Erythrocyte deformability and hemorheological profile in multiple myeloma.

The hemorheological profile in multiple myeloma (MM) has been extensively studied. Our investigation regarded the behavior of whole-blood viscosity, plasma viscosity and erythrocyte deformability in MM. We enrolled 24 MM patients; 13 of them had been recently diagnosed and were at the initial stage of therapy, 6 were on consolidation/conservation therapy and 5 had achieved a complete remission. On fasting venous blood we evaluated whole-blood and plasma viscosity at high and low shear rates, haematocrit, the ratios between whole-blood viscosity (at high and low shear rate) and haematocrit×100, the ratio between plasma viscosity at low and high shear rate and the erythrocyte deformability examined by using laser diffractometry and expressed as elongation index. A significant increase in plasma viscosity at low shear rate and a marked decrease in haematocrit were observed in MM patients compared with normal controls. Also the ratio between the high shear rate whole-blood viscosity and haematocrit ×100 and the ratio between the low and high shear rate plasma viscosity were significantly increased in MM patients. A significant decrease in erythrocyte deformability, especially at low shear stresses, was found. We discuss some hypotheses that might explain the behavior of red blood cell deformability in MM, considering that its impairment, in addition to the increase of plasma viscosity, can alter the microcirculatory flow in these patients.

Hemorheological parameters in Monoclonal Gammopathy of Undetermined Significance (MGUS).

There is scarcity of information about the hemorheological pattern in subjects with Monoclonal Gammopathy of Undetermined Significance (MGUS). This preliminary research is focused on the behaviour of whole-blood and plasma viscosity, haematocrit and erythrocyte deformability in the above clinical condition. We enrolled 21 MGUS subjects (10 women and 11 men; mean age 66.4 ± 11.6 years). In fasting venous blood we examined whole-blood and plasma viscosity at high and low shear rates, haematocrit, the ratios between whole-blood viscosity (at high and low shear rate) and haematocrit × 100, the ratio between plasma viscosity at low and high shear rate, and the erythrocyte deformability expressed as elongation index. By comparing normal controls to MGUS subjects a significant increase in whole-blood viscosity at high shear rate and in plasma viscosity at low shear rate were observed. In MGUS subjects the ratios between the high and low shear rate blood viscosity and haematocrit × 100, as well as the ratio between the low and high shear rate plasma viscosity were significantly higher. In MGUS subjects a marked decrease in erythrocyte deformability was also observed. The alteration of the hemorheological profile found in these subjects might be involved in the pathogenesis of thromboembolic events, which occur with a high frequency in MGUS.

Behaviour of the neutrophil to lymphocyte ratio in young subjects with acute myocardial infarction.

In the last years the neutrophil to lymphocyte ratio (NLR) has been examined in cardiovascular disorders and in particular in coronary artery disease and acute myocardial infarction (AMI). Now we examined this parameter in subjects with juvenile myocardial infarction at the initial stage and after 3 and 12 months. We enrolled 123 young subjects (112 men and 11 women, mean age 39.4 ± 5.8 yrs) with AMI. The time interval between the AMI onset and the investigation was 13 ± 7 days. The mean value of NLR observed in young AMI subjects was significantly increased compared to normal controls (N = 1.817 ± 0.711; young AMI subjects = 2.376 ± 0.873, p <  0.0001). NLR does not discriminate STEMI (2.427 ± 0.878) and non STEMI (2.392 ± 0.868) or diabetics (2.604 ± 1.000) and non diabetics (2.324 ± 0.853), but it differentiates smokers (2.276 ± 0.853) and non smokers (2.837 ± 1.072). NLR at the initial stage is not correlated with the number of cardiovascular risk factors or with the extent of the coronary disease. In this study we found a significant decrease of neutrophil count at 3 and 12 months later AMI without any significant variation of lymphocyte and consequently we observed a decrease in NLR at these two intervals of time in comparison with the initial stage. Despite some limitations present in this study, it is interesting to underline that also in juvenile myocardial infarction this low-cost haematological marker may be considered together with other inflammatory indicators.

