Correlation between individual inflammation genetic profile and platelet rich plasma efficacy in hair follicle regeneration: a pilot study reveals prognostic value of IL-1a polymorphism.

OBJECTIVE: Hair loss generates severe psychosocial implications. To date, exploring the prognostic factors of possible clinical benefit of autologous blood concentrate platelet rich plasma (PRP) was failed. The aim of our pilot study was to explore the correlation between the individual inflammation genetic profile and PRP efficacy in the treatment of hair follicle regeneration. PATIENTS AND METHODS: 41 volunteers (25 men, 16 women) took part in this retrospective study. All the patients were scheduled for 4 sessions of PRP application with intervals of 40-60 days. All the patients were checked up at 6 weekly intervals for 6 months and, then, at the end of the first year. A panel of 5 polymorphisms on 4 genes (IL-1a, IL-1b, IL-6, and IL-10) implicated in the individual genetic inflammation profile were performed. RESULTS: A significant increase rate in hair density was noticed after the third month of treatment in 32/41 (78%) of the subjects. We found an interesting association between the pro-inflammatory cytokine IL-1α polymorphism C>A (rs17561) and responders to PRP treatment. The cases carrying C/C genotype (coding for Ser114) were 21 (66%) in responders and only 2 (22%) in non-responders (p<0.05). In addition, about IL-1a, the frequency of G/G genotype in responder patients was over two times lower in responder (31%) than in non-responder patients (78%). CONCLUSIONS: Our pilot study demonstrated a correlation between the individual genetic inflammatory profile and the efficacy of the PRP treatment in males. On the contrary, in females, it showed a negative correlation. IL-1a could be used as a prognostic value for PRP efficacy. Also, these results provide preliminary evidence that may encourage the design of controlled clinical trials to properly test this modus operandi on a large number of subjects.

Platelet-rich plasma treatment and hemostasis in patients with hemorrhagic risk.

AIM: Our research aimed to evaluate the risk of haemorrhage following oral surgical operations, in patients who were undergoing an anticoagulant therapy, and to test the usefulness of the autologous platelet gel in order to control haemostasis. METHODS: A total of 208 patients (84 males/124 females) undergoing an anticoagulant therapy and submitted to oral surgery, were divided at random into 4 groups (A, B, C, D) consisting of 52 patients each, using as criterion of differentiation the kind of treatment we adopted in order to get haemostasis. The patients belonging to the first 3 groups (A, B, C), underwent a surgical operation without discontinuing the dicumarol therapy. In order to get haemostasis, we used: platelet-rich plasma (PRP) and suture, in group A; PRP, haemostatic sponges and suture, in group B; haemostatic sponges, suture and compression by means of gauzes soaked in tranexamic acid in group C. Group D, instead, consisted of patients who underwent a surgical operation, before which the dicumarol therapy had been suspended and replaced by heparincalcium. RESULTS: Patients belonging to the groups A and B showed a very good haemostasis like the patients of group D (control group). As the coumarin therapy didn't need to be discontinued some days before the surgical operation, so the days of hospital stay were reduced and there wasn't the risk of thromboembolism. As to group C (19 males), 6 patients (i.e. 11.5%) showed a good haemostasis, both at once and in the long term, so that they could be discharged on day 2 after surgery. CONCLUSIONS: The results obtained during our research, highly encourage using PRP regularly when carrying out surgical treatments on patients who are undergoing a coumarin therapy.

Comparison of clevidipine with sodium nitroprusside in the control of blood pressure after coronary artery surgery.

BACKGROUND AND OBJECTIVE: We set out to compare the efficacy of clevidipine and sodium nitroprusside infusions in the control of blood pressure and the haemodynamic changes they produce in hypertensive patients after operation for elective coronary bypass grafting. METHODS: Thirty patients were randomly allocated to receive either clevidipine or sodium nitroprusside after their mean arterial pressure (MAP) had reached > 90 mmHg for at least 10 min in the postoperative period. The MAP was continuously measured and related to time. Thus, the efficacy of the drugs in controlling arterial pressure could be inversely related to the total area under the MAP-time curve outside a target MAP range of 70-80 mmHg normalized per hour (AUC(MAP) mmHg min h(-1)). Haemodynamic variables and the number of dose-rate adjustments required to maintain MAP were also studied. RESULTS: There was no statistically significant difference in the efficacy (AUC(MAP) mmHg min h(-1)) of clevidipine (106 +/- 25 mmHg min h(-1)) compared with sodium nitroprusside (101 +/- 28 mmHg min h(-1)). Nor was any significant difference found in the total number of dose adjustments required to control MAP within the target range. The heart rate in patients receiving clevidipine increased less than in those given sodium nitroprusside. Stroke volume, central venous pressure and pulmonary artery pressure were significantly reduced upon administration of sodium nitroprusside but not of clevidipine. CONCLUSIONS: There was no significant difference between clevidipine and sodium nitroprusside in their efficacy in controlling MAP. The haemodynamic changes, including tachycardia, were less pronounced with clevidipine than with sodium nitroprusside.

