Linking pathogenic and likely pathogenic gene variants to long-COVID symptoms.

OBJECTIVE: Long-COVID is a clinical syndrome characterized by the presence of symptoms related to SARS-CoV-2 infection that persist for at least four weeks after recovery from COVID-19. Genetics have been proposed to play an important role in long-COVID syndrome onset. This study aimed to identify genetic pathogenetic and likely pathogenetic causative variants of Mendelian genetic diseases in patients with Long-COVID syndrome. Additionally, we aimed to establish an association between these genetic variants and the clinical symptoms manifested during long-COVID syndrome. PATIENTS AND METHODS: 95 patients affected by long-COVID syndrome were analyzed with a Next-Generation Sequencing (NGS) panel comprising 494 genes. The analyzed genes and the symptoms of the patients collected with an ad-hoc questionnaire were divided into four groups (cardiological, respiratory, immunological, and neurological). Finally, a statistical analysis comprising descriptive statistics, classification based on reported symptoms, and comparative analysis against a control group of healthy individuals was conducted. RESULTS: 12 patients resulted positive for genetic testing with an autosomal dominance (8) or autosomal recessive (4) inheritance, showing a higher prevalence of cardiovascular genetic diseases (9) in the analyzed cohort compared to the normal population. Moreover, the onset of the long-COVID syndrome and its cardiovascular manifestations was compliant with the onset reported in the literature for the identified genetic diseases, suggesting that COVID-19 could manifest late-onset genetic diseases associated with their appearance. Apart from the 12 positive patients, 57 were healthy carriers of genetic diseases. Analyzing the whole cohort, a statistical correlation between prevalent symptomatology and the gene class was established, suggesting an association between the genetic susceptibility of an individual and the possibility of developing specific long-COVID syndrome symptoms, especially cardiovascular symptoms. Furthermore, 17 genetic variants were identified in CFTR. Finally, we identified genetic variants in IFNAR2 and POLG, supporting their respective involvement in inflammation and mitochondria mechanisms, correlated with long-COVID syndrome according to literature data. CONCLUSIONS: This study proposed COVID-19 to act as a manifest of underlying late-onset genetic diseases Mendelian associated with carrier status. Moreover, according to our results, mutations in cardiological genes are more present in patients who show cardiological symptoms during the syndrome. This underscores the necessity for cardiological investigation and genetic screening in long-COVID patients to address existing or potential clinical implications.

Serum proteomic profiling reveals potential inflammatory biomarkers in long-COVID patients: a comparative analysis with healthy controls.

OBJECTIVE: The highly transmissible severe acute respiratory syndrome-Coronavirus-2 was responsible for the 2020 COVID-19 pandemic. COVID-19 mostly affects the respiratory system; however, this infection also affects several other organs. In addition, the sequelae of this disease affect patients for several months after recovery, resulting in long-COVID syndrome. PATIENTS AND METHODS: In order to characterize the differences between healthy control individuals and long-COVID patients, proteomic profiling of the serum of both groups was performed by mass spectrometry. The obtained data were analyzed with multivariate and univariate statistical analyses. RESULTS: Initially, performing a partial latent square discriminant analysis (PLS-DA) made it possible to identify thirty-three proteins of interest, which were then subjected to a receiver operating characteristic (ROC) analysis. Four proteins were identified as potential stand-alone biomarkers: Sirtuin 1, Natriuretic Peptide B, Hemopexin, and Arachidonate 5-Lipoxygenase. Moreover, a multivariate ROC analysis identified a panel of biomarkers composed of Natriuretic Peptide B, Anterior Gradient 2 Protein, Adiponectin, Endothelin Converting Enzyme 1, Interferon Induced Transmembrane Protein 1, Mannose Binding Lectin 2, Prostaglandin-Endoperoxide Synthase 2, Pirin, Prostaglandin Reductase 1 and Cystatin C. CONCLUSIONS: The identified biomarkers are associated with inflammatory processes, corroborating literature evidence that long-COVID patients develop an inflammatory state that damages many tissues. Nevertheless, these data should be validated in a larger cohort.