Nitric oxide metabolites (nitrite and nitrate) in several clinical condition.

We determined the concentration of nitric oxide metabolites (NO2-+NO3-), expressed as NOx, in several clinical conditions. Regarding this, we have examined 25 subjects with arterial hypertension, 41 subjects with chronic kidney disease in conservative treatment, 106 subjects with metabolic syndrome subdivided according to the presence (n = 43) or not (n = 63) of diabetes mellitus, 48 subjects with obstructive sleep apnea syndrome (OSAS), 14 women with systemic sclerosis complicated with Raynaud's phenomenon, 42 dialyzed subjects and 105 young subjects with acute myocardial infarction (AMI). In subjects with arterial hypertension, chronic kidney disease, metabolic syndrome, systemic sclerosis, as well as, in dialyzed and AMI subjects, we found at baseline a NOx increase. In dyalized subjects after a standard dialysis session, we observed a decrease in NOx. The increase in NOx in juvenile AMI was significantly influenced by cigarette smoking and less by cardiovascular risk factors and the extent of coronary lesions; at 3 and 12 months later than the initial event, we observed a decrease of NOx that remains significantly higher than the control group. In subjects with OSAS no difference in NOx was noted in comparison with normal controls, although their subdivision according to the apnea/hypopnea index operates a clear distinction regarding NOx concentration.

Myocardial infarction in young adults: risk factors, clinical characteristics and prognosis according to our experience.

OBJECTIVES: Myocardial infarction is a relatively unusual phenomenon in young subjects. The aim if this work is to characterize the risk profile and factors influencing outcomes of these patients since it makes possible to manage prevention interventions. PATIENTS AND METHODS: We examined cardiovascular risk factors, clinical presentation, angiographic picture and outcome of a group of young patients hospitalized for a myocardial infarction. We enrolled 121 young patients consecutively admitted to our hospital for a myocardial infarction and examined them not only at the initial stage, but also after 3 months and one year; finally a long-term telephonic follow up was performed, when possible. RESULTS: We found some peculiarity making these patients quite different from the older ones who develop a myocardial infarction: cigarettes smoking, family history of ischemic heart disease and hyperlipidemia were the most frequent cardiovascular risk factors, while diabetes and hypertension were less represented; moreover coronary angiography showed more frequently a less extensive coronary atherosclerosis. Patients who developed a cardiovascular event at follow-up presented a significantly higher prevalence of hypertension and obesity and a significantly lower frequency of healthy coronary arteries and of previous revascularization. CONCLUSIONS: Myocardial infarction in young adults presents several peculiarities, represented not only by the risk profile, but also by the angiographic picture and the prognosis. Considering the long life expectancy of the involved population, the essential role of preventive interventions should be strongly underlined.

Chronic renal failure: oxidative stress, endothelial dysfunction and wine.

Atherosclerosis development is accelerated in chronic renal failure (CRF) and is the major cause of death in this clinical condition. An increased oxidative stress and an endothelial dysfunction, with their complex interrelationships, are relevant aspects of atherogenesis in CRF patients and might be targets for treatment. Many studies have underlined the cardiovascular protection provided by a moderate wine consumption. This beneficial effect is due to both alcohol and nonalcoholic components of wine including several phenolic molecules such as quercetin and resveratrol. Wine polyphenols have antioxidant properties and favorably influence endothelial function, in particular by stimulating nitric oxide-mediated vasodilation and inhibiting the endothelin-1 pathway. The possible advantage of a moderate wine consumption in CRF patients can be hypothesized and deserves clinical investigation.

Wine and endothelial function.

