. (ORCID:0000-0003-0153-5819), Rinninella, Emanuele, Cintoni, M., Raoul, P., Ianiro, Gianluca, Laterza, Lucrezia, Lopetuso, Loris Riccardo, Ponziani, Francesca Romana, Gasbarrini, Antonio, Mele, Maria Cristina, Rinninella E. (ORCID:0000-0002-9165-2367), Ianiro G. (ORCID:0000-0002-8318-0515), Laterza L., Lopetuso L. R., Ponziani F. R. (ORCID:0000-0002-5924-6238), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Mele M. C. (ORCID:0000-0003-0153-5819)

Abstract

In recent decades, there has been a growing interest in dietary restrictions for their promising effects on longevity and health span. Indeed, these strategies are supposed to delay the onset and burden of non-communicable diseases (NCDs) such as obesity, diabetes, cancer and neurological and gastrointestinal inflammatory diseases. At the same time, the gut microbiota has been shown to play a crucial role in NCDs since it is actively involved in maintaining gut homeostasis through its impact on nutrients metabolism, gut barrier, and immune system. There is evidence that dietary restrictions could slow down age-related changes in the types and numbers of gut bacteria, which may counteract gut dysbiosis. The beneficial effects on gut microbiota may positively influence host metabolism, gut barrier permeability, and brain functions, and subsequently, postpone the onset of NCDs prolonging the health span. These new insights could lead to the development of novel strategies for modulating gut microbiota with the end goal of treating/preventing NCDs. This review provides an overview of animal and human studies focusing on gut microbiota variations during different types of dietary restriction, in order to highlight the close relationship between gut microbiota balance and the host’s health benefits induced by these nutritional regimens.