Cesium and iodine release from fluoride-based molten salt reactor fuel.

Cesium and iodine, which are formed during a fission process in a nuclear reactor, are considered as major fission products responsible for the environmental burden in case of a nuclear accident. From the safety point of view, it is thus important to understand their release mechanism when overheating of the reactor core occurs. This work presents an experimental investigation of the behaviour of caesium iodide and caesium fluoride in fluoride based molten salt reactor fuel during high temperature events. It has been demonstrated that CsF will be retained in the fuel salt and thus its volatility will be significantly reduced, while CsI will not dissolve in the fluoride-based fuel matrix and will thus remain more volatile. The influence of the presence of CsI and CsF on the melting behaviour of the fuel has been investigated using calorimetry, revealing their negligible effects.

Effects of vineyard soil management on the characteristics of soils and roots in the lower Oltrepò Apennines (Lombardy, Italy).

Cultivation of grapevines in sloping soils is very widespread all over the world, representing also fundamental branch of local economy of several hilly areas. Vineyards can be managed in different ways. Agronomical practices in inter-rows can be significantly different and may influence deeply the soil properties and the grapevine root development. Therefore, this paper aimed to analyze the effects of different management practices of inter-rows. We focused on the traditional agricultural techniques of tillage and permanent grass mulching as well as the alternation of these two practices between adjacent inter-rows, in terms of: i) soil physical properties; ii) soil hydrological properties; iii) root density; iv) root mechanical properties and root reinforcement; as well as v) biodiversity. The research was conducted in several test-sites of Oltrepò Pavese (Lombardy region, north-western Italy), one of the most important Italian zones for wine production in northern Italian Apennines. Among the examined soil properties, hydraulic conductivity was the most influenced soil property by different soil management practices. The absence of soil tillage allowed to increase superficial (first 0.2 m of soil) hydraulic conductivity, as a consequence of higher macroporosity and amount in organic matter. Vineyards with alternation management (grass mulching together with tillage) of inter-rows had the highest root density and the strongest root reinforcement, of up to 45% in comparison to permanent grass cover, and up to 67-73% in comparison to tilled vineyards. Soil microarthropod communities had more complexity where sustainable agricultural practices (permanent grass cover; alternation management of the inter-rows) were applied. The results of this study yielded important information to establish effective management practices of vineyards such as conserving organic matter and reducing slope instabilities by a better development of root apparatus in the soil.

Genetic evaluation of AMPD1, CPT2, and PGYM metabolic enzymes in patients with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is a disease that can seriously impair one's quality of life; patients complain of excessive fatigue and myalgia following physical exertion. This disease may be associated with abnormalities in genes affecting exercise tolerance and physical performance. Adenosine monophosphate deaminase (AMPD1), carnitine palmitoyltransferase II (CPT2), and the muscle isoform of glycogen phosphorylase (PYGM) genes provide instructions for producing enzymes that play major roles in energy production during work. The aim of this study was to look for evidence of genotype-associated excessive muscle fatigue. Three metabolic genes (AMPD1, CPT2, and PYGM) were therefore fully sequenced in 17 Italian patients with CFS. We examined polymorphisms known to alter the function of these metabolic genes, and compared their genotypic distributions in CFS patients and 50 healthy controls using chi-square tests and odds ratios. One-way analysis of variance with F-ratio was carried out to determine the associations between genotypes and disease severity using CF scores. No major genetic variations between patients and controls were found in the three genes studied, and we did not find any association between these genes and CFS. In conclusion, variations in AMPD1, CPT2, and PGYM genes are not associated with the onset, susceptibility, or severity of CFS.

Chronic fatigue syndrome: Features of a population of patients from northern Italy.