In recent years many studies have focused on the well-known relationship between wine consumption and cardiovascular risk. Wine exerts its protective effects through various changes in lipoprotein profile, coagulation and fibrinolytic cascades, platelet aggregation, oxidative mechanisms and endothelial function. The last has earned more attention for its implications in atherogenesis. Endothelium regulates vascular tone by a delicate balancing among vasorelaxing (nitric oxide [NO]) and vasoconstrincting (endothelins) factors produced by endothelium in response to various stimuli. In rat models, wine and other grape derivatives exerted an endothelium-dependent vasorelaxing capacity especially associated with the NO-stimulating activity of their polyphenol components. In experimental conditions, reservatrol (a stilbene polyphenol) protected hearts and kidneys from ischemia-reperfusion injury through antioxidant activity and upregulation of NO production. Wine polyphenols are also able to induce the expression of genes involved in the NO pathway within the arterial wall. The effects of wine on endothelial function in humans are not yet clearly understood. A favorable action of red wine or dealcoholized wine extract or purple grape juice on endothelial function has been observed by several authors, but discrimination between ethanol and polyphenol effects is controversial. It is, however likely that regular and prolonged moderate wine drinking positively affects endothelial function. The beneficial effects of wine on cardiovascular health are greater if wine is associated with a healthy diet. The most recent nutritional and epidemiologic studies show that the ideal diet closely resembles the Mediterranean diet.

Granulocyte integrins before and after activation in acute ischaemic stroke.

We examined in 19 subjects with acute ischaemic stroke (AIS) the PMN integrin pattern (CD11a, CD11b, CD11c, CD18), using indirect immunofluorescence and adopting a flow cytometer, at baseline and during activation, prolonged for 5 and 15 min, with 4-phorbol 12-myristate 13-acetate (PMA). At baseline, an increase in the expression of CD11c and CD18 and a decrease in the CD11b were evident in AIS subjects compared to normals. After activation, we found in normals a constant and significant increase of all PMN adhesive molecules, while in AIS subjects, we found an increase in CD11b and CD18, a decrease in CD11a and no variation in CD11c. While the basal upregulation of CD11c and CD18 may depend on the PMN spontaneous activation or on the increase of cytokines, the decrease of CD11b may be due to its self-consumption. After activation, the decrease in CD11a noted in AIS may be related to its cleavage or to an altered integrin phosphorylation/dephosphorylation balance.

Essential hypertension: leukocyte rheology and polymorphonuclear cytosolic Ca2+ content at baseline and after activation.

In 24 hypertensives we evaluated, at baseline, the leukocyte filtration parameters (using the St. George's Filtrometer), polymorphonuclear (PMN) membrane fluidity (with the fluorescent probe 1-[4-(trimethylamino)phenyl]-6-phenyl-1,3,5-hexatriene [TMA-DPH]) and PMN cytosolic Ca2+ content (with the fluorescent probe Fura 2-AM). In a subgroup of hypertensives (n = 17) the PMN filtration parameters, PMN membrane fluidity and cytosolic Ca2+ content were evaluated after in vitro chemotactic activation (prolonged for 5 and 15 min) with two stimulating agents (4-phorbol 12-myristate 13-acetate [PMA] and N-formyl-methionyl-leucyl-phenylalanine [fMLP]). It was evident, from the baseline data, that there was a significant difference in the mononuclear (MN) initial relative flow rate (IRFR), clogging rate (CR) and clogging particles (CP), and in PMN cytosolic Ca2+ content. There were, however, no differences in the filtration parameters of unfractionated leukocytes and PMNs or in PMN membrane fluidity. After activation, in normals and in hypertensives, a significant variation in PMN filtration parameters was evident. In normals no variation was present in PMN membrane fluidity or cytosolic Ca2+ content after activation. In hypertensives, however, we found an increase solely in PMN cytosolic Ca2+ content after fMLP activation. After PMN activation (at 15 min) one parameter (IRFR) of PMN filtration distinguished normal subjects from hypertensives. No difference between the two groups was found in PMN membrane fluidity or PMN cytosolic Ca2+ content after PMN activation.