Published
2020

44. Assessment of neurological manifestations in hospitalized patients with COVID-19

Author

Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), Scaldaferri F. (ORCID:0000-0001-8334-7541), Luigetti, Marco, Iorio, Raffaele, Bentivoglio, Anna Rita, Tricoli, Luca, Riso, Vittorio, Marotta, Jessica, Piano, Carla, Primiano, Guido Alessandro, Zileri Del Verme, L., Lo Monaco, Maria Rita, Calabresi, Paolo, Abbate, V., Acampora, N., Addolorato, G., Agostini, F., Ainora, M. E., Akacha, K., Amato, E., Andreani, F., Andriollo, G., Annetta, Maria Giuseppina, Annicchiarico, B. E., Antonelli, Massimo, Antonucci, G., Anzellotti, G. M., Armuzzi, A., Baldi, F., Barattucci, I., Barillaro, C., Barone, F., Bellantone, R. D. A., Bellieni, A., Bello, G., Benicchi, A., Benvenuto, F., Berardini, L., Berloco, F., Bernabei, R., Bianchi, A., Biasucci, D. G., Biasucci, L. M., Bibbo, S., Bini, A., Bisanti, A., Biscetti, F., Bocci, M. G., Bonadia, N., Bongiovanni, F., Borghetti, A., Bosco, G., Bosello, Silvia Laura, Bove, V., Bramato, G., Brandi, V., Bruni, T., Bruno, C., Bruno, D., Bungaro, M. C., Buonomo, A., Burzo, L., Calabrese, A., Calvello, M. R., Cambieri, A., Cambise, C., Camma, G., Candelli, M., Canistro, G., Cantanale, A., Capalbo, G., Capaldi, L., Capone, E., Capristo, E., Carbone, L., Cardone, S., Carelli, S., Carfi, A., Carnicelli, A., Caruso, C., Casciaro, F. A., Catalano, L., Cauda, R., Cecchini, A. L., Cerrito, L., Cesarano, M., Chiarito, A., Cianci, Rossella, Cicchinelli, S., Ciccullo, A., Cicetti, M., Ciciarello, F., Cingolani, A., Cipriani, M. C., Consalvo, M. L., Coppola, G., Corbo, G. M., Corsello, A., Costante, F., Costanzi, M., Covino, M., Crupi, D., Cutuli, S. L., D'Addio, S., D'Alessandro, A., D'Alfonso, M. E., D'Angelo, E., D'Aversa, F., Damiano, F., De Berardinis, G. M., De Cunzo, T., De Gaetano, D. K., De Luca, G., De Matteis, G., De Pascale, G., De Santis, P., De Siena, M., De Vito, F., Del Gatto, V., Del Giacomo, P., Del Zompo, F., Dell'Anna, A. M., Della, P. D., Di Gialleonardo, L., Di Giambenedetto, S., Di Luca, R., Di Maurizio, L., Di Muro, M., Dusina, A., Eleuteri, D., Esperide, A., Fachechi, D., Faliero, D., Falsiroli, C., Fantoni, M., Fedele, A., Feliciani, D., Ferrante, C., Ferrone, G., Festa, R., Fiore, M. C., Flex, A., Forte, E., Franceschi, Francesco, Francesconi, A., Franza, L., Funaro, B., Fuorlo, M., Fusco, D., Gabrielli, M., Gaetani, E., Galletta, C., Gallo, A., Gambassi, G., Garcovich, M., Gasbarrini, A., Gasparrini, I., Gelli, S., Giampietro, A., Gigante, L., Giuliano, G., Giupponi, B., Gremese, E., Grieco, Domenico Luca, Guerrera, M., Guglielmi, V., Guidone, C., Gulli, A., Iaconelli, A., Iafrati, A., Ianiro, Gianluca, Iaquinta, A., Impagnatiello, M., Inchingolo, R., Intini, E., Iorio, R., Izzi, I. M., Jovanovic, T., Kadhim, C., La Macchia, R., La Milia, D. I., Landi, F., Landi, G., Landi, R., Landolfi, R., Leo, M., Leone, P. M., Levantesi, L., Liguori, A., Liperoti, R., Lizzio, M. M., Lo Monaco