Michela Masotti

Serum hepcidin in inflammatory bowel diseases: biological and clinical significance.

Background: Hepcidin, a peptide produced by hepatocytes, regulates body iron homeostasis. Inflammation increases serum hepcidin, and its determination can be useful in the differential diagnosis of anemias during inflammatory diseases. Methods: We measured serum hepcidin-25 and hepcidin-20 isoforms in 54 patients with inflammatory bowel diseases (IBD) and 54 reference subjects (36 healthy controls and 18 anemic patients without inflammation or renal failure). Disease activity, blood counts, iron status, and erythropoiesis-related parameters were obtained for all study subjects. Results: In IBD hepcidin-25, the peptide bioactive isoform correlated positively with C-reactive protein and serum ferritin; an inverse correlation was observed with transferrin, the soluble transferrin receptor, and the soluble transferrin receptor to Log(ferritin) ratio. Similar correlations were found in reference subjects. Patients with anemia of inflammation had higher hepcidin-25 levels than those with iron deficiency anemia or a combination of iron deficiency anemia and inflammation (P = 0.0061). In patients with inflammation and serum ferritin concentration 100 to 200 ng/mL, hepcidin-25 was low, suggesting that these patients had iron deficiency. A serum hepcidin-25 concentration below 2.0 nM differentiated 85% of patients with iron deficiency anemia (with or without inflammation) from patients with anemia of inflammation. In IBD, hepcidin-20 correlated with both hepcidin-25 and C-reactive protein. Conclusions: In IBD, iron stores, inflammation, and iron requirement for erythropoiesis influence serum hepcidin-25. Hepcidin-25 determination can be useful in the differential diagnosis of IBD-associated anemias. Serum hepcidin-20 is linked to hepcidin-25, but inflammation has an independent regulatory role on its concentration, indicating that hepcidin-20 may have a biological function.

A case of fever of unknown origin

A 74-year-old man was admitted to the Emergency Department (ED) of our Institution for fatigue and fever of 3-week duration. During the last 3 days; 2 days before admission, an empiric antibiotic therapy had been started. The patient had an history of chronic obstructive pulmonary disease, ischemic cardiomyopathy, hemorrhagic stroke, which had caused a cognitive impairment and difficulties in mobilization, HCV-related hepatopathy, obesity, diverticula and an aortic abdominal aneurysm treated with an endoprosthesis 1 year earlier. Two days before admission, he went to the ED of the same Hospital for confusion, and was discharged within a few hours with a diagnosis of progressive cognitive impairment. At the ED, the patient had mild confusion, but the physical examination was otherwise normal. Blood tests showed a mild normocytic anemia. A chest X-ray study was negative for acute lesions. On admission to the Department of Internal Medicine, blood tests showed signs of inflammation and an elevation of procalcitonin. The physical examination showed abdominal tenderness, but there was only mild abdominal pain with no signs of peritonitis. Differential and preliminary diagnosis

P.03.4 SERUM HEPCIDIN IN INFLAMMATORY BOWEL DISEASES

20)-untreated) rats. 2) TNBS up-regulated mRNA expression of COX-2, TGF-β, TNF-α, HB-EGF and t-TG in colonic tissue. 3) both concentrations of Hp 2-20 significantly (p<0.05) decreased TNBS-induced mRNA overexpression of COX-2, TNF-α, t-TG and TGF-β, whereas HB-EGF mRNA tissue levels remained unchanged; 4) TNBS up-regulated FPR and FPRL-1 mRNA expression and this was counteracted by Hp(2-20). Conclusions: 1) Peptide Hp(2-20) significantly accelerates mucosal healing in a rat model of TNBS-induced colitis, both at the macroscopic and histological level; 2) This effect is associated with a significant reduction in mRNA colonic tissue levels of COX-2, TGF-β, TNF-α, and tissue transglutaminase; 3) Hp(2-20) decreased FPR and FPRL-1 gene expression induced by TNBS; 4) We postulate that Hp(2-20) down-regulation of pro-inflammatory responses in TNBS-colitis may partly explain the inverse association between H. pylori infection and IBD.

Diagnosi e trattamento della malattia celiaca refrattaria: presentazione di un caso clinico

Refractory celiac disease (RCD) is defined by persistent symptoms of malabsorption and villous atrophy despite a 8-12 months strictly gluten free diet, in the absence of other causes of unresponsiveness to diet or malignancies. RCD can be classified into two types: intestinal bioptic samples of RCD type 1 show an intraepithelial lymphocytic infiltrate with normal phenotype, in contrast with RCD type 2 where intestinal lymphocytes are aberrant. RCD type 1 is usually characterized by clinical improvement using a treatment strategy that includes nutritional support, gluten free diet and immunosuppressive drugs; RCD type 2 does not benefit from this therapy and shows poor prognosis and elevated risk of developing EATL. The description of this case is due to improve our knowledge on alternative therapeutic strategy for the treatment of RCD in patients with refractory celiac steroid-unresponsive.