Exercise test: trend of the leukocyte flow properties, polymorphonuclear membrane fluidity and cytosolic Ca2+ content in normals, in subjects with previous acute myocardial infarction and in subjects with aortocoronary by-pass.

We evaluated, during an exercise test, the leukocyte flow properties, the polymorphonuclear leukocyte (PMN) membrane fluidity and PMN cytosolic Ca2+ content in normals, in subjects with previous acute myocardial infarction (AMI) and in subjects previously submitted to a aortocoronary by-pass. Leukocyte flow properties were evaluated using the St. George filtrometer. Examination of the PMN membrane fluidity was effected employing the probe TMA-DPH; while evaluation of the PMN cytosolic Ca2+ content was carried out using the probe Fura 2-AM. At baseline, in both cardiopathic groups a significant difference in PMN filtration parameters and in PMN cytosolic Ca2+ content was evident compared to normals. In normals, at peak of exercise, there was an evident reduction of mononuclear filtration parameters, while during recovery a slight increase of the PMN cytosolic Ca2+ content was observed. In subjects with previous AMI and in subjects with aortocoronary by-pass, however, we observed, at peak of exercise, a decrease of the mononuclear filtration parameters, a reduction of the PMN membrane fluidity and an increase of the PMN cytosolic Ca2+ content. In both groups, the changes in PMN membrane fluidity and cytosolic Ca2+ content remained during recovery. The trend of the PMN membrane fluidity and cytosolic Ca2+ content found in the cardiopathic subjects during the exercise test suggest the PMN activation may be more evident in these subjects.

Behavior of the polymorphonuclear leukocyte membrane fluidity and cystolic Ca2+ content in vascular atherosclerotic disease with and without non-insulin-dependent diabetes mellitus.

In 71 subjects with vascular atherosclerotic disease (VAD), in 32 VAD subjects with non-insulin-dependent diabetes mellitus (NIDDM) and in 31 normal controls, we evaluated polymorphonuclear leukocyte (PMN) membrane fluidity and PMN cytosolic Ca2+ content. The PMN membrane fluidity was obtained by marking intact and unstimulated PMN cells with fluorescent probe 1-[4-(trimethylamino)phenyl]-6-phenyl-1,3,5-hexatriene (TMA-DPH) and the PMN cytosolic Ca2+ content was obtained by marking intact and unstimulated PMN cells with the fluorescent probe Fura 2-AM. From the obtained results, it is evident that PMN membrane fluidity does not differentiate normals from VAD subjects and VAD subjects with NIDDM, and normals from subjects with monovascular disease (MVAD) and polyvascular disease (PVAD) with and without NIDDM. The PMN cytosolic Ca2+ content is significantly increased in VAD subjects and VAD subjects with NIDDM, and also in MVAD and PVAD subjects with and without NIDDM. A positive correlation is present between PMN membrane fluidity and PMN cytosolic Ca2+ content in normals and VAD subjects, but not in VAD subjects with NIDDM. In conclusion, in VAD subjects with and without NIDDM, an increase of the PMN cytosolic Ca2+ content is present; this increase might be related to the PMN spontaneous activation.

[Physiopathological aspects of secondary hyperuricemia]. / Aspetti fisiopathologici delle iperuricemie secondarie.

Secondary hyperuricaemia expresses a heterogeneous group of clinical conditions generally classified according to the pathogenetic criteria. Hyperuricaemia can depend on an increased production, reduced renal excretion or on the combination of both. Myelo and lymphoproliferative diseases are clinically prevalent among the conditions accompanying this overproduction. The most frequent causes of reduced uric acid excretion are chronic renal failure and diuretic treatment. In recent years, several conditions of hyperuricaemia with mixed pathogenesis have revealed a common mechanism connected to the ATP cellular depletion.