Maria, R., Locantore, P., Lombardi, F., Lombardi, G., Lopetuso, L., Loria, V., Losito, A. R., Lucia, M. B. P., Macagno, F., Macerola, N., Maggi, G., Maiuro, G., Mancarella, F., Mangiola, F., Manno, A., Marchesini, D., Maresca, G. M., Marrone, G., Martis, I., Martone, A. M., Marzetti, Emanuele, Mattana, C., Matteo, M. V., Maviglia, R., Mazzarella, A., Memoli, C., Miele, Luca, Migneco, A., Mignini, I., Milani, A., Milardi, D., Montalto, M., Montemurro, G., Monti, F., Montini, Luca, Morena, T. C., Morra, V., Morretta, C., Moschese, D., Murace, C. A., Murdolo, M., Murri, Rita, Napoli, M., Nardella, E., Natalello, G., Natalini, D., Navarra, S. M., Nesci, A., Nicoletti, A., Nicoletti, R., Nicoletti, T. F., Nicolo, R., Nicolotti, N., Nista, E. C., Nuzzo, E., Oggiano, M., Ojetti, V., Pagano, F. C., Paiano, G., Pais, C., Pallavicini, F., Palombo, A., Paolillo, F., Papa, Alfredo, Papanice, D., Papparella, L. G., Paratore, M., Parrinello, G., Pasciuto, G., Pasculli, P., Pecorini, G., Perniola, S., Pero, E., Petricca, L., Petrucci, M., Picarelli, C., Piccioni, A., Piccolo, A., Piervincenzi, E., Pignataro, G., Pignataro, R., Pintaudi, G., Pisapia, L., Pizzoferrato, M., Pizzolante, F., Pola, R., Policola, C., Pompili, M., Pontecorvi, F., Pontecorvi, V., Ponziani, F., Popolla, V., Porceddu, E., Porfidia, A., Porro, L. M., Potenza, A., Pozzana, F., Privitera, G., Pugliese, D., Pulcini, G., Racco, S., Raffaelli, F., Ramunno, V., Rapaccini, G. L., Richeldi, Luca, Rinninella, Emanuele, Rocchi, S., Romano, B., Romano, S., Rosa, F., Rossi, L., Rossi, R., Rossini, E., Rota, E., Rovedi, F., Rubino, C., Rumi, G., Russo, A., Sabia, L., Salerno, A., Salini, S., Salvatore, L., Samori, D., Sandroni, Claudio, Sanguinetti, M., Santarelli, L., Santini, P., Santolamazza, D., Santoliquido, A., Santopaolo, F., Santoro, M. C., Sardeo, F., Sarnari, C., Saviano, A., Saviano, L., Scaldaferri, Franco, Scarascia, R., Schepis, T., Schiavello, F., Scoppettuolo, G., Sedda, D., Sessa, F., Sestito, L., Settanni, C., Siciliano, M., Siciliano, V., Sicuranza, R., Simeoni, B., Simonetti, J., Smargiassi, A., Soave, P. M., Sonnino, C., Staiti, D., Stella, C., Stella, L., Stival, E., Taddei, E., Talerico, R., Tamburello, E., Tamburrini, E., Tanzarella, E. S., Tarascio, E., Tarli, C., Tersali, A., Tilli, P., Timpano, J., Torelli, E., Torrini, F., Tosato, M., Tosoni, A., Tricoli, L., Tritto, M., Tumbarello, M., Tummolo, A. M., Vallecoccia, M. S., Valletta, F., Varone, F., Vassalli, F., Ventura, G., Verardi, L., Vetrone, L., Vetrugno, G., Visconti, E., Visconti, F., Viviani, A., Zaccaria, R., Zaccone, C., Zelano, L., Zileri Dal Verme, L., Zuccala, G., Luigetti M. (ORCID:0000-0001-7539-505X), Iorio R. (ORCID:0000-0002-6270-0956), Bentivoglio A. R. (ORCID:0000-0002-9663-095X), Tricoli L., Riso V., Marotta J., Piano C., Primiano G., Lo Monaco M. R. (ORCID:0000-0002-1457-7981), Calabresi P. (ORCID:0000-0003-0326-5509), Annetta M. G. (ORCID:0000-0001-7574-1311), Antonelli M. (ORCID:0000-0003-3007-1670), Bosello S. (ORCID:0000-0002-4837-447X), Cianci R. (ORCID:0000-0001-5378-8442), Franceschi F. (ORCID:0000-0001-6266-445X), Grieco D. L. (ORCID:0000-0002-4557-6308), Ianiro G. (ORCID:0000-0002-8318-0515), Marzetti E. (ORCID:0000-0001-9567-6983), Miele L. (ORCID:0000-0003-3464-0068), Montini L. (ORCID:0000-0003-4602-5134), Murri R. (ORCID:0000-0003-4263-7854), Papa A. (ORCID:0000-0002-4186-7298), Richeldi L. (ORCID:0000-0001-8594-1448), Rinninella E. (ORCID:0000-0002-9165-2367), Sandroni C. (ORCID:0000-0002-8878-2611), and Scaldaferri F. (ORCID:0000-0001-8334-7541)