Neopterin serum levels in pancreatic adenocarcinoma.

CONCLUSIONS: Activation of the immune system in pancreatic cancer is demonstrated by increased serum levels of neopterin, soluble Interleukin 2 receptor (sIL-2R), and Interleukin 6 (IL-6). Determination of these parameters does not provide benefit in the diagnosis of pancreatic cancer. BACKGROUND: The aim of the study was to define the diagnostic value of serum neopterin, an in vivo marker of macrophage activity, in pancreatic cancer. METHODS: Thirty-four patients with pancreatic cancer were studied. According to the UICC TNM classification 6 were in stage I, 9 in stage II, 6 in stage III, and 13 in stage IV. Twenty-four patients with chronic pancreatitis, 72 healthy blood donors, and 20 patients with jaundice resulting from gallstones were used as control groups. Neopterin, tumor necrosis factor (TNF), sIL-2R, and IL-6 were measured in serum in the different groups; Ca 19-9 was also measured in cancer and pancreatitis. RESULTS: Serum levels of neopterin, sIL-2R, and IL-6 were higher in cancer than in pancreatitis and healthy donors, and in pancreatitis higher than in donors. Serum TNF was similar in the three groups. Serum levels of neopterin, TNF, sIL-2R, and IL-6 were not related to the tumor stage or to Ca 19-9 levels. A positive correlation was found between sIL-2R and neopterin levels. Neopterin levels in obstructive jaundice were similar to those of pancreatitis. Ca 19-9 at the recommended cutoff of 37 U/mL showed the best sensitivity and specificity (88.2 and 87.5%, respectively). At the selected cutoff neopterin, TNF, sIL-2R, and IL-6 showed low sensitivity and specificity in differentiating cancer from pancreatitis.

Neopterin in acute pancreatitis.

BACKGROUND: Activation of the cellular immune system may play a role in the pathogenesis of acute pancreatitis (AP); it has recently been proposed that excessive leukocyte stimulation may lead to the most severe forms of AP. The aim of this study was to investigate serum neopterin, a useful in vivo marker of macrophage activation, in mild and severe AP and its relationship with other markers of leukocyte activation, such as interleukin-6 (IL-6) and tumor necrosis factor (TNF). METHODS: Serum levels of neopterin (mmol/ml), IL-6 (pg/ml), and TNF (pg/ml) were measured on the 1st and 7th day of hospitalization in 17 patients with severe AP and 24 with mild AP. Severe AP was defined in accordance with the Atlanta criteria: all patients have necrosis at contrast-enhanced computerized tomography scan. RESULTS: Day 1: Neopterin and IL-6 levels were significantly higher in severe than in mild AP and normal controls; mild AP values were also significantly higher than in normal controls. The best neopterin cutoff level we obtained (30 mmol/ml) reached a specificity of 76% and a sensitivity of 46% in distinguishing severe from mild AP. Day 7: Neopterin was significantly higher in severe AP than in mild AP and in normal controls; no difference was seen between mild AP values and normal controls; neopterin serum levels were significantly higher on day 7 than on day 1 in severe AP but not in mild AP; in both groups of patients IL-6 was significantly higher on day 1 than on day 7. Using a neopterin cutoff level of 40 mmol/ml, we found specificity and sensitivity value of 92% in differentiating severe from mild AP. With regard to TNF values, no difference was seen on day 1 and 7 in the two groups of patients in comparison with normal controls. Neopterin serum values did not correlate with IL-6 and TNF on either day. CONCLUSIONS: These results confirm the activation of the cellular immune system in AP. Initially enhanced NEOP and IL-6 serum levels reflect the severity of the disease; neopterin may be considered a reliable prognostic indicator also at a distance from AP onset because its levels increase during the 1st week of AP in patients with severe forms only.