In this study we analyzed the clinical features of a population of Italian patients with chronic fatigue syndrome (CFS) diagnosed according to the CDC-1994 criteria. The aim was to investigate CFS patients and their relatives, in order to search for events related to the onset of the disease and to identify correlations with other diseases. The analysis was carried out by examining medical records belonging to 82 patients suffering from the syndrome. The documentation was collected between 2008 and 2011 and provided by the non-profit Italian organization AMCFS (Associazione Malati di CFS). The influence of gender on the age of onset and association with potential risk factors were investigated in patients and in their relatives. From the results a significant correlation between the age of onset and autoimmunity was observed.

Excess heat capacity in liquid binary alkali-fluoride mixtures.

Using drop calorimetry, we measured enthalpy increments of the LiF-KF, LiF-RbF, and LiF-CsF binary systems at temperatures above the melting point. Ten samples with different compositions (four compositions for LiF-KF, one composition for LiF-RbF, and five compositions for LiF-CsF) were prepared and measured between 884 K and 1382 K. To protect the calorimeter from corrosive fluoride vapor at high temperature, an encapsulating technique developed for this purpose was used. The samples were filled in nickel containers that were sealed by laser welding and afterward used for the measurements. From the obtained results, we derived the molar heat capacity functions of the respective samples. The heat capacities of the samples, having different compositions of the same binary system, were compared with the values for ideal behavior and the excess heat capacity function was determined for the entire composition range of the liquid solution. It was found that the excess heat capacities clearly depend on the cation radius and increase in the following order: LiF-NaF < LiF-KF < LiF-RbF < LiF-CsF.

Dipeptidylpeptidase--IV, a key enzyme for the degradation of incretins and neuropeptides: activity and expression in the liver of lean and obese rats.

Given the scarcity of donors, moderately fatty livers (FLs) are currently being considered as possible grafts for orthotopic liver transplantation (OLT), notwithstanding their poor tolerance to conventional cold preservation. The behaviour of parenchymal and sinusoidal liver cells during transplantation is being studied worldwide. Much less attention has been paid to the biliary tree, although this is considered the Achille's heel even of normal liver transplantation. To evaluate the response of the biliary compartment of FLs to the various phases of OLT reliable markers are necessary. Previously we demonstrated that Alkaline Phosphatase was scarcely active in bile canaliculi of FLs and thus ruled it out as a marker. As an alternative, dipeptidylpeptidase-IV (DPP-IV), was investigated. This ecto-peptidase plays an important role in glucose metabolism, rapidly inactivating insulin secreting hormones (incretins) that are important regulators of glucose metabolism. DPP-IV inhibitors are indeed used to treat Type II diabetes. Neuropeptides regulating bile transport and composition are further important substrates of DPP-IV in the enterohepatic axis. DPP-IV activity was investigated with an azo-coupling method in the liver of fatty Zucker rats (fa/fa), using as controls lean Zucker (fa/+) and normal Wistar rats. Protein expression was studied by immunofluorescence with the monoclonal antibody (clone 5E8). In Wistar rat liver, DPP-IV activity and expression were high in the whole biliary tree, and moderate in sinusoid endothelial cells, in agreement with the literature. Main substrates of DPP-IV in hepatocytes and cholangiocytes could be incretins GLP-1 and GIP, and neuropeptides such as vasoactive intestinal peptide (VIP) and substance P, suggesting that these substances are inactivated or modified through the biliary route. In lean Zucker rat liver the enzyme reaction and protein expression patterns were similar to those of Wistar rat. In obese rat liver the patterns of DPP-IV activity and expression in hepatocytes reflected the morphological alterations induced by steatosis as lipid-rich hepatocytes had scarce activity, located either in deformed bile canaliculi or in the sinusoidal and lateral domains of the plasma membrane. These findings suggest that bile canaliculi in steatotic cells have an impaired capacity to inactivate incretins and neuropeptides. Incretin and/or neuropeptide deregulation is indeed thought to play important roles in obesity and insulin-resistance. No alteration in enzyme activity and expression was found in the upper segments of the biliary tree of obese respect to lean Zucker and Wistar rats. In conclusion, this research demonstrates that DPP-IV is a promising in situ marker of biliary functionality not only of normal but also of fatty rats. The approach, initially devised to investigate the behaviour of the liver during the various phases of transplantation, appears to have a much higher potentiality as it could be further exploited to investigate any pathological or stressful conditions involving the biliary tract (i.e., metabolic syndrome and cholestasis) and the response of the biliary tract to therapy and/or to surgery.