Abstract

Background and purpose: The objective of this study was to assess the neurological manifestations in a series of consecutive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive patients, comparing their frequency with a population hospitalized in the same period for flu/respiratory symptoms, finally not related to SARS-CoV-2. Methods: Patients with flu/respiratory symptoms admitted to Fondazione Policlinico Gemelli hospital from 14 March 2020 to 20 April 2020 were retrospectively enrolled. The frequency of neurological manifestations of patients with SARS-CoV-2 infection was compared with a control group. Results: In all, 213 patients were found to be positive for SARS-CoV-2, after reverse transcriptase polymerase chain reaction on nasal or throat swabs, whilst 218 patients were found to be negative and were used as a control group. Regarding central nervous system manifestations, in SARS-CoV-2-positive patients a higher frequency of headache, hyposmia and encephalopathy always related to systemic conditions (fever or hypoxia) was observed. Furthermore, muscular involvement was more frequent in SARS-CoV-2 infection. Conclusions: Patients with COVID-19 commonly have neurological manifestations but only hyposmia and muscle involvement seem more frequent compared with other flu diseases.

Published
2020

45. Common issues in the management of patients in the waiting list and after liver transplantation

Author

Burra, P, Belli, L, Ginanni, Corradini, S, Volpes, R, Marzioni, M, Giannini, E, Toniutto, P, Carrai, P, Donato, F, Lanza-Galeota, A, Martini, S, Pasulo, L, Ponziani, F, Russo, F, Coppola, C, Forte, P, Mazzarelli, C, Merli, M, Montalbano, M, Picciotto, F, Rendina, M, Zanetto, A, Angeli, P, Foschi, F, Manini, M, Marzano, A, Perricone, G, Pianta, P, Tamè, M, De Maria, N, Domenicali, M, Ottobrelli, A, Picciotto, A, Ponti, L, Vizzini, G, Corradini, S, Bhoori, S, Ferri, F, Gaffuri, G, Lenci, I, Mameli, L, Morelli, M, and Piras, M. R.

Subjects
medicine.medical_specialty, Alcoholic liver disease, DAAs, HBV recurrence, Immunosuppression, Liver transplantation, Antiviral Agents, Hepatitis C, Chronic, Humans, Italy, Liver Diseases, Alcoholic, Recurrence, Societies, Medical, Disease Management, Liver Transplantation, Waiting Lists, Hepatology, Gastroenterology, medicine.medical_treatment, 030230 surgery, 03 medical and health sciences, 0302 clinical medicine, Medical, Internal medicine, medicine, In patient, Chronic, Disease management (health), business.industry, Liver Diseases, General surgery, Hcv recurrence, Evidence-based medicine, Alcoholic, medicine.disease, Hepatitis C, surgical procedures, operative, Waiting list, 030211 gastroenterology & hepatology, Societies, business
Abstract

The present document contains the recommendations of an expert panel of transplant hepatologists, appointed by the Italian Association for the Study of the Liver (AISF), on how to manage the most common aspects of liver transplantation: the topics covered include: new treatments for HCV in patients on the waiting list for liver transplantation; antiviral treatments in patients with HCV recurrence after liver transplantation; prophylaxis for HBV recurrence after liver transplantation; indications for liver transplantation in alcoholic liver disease; and Immunosuppressive therapy. The statements on each topic were approved by participants at the AISF Transplant Hepatologist Expert Meeting (organized by the Permanent Committee on Liver Transplantation in Mondello on 4–5 October 2015), and are graded according to the Oxford classification of levels of evidence.

Published
2017

46. Critical analysis of major and ancillary features of LI-RADS v2018 in the differentiation of small (< 2 cm) hepatocellular carcinoma from dysplastic nodules with gadobenate dimeglumine-enhanced magnetic resonance imaging

Author

De Gaetano, Anna Maria, Catalano, M., Pompili, Maurizio, Marinp, M. G., Rodriguez Carnero, P., Gulli, C., Infante, A., Iezzi, Roberto, Ponziani, Francesca Romana, Cerrito, Lucia, Marrone, Giuseppe, Giuliante, Felice, Ardito, Francesco, Rapaccini, Gian Ludovico, Vecchio, Fabio Maria, Giraldi, Luca, Manfredi, Riccardo, De Gaetano A. M. (ORCID:0000-0002-7493-9462), Pompili M. (ORCID:0000-0001-6699-7980), Iezzi R. (ORCID:0000-0002-2791-481X), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerrito L., Marrone G., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Vecchio F. M. (ORCID:0000-0002-9197-2264), Giraldi L., Manfredi R. (ORCID:0000-0002-4972-9500), De Gaetano, Anna Maria, Catalano, M., Pompili, Maurizio, Marinp, M. G., Rodriguez Carnero, P., Gulli, C., Infante, A., Iezzi, Roberto, Ponziani, Francesca Romana, Cerrito, Lucia, Marrone, Giuseppe, Giuliante, Felice, Ardito, Francesco, Rapaccini, Gian Ludovico, Vecchio, Fabio Maria, Giraldi, Luca, Manfredi, Riccardo, De Gaetano A. M. (ORCID:0000-0002-7493-9462), Pompili M. (ORCID:0000-0001-6699-7980), Iezzi R. (ORCID:0000-0002-2791-481X), Ponziani F. R. (ORCID:0000-0002-5924-6238), Cerrito L., Marrone G., Giuliante F. (ORCID:0000-0001-9517-8220), Ardito F. (ORCID:0000-0003-1596-2862), Rapaccini G. L. (ORCID:0000-0002-6467-857X), Vecchio F. M. (ORCID:0000-0002-9197-2264), Giraldi L., and Manfredi R. (ORCID:0000-0002-4972-9500)