Dosaggio dell’epcidina nel siero di pazienti con malattia infiammatoria intestinale

L’anemia e tra le piu frequenti manifestazioni extraintestinali nei pazienti affetti da malattia infiammatoria intestinale. La diagnosi differenziale tra anemia da carenza di ferro e da infiammazione cronica in questi pazienti assume un’importanza fondamentale nella scelta terapeutica; puo risultare altresi particolarmente difficoltosa, poiche spesso entrambi i meccanismi patogenetici contribuiscono all’anemizzazione nel medesimo paziente. In questo lavoro abbiamo dosato l’epcidina nel siero di pazienti affetti da malattie infiammatorie intestinali ed in un gruppo di soggetti di controllo, sani o con anemie non infiammatorie ne secondarie ad insufficienza renale. Abbiamo quindi analizzato i fattori che influenzano i livelli sierici di epcidina nelle malattie infiammatorie intestinali e la possibilita di utilizzare l’epcidina per discriminare i casi di anemia da infiammazione cronica dai casi di anemia da carenza di ferro associata ad anemia da infiammazione cronica. Tramite la concentrazione dell’epcidina e stato possibile discriminare la maggior parte dei nostri pazienti con anemia da carenza di ferro dai pazienti con anemia da infiammazione cronica, per cui possiamo assumere che il dosaggio dell’epcidina puo essere utile per una corretta diagnosi differenziale della patogenesi dell’anemia nelle malattie infiammatorie intestinali e, potenzialmente, in altre malattie infiammatorie croniche.

Complicanze degli accessi vascolari centrali a lungo termine: presentazione di un caso clinico

Long term central vascular accesses are frequently used in the common clinical practice for drug infusion or sample taking; nevertheless they expose the patient to possible severe complications, mainly infectious and thrombotic ones. This case report summarizes main complications directly or indirectly linked to the long-term permanence of the device, and highlights the importance of an accurate evaluation of risk-benefit ratio of catheter placement and of an adequate knowledge of the patient about the maintenance of the device.

Un caso di cirrosi epatica a duplice eziologia

La cirrosi epatica e una malattia cronica molto diffusa in Italia, e rappresenta l’evoluzione finale di epatopatie croniche a diversa eziologia; le forme virali ed alcoliche sono le piu frequenti, seguite da forme piu rare che comprendono anche malattie genetiche da accumulo come l’emocromatosi primaria. Sia nell’emocromatosi primaria che nelle epatopatie croniche, in particolare virali ed alcoliche, e possibile osservare accumulo di ferro. Nel paziente affetto da cirrosi epatica una corretta valutazione dello stato del ferro e fondamentale per l’ inquadramento diagnostico e la stratificazione prognostica.

Un caso di linfoma gastrico in un paziente anziano polipatologico

Il linfoma gastrico e una neoplasia relativamente rara, tuttavia la sua frequenza e aumentata negli ultimi 25 anni. Fondamentale importanza per un inquadramento prognostico e terapeutico rivestono la diagnosi differenziale rispetto all’adenocarcinoma gastrico, che risponde meno brillantemente alla terapia medica, e il sottotipo istologico: i MALTomi spesso vanno incontro a remissione in seguito a terapia eradicante per Helicobacter Pylori mentre i DLBCL richiedono una terapia piu aggressiva. Nel paziente anziano polipatologico un adeguato iter diagnostico e terapeutico puo portare miglioramento della qualita di vita nonostante l’aggressivita clinica della malattia, l’eta avanzata e le comorbilita.

Un caso di ileo biliare

Gallstone ileus is a rare complication of cholelithiasis caused by the impaction of one or more stones in the lumen of the gastrointestinal tract; pathophysiological prerequisite is the presence of a bilio-digestive fistula. The clinical signs and symptoms of intestinal obstruction, such as constipation, abdominal pain, nausea, vomiting and abdominal distension predominate, usually preceded by symptoms of acute cholecystitis. Plain abdominal X-ray, ultrasound and TC (gold standard) are cardinal for the diagnosis. Early diagnosis is a crucial point for the improvement of the prognosis, since this pathological condition is still characterized by an high morbidity and mortality burden. Treatment is surgical; currently most of the authors prefer a two-stage strategy. The case described below shows how diagnosis of gallstone ileus can be laborious and complex, requiring integration of more instrumental examination to reach the diagnosis as early as possible.