Chronic fatigue syndrome/myalgic encephalomyelitis: an update.

Chronic Fatigue Syndrome (CFS), also referred to as Myalgic Encephalomyelitis (ME), is a disease of unknown origin. It is classified as Post Viral Fatigue Syndrome (PVFS) in the WHO International Classification of Diseases (ICD) and listed as sub-category at G93.3 under chapter G93, other disorders of the brain. ME/CFS is primarily an endemic disorder but occurs in both epidemic and sporadic forms. It affects all racial-ethnic groups and is seen in all socioeconomic strata. A diagnosis of CFS is a diagnosis of exclusion, meaning other medical conditions, including psychiatric disorders, must be first ruled out. CFS is diagnosed if there is no other explanation for the fatigue and if the other symptoms did not develop before the fatigue. The estimated worldwide prevalence of CFS is 0.4?1 percent. The disease predominantly affects young adults, with a peak age of onset of between 20 and 40 years, and women, with a female to male ratio of 6:1. Mean illness duration ranges from 3 to 9 years. The patho-physiological mechanism of CFS is unclear but the immunological pattern of CFS patients gleaned from various studies indicates that the immune system is chronically activated. Besides the role of environmental insults (xenobiotics, infectious agents, stress) the genetic features of patients are studied to evaluate their role in triggering the pathology. At present there are no specific pharmacological therapies to treat the disease but a variety of therapeutic approaches have been described as benefiting patients. Treatment programs are directed at relief of symptoms, with the goal of the patient regaining some level of preexisting function and well-being.

Immunobiological and experimental aspects of malignant astrocytoma.

Today several findings indicate that a multifactorial strategy is the best strategy for treating cancer. Although radiotherapy, chemotherapy and surgery have been differently applied to treat human gliomas, no substantial improvement in life expectancy has been observed. Starting from 1992, the goal of our studies was to obtain new biological data on malignant astrocytomas to better understand the basic biology of the tumour and these are reviewed here. Immunotherapy may represent an available method in addition to the traditional therapeutic approaches. Starting from 1991, we set up a cellular model of lymphocytes obtained from peripheral blood of healthy patients treated with interleukin-2 (IL-2) in order to study the role of IL-2 in regulating lymphocytes activation. The lymphocytes responding to IL-2 treatment, named lymphokine-activated killer (LAK) cells, have a killer non MHC restricted activity, and are able to kill autologous and allogenic glioma cells. The interaction of LAK cells with various normal and transformed targets indicates that LAK cells recognize surface structures present both on normal and transformed cells. However, only the interaction with transformed cells induces lytic events and LAK cells can act as "surgical weapons" against tumour cells independently from their cell cycle. Much recent effort has focused on identifying the immune escape mechanisms used by glioma cells, in particular the modulation of the human leukocyte antigen (HLA) and antigen processing machinery component expression. Finally, another interesting field of research that will be presented is that of new tumour biomarkers of proliferation and apoptosis, cytokine/chemokine release and cytokine/chemokine receptors.

Immediate effectiveness of the "new identity" reality orientation therapy (ROT) for people with dementia in a geriatric day hospital.