Abstract

OBJECTIVE: To evaluate the performance of major features, ancillary features, and categories of Liver Imaging Reporting and Data System (LI-RADS) version 2018 at magnetic resonance (MR) imaging in the differentiation of small hepatocellular carcinoma (HCC) from dysplastic nodules (DNs). PATIENTS AND METHODS: This retrospective study included cirrhotic patients with pathologically proven untreated HCCs and DNs (< 2 cm) and liver MR imaging performed with gadobenate dimeglumine contrast agent within 3 months before pathological analysis, between 2015 and 2018. 37 patients with 43 observations (17 HCCs and 26 DNs) met the inclusion criteria. Two radiologists assessed major and ancillary imaging features for each liver observation and assigned a LI-RADS v2018 category in consensus. Estimates of diagnostic performance of major features, ancillary features, and LI-RADS categories were assessed based on their sensitivity, specificity, positive (PPV), and negative predictive values (NPV). RESULTS: Major features (nonrim arterial phase hyperenhancement, nonperipheral "washout", and enhancing "capsule") had a sensitivity of 94.1%, 88.2%, and 41.2%, and a specificity of 57.7%, 42.3%, and 88.5% for HCC, respectively. Ancillary features (hepatobiliary phase hypointensity, mild-moderate T2 hyperintensity, restricted diffusion, and fat in the lesion more than adjacent liver) had a sensitivity of 94.1%, 64.7%, 58.8%, and 11.8%, and a specificity of 26.9%, 61.5%, 65.4%, and 76.9% for HCC, respectively. The LR-5 category (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 88.2% at both evaluations and a specificity of 76.9% and 80.8% for HCC, respectively. The combination of LR-4, LR-5 categories (determined by using major features only vs. the combination of major and ancillary features) had a sensitivity of 94.1% at both interpretations and a specificity of 65.4% and 26.9% for HCC, respectively. The use of ancillary

Published
2019

47. Late reactivation of hepatitis B virus after rituximab-containing chemotherapy for mantle cell lymphoma: a case report

Author

Ciccullo, A., Ponziani, Francesca Romana, Maiolo, E., Pallavicini, Federico, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Pallavicini F. (ORCID:0000-0001-6874-0302), Pompili M. (ORCID:0000-0001-6699-7980), Ciccullo, A., Ponziani, Francesca Romana, Maiolo, E., Pallavicini, Federico, Pompili, Maurizio, Ponziani F. R. (ORCID:0000-0002-5924-6238), Pallavicini F. (ORCID:0000-0001-6874-0302), and Pompili M. (ORCID:0000-0001-6699-7980)

Abstract

Background: Hepatitis B virus (HBV) reactivation is commonly observed in HBsAg-positive hematologic patients undergoing immunosuppressive chemotherapy. Recent guidelines recommend antiviral prophylaxis to be continued for up to 12 months after the discontinuation of the anticancer regimen. Case Presentation: We report a case of a patient who underwent antiviral prophylaxis for 26 months after the discontinuation of a rituximab-containing chemotherapy regimen for a lymphoma and was admitted in the infectious diseases department with a 3-day history of jaundice, itching, and dark urine. After excluding other possible causes of acute liver damage, HBV reactivation was suspected. HBV-DNA was 4497000 IU/mL. Following reintroduction of entecavir, we observed a steady decline of ALT, AST, bilirubin and HBV-DNA serum levels, with a rapid resolution of acute hepatitis and an improvement in clinical conditions; one year after the event of HBV reactivation and beginning of antiviral therapy, the patient was virologically suppressed. Discussion: Our study demonstrates that the risk of HBV reactivation in HBsAg-positive patients with undetectable HBV-DNA can occur even after three years from the last administration of rituximab and several months after the withdrawal of prophylactic antiviral therapy in patients with hematological malignancies. This implies that a close monitoring of HBV-related markers including HBV-DNA must continue after the withdrawal of prophylactic NA therapy.

