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Immune response to vaccines in children with celiac disease

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World Journal of Gastroenterology 2017年第18期23卷 3205-3213页

作者： Caterina Anania Francesca Olivero Alessandra Spagnolo Claudio Chiesa Lucia Pacifico Policlinico Umberto I Sapienza University of Rome Department of Public Health and Infectious Diseases Sapienza University of Rome Institute of Translational Pharmacology National Research Council

Celiac disease(CD) is an immune-mediated systemic condition evoked by ingestion of gluten and related prolamines in genetically susceptible subjects. The disease is featured by a variable combination of clinical signs, specific antibodies, HLA-DQ2 and HLA-DQ8 haplotypes, and enteropathy. Vaccination is the most potent intervention for infectious disease prevention. Several factors including age, gender, ethnicity, quality and quantity of vaccine antigen, doses, and route of administration can influence immune response to vaccination, although the main cause of variation in the responsiveness among vaccine recipients is host genetic variability. The HLA system has a fundamental role in identifying the antigens introduced into the host with the vaccines and in the development of specific antibodies, and some HLA phenotypes have been associated with a less effective immunological response. The available literature indicates that the immunological response to vaccines in CD children does not differ markedly from that of general population and antibody titres are high enough to provide long-term protection, except for hepatitis B virus vaccine. In this article, we review and discuss the scarce literature in this field in order to provide clinical practice guidelines to achieve the most efficient monitoring of the response to vaccines in pediatric CD patients.

关键词：腹的疾病孩子感染疫苗肝炎 B 疫苗 HLA 面筋免费饮食

Non-alcoholic fatty liver disease connections with fat-free tissues: A focus on bone and skeletal muscle

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World Journal of Gastroenterology 2017年第10期23卷 1747-1757页

作者： Eleonora Poggiogalle Lorenzo Maria Donini Andrea Lenzi Claudio Chiesa Lucia Pacifico Department of Experimental Medicine-Medical Pathophysiology Food Science and Endocrinology SectionSapienza University of Rome Institute of Translational Pharmacology National Research Council Policlinico Umberto I Hospital Sapienza University of Rome

The estimates of global incidence and prevalence of non-alcoholic fatty liver disease(NAFLD) are worrisome, due to the parallel burden of obesity and its metabolic complications. Indeed, excess adiposity and insulin resistance represent two of the major risk factors for NAFLD; interestingly, in the last years a growing body of evidence tended to support a novel mechanistic perspective, in which the liver is at the center of a complex interplay involving organs and systems, other than adipose tissue and glucose homeostasis. Bone and the skeletal muscle are fat- free tissues which appeared to be independently associated with NAFLD in several cross-sectional studies. The deterioration of bone mineral density and lean body mass, leading to osteoporosis and sarcopenia, respectively, are age-related processes. The prevalence of NAFLD also increases with age. Beyond physiological aging, the three conditions share some common underlying mechanisms, and their elucidations could be of paramount importance to design more effective treatment strategies for the management of NAFLD. In this review, we provide an overview on epidemiological data as well as on potential contributors to the connections of NAFLD with bone and skeletal muscle.

关键词：非酒精的脂肪肝疾病骨头骨胳的肌肉骨质疏松症 Sarcopenia

Pediatric nonalcoholic fatty liver disease,metabolic syndrome and cardiovascular risk

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世界胃肠病学杂志：英文版 2011年第26期17卷 3082-3091页

作者： Lucia Pacifico Valerio Nobili Caterina Anania Paola Verdecchia Claudio Chiesa Department of Pediatrics Sapienza University of Rome Department of Hepato-gastroenterology and Nutrition Pediatric Hospital "Bambino Gesù" Institute of Translational Pharmacology National Research Council

Nonalcoholic fatty liver disease(NAFLD) encompasses a range of liver histology severity and outcomes in the absence of chronic alcohol use.The mildest form is simple steatosis in which triglycerides accumulate within hepatocytes.A more advanced form of NAFLD,nonalcoholic steatohepatitis,includes inflammation and liver cell injury,progressive to cryptogenic cirrhosis.NAFLD has become the most common cause of chronic liver disease in children and adolescents.The recent rise in the prevalence rates of overweight and obesity likely explains the NAFLD epidemic worldwide.NAFLD is strongly associated with abdominal obesity,type 2 diabetes,and dyslipidemia,and most patients have evidence of insulin resistance.Thus,NAFLD shares many features of the metabolic syndrome(MetS),a highly atherogenic condition,and this has stimulated interest in the possible role of NAFLD in the development of atherosclerosis.Accumulating evidence suggests thatNAFLD is associated with a significantly greater overall mortality than in the general population,as well as with increased prevalence of cardiovascular disease(CVD),independently of classical atherosclerotic risk factors.Yet,several studies including the pediatric population have reported independent associations between NAFLD and impaired flow-mediated vasodilatation and increased carotid artery intimal medial thickness-two reliable markers of subclinical atherosclerosis-after adjusting for cardiovascular risk factors and MetS.Therefore,the rising prevalence of obesity-related MetS and NAFLD in childhood may lead to a parallel increase in adverse cardiovascular outcomes.In children,the cardiovascular system remains plastic and damage-reversible if early and appropriate interventions are established effectively.Therapeutic goals for NAFLD should address nutrition,physical activity,and avoidance of smoking to prevent not only end-stage liver disease but also CVD.