Techniques of reality orientation in dementia are widely used around the world and indifferent settings. Nevertheless, after the controversies for adverse effects and frustration,by the new millennium "a new era" is coming on where cognitive rehabilitation "has come of age" and a series of positive results appeared until the fulfillment in the global and person-centered approach. This renewed technique may no more be based only on cognitive psychology but it is necessary to apply a more complete psychosocial approach taking into account also emotional, behavioral and functional domains of the globally considered person. The aims of our study are: (1) To assess the global efficacy on cognitive and affective functions. (2) To detect cognitive subsystems more sensible to our three-phase stimulation program. We studied 34 outpatients, 13 men and 21 women, age range 67-88 years, referred to our Expertise Center, all but one affected by mild cognitive impairment(MCI), suffering from mild dementia (clinical dementia rating, CDR <1). After 20 sessions of formal and complementary activities, a comprehensive improvement of cognition, language,memory and affective functions was observed. Semantic fluency improved with high statistically significant difference. The immediate recall, free or cued, appeared more sensible to stimulation than the delayed one. A correlation between a mini mental state examination (MMSE) low basal score and higher performance after the program was also obtained.

Evaluation of serum levels of cytokines and intercellular adhesion molecule-1 (ICAM-1) in astrocytic tumours.

Soluble form of intercellular adhesion molecules (sICAM) are increased in serum of many inflammatory diseases and tumours: the expression of such molecules is regulated by cytokines. In the present paper serum levels of interleukin-2 (IL-2), soluble interleukin-2 receptor (sIL-2R) and sICAM-1 were evaluated in patients with glioma compared with different tumours (lung and kidney carcinoma) in order to investigate the compromise of the immune system in these malignancies and to understand the host defence mechanisms. 14 cases of astrocytomas (WHO grade II, III), 20 cases of glioblastomas (GBL, WHO grade IV), 5 cases of lung carcinoma and 6 cases of kidney carcinoma were studied; the results were compared with 15 healthy controls. IL-2, sIL-2R, sICAM-1 concentrations were assessed by an enzyme-linked immunosorbent assay (ELISA) technique. The results were analyzed by Student's t test. Our findings showed that serum levels of IL-2 and sIL-2R were increased in all cancer patients; on the contrary, sICAM-1 serum levels were not significantly increased in GBL and astrocytoma patients. The increased values of IL-2 and sIL-2R are in agreement with a depression of the immune reactivity in patients with glioblastoma and astrocytoma, as reported in literature. On the contrary the levels of sICAM-1 are unchanged in astrocytic tumours while patients with kidney carcinoma presented the higher levels and an unfavourable prognosis.

HLA class I molecules expression: evaluation of different immunocytochemical methods in malignant lesions.

It is generally accepted that human and experimental tumour cells can lose Major Histocompatibility Complex (MHC) class I molecules and this represents the major mechanism of tumour escape from T-cell immune responses. Nevertheless testing of HL4 class I antigen expression in malignant lesions is not routinely used to evaluate the immunological conditions of the patients because of the pathologists' reluctance to utilise frozen tissue sections in immunocytochemisty. We analysed the expressions of HLA class I molecule and beta2-microglobulin in normal and neoplastic tissues, comparing different samples and methods. The expression of HLA receptors was studied in 7 brain tumours, 10 colon adenocarcinoma and 2 breast carcinoma by immunocytochemical technique. 4 normal tissues and peripheral blood mononucleated cells were analysed as positive control. The peroxidase staining method was performed on fresh imprints, frozen sections, formalin- fixed tissues and fine-needle aspirates. The results indicated that the best and simplest conditions for the detection of HLA molecules were obtained using fresh imprints and fine-needle aspirates.

Cytoskeleton actin changes in IL-2 activated cells.

In the present study we analysed the changes in cytoskeleton actin in lymphoid cells following IL-2 activation and during cell interactions by means of light and electron microscopy, immunofluorescence and molecular analysis. By morphological analysis we observed a higher fluorescence in the activated cells than in the quiescent ones with no modifications in the cytoskeleton pattern comparing activated to resting cells. The results of molecular analysis indicate that, after IL-2 activation, there is a reorganisation of the actin component of the cell cytoskeleton accompanied by the differential expression of the corresponding genes. A future study will be extended to the analysis of others components of the cytoskeleton network.