Published
2019

48. OC.05.5 ALTERATION IN THE ABUNDANCE OF AKKERMANSIA MUCINIPHILA IS ASSOCIATED TO GASTROINTESTINAL AND EXTRA-INTESTINAL DISEASES: TOWARDS THE IDENTIFICATION OF SPECIFIC MICROBIAL SIGNATURES OF DISEASE

Author

Lopetuso, L.R., primary, Quagliariello, A., additional, Schiavoni, M., additional, Petito, V., additional, Ponziani, F., additional, Cammarota, G., additional, Putignani, L., additional, Scaldaferri, F., additional, and Gasbarrini, A., additional

Published
2019
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49. A novel ultrasound-based vascular calcification score (CALCS) to detect subclinical atherosclerosis

Author

Flore, Roberto Antonio, Zocco, Maria Assunta, Ainora, Maria Elena, Fonnesu, C., Nesci, Domenico Arturo, Gasbarrini, Antonio, Ponziani, Francesca Romana, Flore R. (ORCID:0000-0003-1659-1338), Zocco M. A. (ORCID:0000-0002-0814-9542), Ainora M. E., Nesci A. (ORCID:0000-0001-9466-1755), Gasbarrini A. (ORCID:0000-0002-7278-4823), Ponziani F. R. (ORCID:0000-0002-5924-6238), Flore, Roberto Antonio, Zocco, Maria Assunta, Ainora, Maria Elena, Fonnesu, C., Nesci, Domenico Arturo, Gasbarrini, Antonio, Ponziani, Francesca Romana, Flore R. (ORCID:0000-0003-1659-1338), Zocco M. A. (ORCID:0000-0002-0814-9542), Ainora M. E., Nesci A. (ORCID:0000-0001-9466-1755), Gasbarrini A. (ORCID:0000-0002-7278-4823), and Ponziani F. R. (ORCID:0000-0002-5924-6238)

Abstract

OBJECTIVE: To quantify non-coronary vascular calcifications (VC) in asymptomatic patients at low-intermediate cardiovascular risk by a new color Doppler ultrasound (DUS)-based score (the carotid, aortic, lower limbs calcium score, CALCs), and to correlate this score with classical parameters associated with cardiovascular risk [carotid intima media thickness (IMT), and arterial stiffness (AS)].PATIENTS AND METHODS: All consecutive asymptomatic patients who underwent a screening DUS of non-coronary circulation were evaluated and patients at low-intermediate cardiovascular risk were selected according to Framingham risk score (FRS).Among them, we enrolled 70 patients with US evidence of VC and 71 age, sex and FRS matched controls. The presence of VC was correlated with classical markers of cardiovascular risk, such as AS and intima-media thickness (IMT). AS, expressed as pulse wave velocity (PWV) and arterial distensibility, carotid IMT and CALCs were measured for both groups. AS and c-IMT were assessed by a new Radio-Frequency (RF) DUS-based method. CALCs was generated by our previously described B-mode DUS-based method according to number/size of VC in 11 non-coronary segments (range 0-33).RESULTS: Patients with VC presented higher AS and IMT values than controls (PWV 8.34 +/- 0.98 m/s vs. 6.74 +/- 0.68 m/s, p<0.0001; arterial distensibility 267 12 mm vs. 315 65 mm, p=0.001; IMT 687 132 mm vs. 572 91 mm, p<0.0001). Mean CALCs of patients with VC was 8.41 +/- 7.78. CALCs were significantly correlated with c-IMT (p<0.0001; r=0.3), PWV (p<0.0001; r=0.4) and arterial distensibility (p=0.002; r=-0.1).CONCLUSIONS: DUS-based CALCs is highly correlated with other validated markers of sub clinical atherosclerosis, such as c-IMT and AS. Our results demonstrated the ability of CALCs to identify individual predictive factors beyond the traditional risk factors by quantifying an interesting and novel step of the atherogenic pro cess. Future studies on larger series a

Published
2018

50. Gut microbiota and aging

Author

Mangiola, F, Nicoletti, Alberto, Gasbarrini, Antonio, Ponziani, F R, Nicoletti, A, Gasbarrini, A (ORCID:0000-0002-7278-4823), Mangiola, F, Nicoletti, Alberto, Gasbarrini, Antonio, Ponziani, F R, Nicoletti, A, and Gasbarrini, A (ORCID:0000-0002-7278-4823)

Abstract

n/a

Published
2018

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