Dendritic cells and interleukin-2: cytochemical and ultrastructural study.

The aim of the present study was to verify the effect of IL-2 on dendritic cell (DC) differentiation. Various cytokines have been indicated as factors inducing DC differentiation, but no data about the interleukin-2 (IL-2) effect on DC differentiation have been reported. Monocytes isolated from peripheral blood were treated in vitro with the following factors: IL-2, IL-4, GM-CSF and G-CSF alone or in combination. Morphological (also ultrastructural) and cytochemical observations were carried out starting from 3 to 21 days of treatment. The results indicate that the differentiation of cells showing dendritic pattern is related to the presence of IL-2. Moreover a synergic effect of IL-2 and GM-CSF was observed. The enzymatic features changed with the culture time: before the differentiation into DC, the stimulated cells expressed the typical pattern of monocytes. On the contrary, at advanced stage of differentiation, some enzyme activities changed and in terminally differentiated dendritic cells the reactions for peroxidase and serine esterase were negative. Considering the morphological features, the ability to interact with lymphocytes and the enzymatic pattern observed, we suppose that IL-2 may act as a maturative factor rather than as a growth factor in the DC differentiation.

Identification of genetic markers of the glial tumor by means of differential display technique.

The Differential Display Reverse Transcriptase (DDRT) technique was adopted to isolate genetic markers specific for the two main grades of the Glial tumor, the Astrocytoma and the Glioblastoma. A total of 16 brain biopsies (4 Astrocytoma and 12 Glioblastoma) were analysed. The technique was modified in order to reduce the false-positive ratio by means of more stringent amplification conditions. Electrophoretic patterns with previously selected arbitrarily primers revealed differences between the grades, four of them were investigated through sequencing. These sequences did not show significant nucleotide and aminoacid similarity to any known sequences in the DataBase. Sensitivity of the method was documented by the evidence that only one of the selected markers was an artefact, while the others represented genetic markers of the human Glial neoplasm.

Interleukin-2 induces the growth of human glioblastoma cells in culture.

The ability of the T cell growth factor interleukin-2 (IL-2) to support the proliferation of human glioblastoma cells in short-term cultures was evaluated. A morphological, cytochemical and immunocytochemical analysis was carried out at different times of treatment. In the presence of IL-2 growth of tumor cells was observed. On the contrary, in the absence of IL-2 only few colonies derived from tumor fragments were obtained and these were so after a long time. The immunocytochemical study revealed that IL-2 induces the expression of the IL-2 receptor on human glioblastoma cells. In the presence of IL-2 proliferation of infiltrating lymphoid cells inside the tumor fragments was also observed. Morphological and cytochemical analysis of these cells revealed positivity for acid phosphatase (AP), dihydrofolate reductase (DHFR), dipeptydilaminopeptidase (DAP IV) and negativity for serine esterase. These data are in agreement with our previous study on activated lymphoid subsets. On the other hand, an absence of infiltrating lymphocytes was observed in cultures without IL-2. These results indicate that local treatment of human glioblastoma using IL-2 might produce tumor cell proliferation.

Advantages of spinal anesthesia in abdominal gynecologic surgery.

The advantages obtained in vaginal surgery and caesarean section using spinal anesthesia led us to test this anesthesia to verify feasibility, problems and advantages in abdominal surgery. Spinal anesthesia was performed in 60 patients between 21 and 87 years of age. Thirty-seven total abdominal hysterectomies with or without adnexectomy, 5 laparotomic miomectomies, 3 adnexectomies, 5 colposacropexies, 2 hysterectomies with lymphadenectomy, 7 Burch colposuspension with or without hysterectomy and 1 laparoscopy for sterilization were performed. No significant problems during surgery and the postoperative period were observed. Resumption of the different physiologic functions were more rapid, hospital stay shorter and compliance greater than with general anesthesia.