关键词：心血管疾病脂肪肝病代谢综合征酒精性肝疾病动脉粥样硬化小儿风险

Impact of healthy plant-based diet on abdominal visceral and liver fat contents

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 136-138页

作者： Lucia Pacifico Francesco Massimo Perla Claudio Chiesa Department of Maternal and Child health Sapienza University of RomeRomeItaly Institute of Translational Pharmacology National Research CouncilRomeItaly

Diet is an important modifiable risk factor for obesity and obesity-related complications,and there has been growing interest in plant-based diets,mainly defined as“vegetarian”diets,which have been associated with a lower prevalence rate of overweight/obesity as well as a lower risk of coronary heart disease,type 2 diabetes,other cardiometabolic diseases,and all-cause mortality(1).Such dietary patterns are also a major determinant of environmental sustainability(1).Of note,however,vegetarian diets can include less healthy plant foods,such as refined grains and sugar-sweetened beverages which have detrimental effects on health(2).

关键词： obesity mortality diseases

Consequences of Helicobacter pylori infection in children

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World Journal of Gastroenterology 2010年第41期16卷 5181-5194页

作者： Lucia Pacifico Caterina Anania John F Osborn Flavia Ferraro Claudio Chiesa Department of Pediatrics Sapienza University of Rome 324 I-00161 Rome Italy Department of Public Health Sciences Sapienza University of Rome I-00185 Rome Italy Department of Molecular Medicine National Research Council I-00133 Rome Italy

Although evidence is emerging that the prevalence of Helicobacter pylori (H. pylori) is declining in all age groups, the understanding of its disease spectrum continues to evolve. If untreated, H. pylori infection is lifelong. Although H. pylori typically colonizes the hu-man stomach for many decades without adverse con-sequences, children infected with H. pylori can manifest gastrointestinal diseases. Controversy persists regarding testing (and treating) for H. pylori infection in children with recurrent abdominal pain, chronic idiopathic thrombocytopenia, and poor growth. There is evidence of the role of H. pylori in childhood iron deficiency anemia, but the results are not conclusive. The possibility of an inverse relationship between H. pylori and gastroesophageal reflux disease, as well as childhood asthma, remains a controversial question. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae.

关键词： Helicobacter pylori Children Gastrointestinal diseases Epigastric pain Anemia Growth retardation Chronic idiopathic thrombocytopenic pupura

Sarcopenia and nonalcoholic fatty liver disease: a causal relationship

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Hepatobiliary Surgery and Nutrition 2019年第2期8卷 144-147页

作者： Lucia Pacifico Francesco Massimo Perla Claudio Chiesa Department of Pediatrics Sapienza University of RomeRomeItaly Institute of Translational Pharmacology National Research CouncilRomeItaly

Concurrent with the obesity epidemic,non-alcoholic fatty liver disease(NAFLD)is rapidly becoming the leading cause of chronic liver disease worldwide(1).NAFLD,particularly its histological phenotype non-alcoholic steatohepatitis(NASH),can progress to advanced liver disease,cirrhosis and hepatocellular carcinoma and indication for liver transplantation(2).Although remarkable advances have been made in the understanding of the pathophysiology of NAFLD,the exact mechanism of hepatic fat accumulation and the progression to NASH is not fully understood.Thus,in order to reduce the burden associated with these diseases,it is imperative that all major factors that contribute to the development of NAFLD are identified.

关键词： NAFLD becoming exact

Probiotics for the treatment of Helicobacter pylori infection in children

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World Journal of Gastroenterology 2014年第3期20卷 673-683页

作者： Lucia Pacifico John Frederick Osborn Enea Bonci Sara Romaggioli Rossella Baldini Claudio Chiesa Department of Pediatrics and Child Neuropsychiatry Sapienza University of Rome Department of Health Sciences and Infectious Diseases Sapienza University of Rome Department of Experimental Medicine Sapienza University of Rome Department of Human Anatomy Sapienza University of Rome Institute of Translational Pharmacology National Research Council

The combination of a proton pump inhibitor and two antibiotics(clarithromycin plus amoxicillin or metronidazole)has been the recommended first-line therapy since the first guidelines for Helicobacter pylori(H.pylori)infection in children were published.In recent years,the success of eradication therapies has declined,in part due to the development of H.pylori resistant strains.Alternative anti-H.pylori treatments are currently becoming more popular than the traditional eradication methods.Components that may be used either as a monotherapy or,in combination with antimicrobials,resulting in a more effective anti-H.pylori therapy have been investigated in depth by several researchers.One of the potential therapies is probiotic cultures;promising results have been observed in initial studies with numerous probiotic strains.Nevertheless,many questions remain unanswered.In this article,we comprehensively review the possible mechanisms of action of probiotics on H.pylori infection,and present the results of published studies using probiotics as possible agents to control H.pylori infection in children.The effect of the addition of probiotics to the standard H.pylori eradication therapy for the prevention of antibiotic associated side-effects is also discussed.

关键词： Helicobacter pylori Children Probiotics Eradicatio

Helicobacter pylori infection and extragastric disorders in children: A critical update

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World Journal of Gastroenterology 2014年第6期20卷 1379-1401页

作者： Lucia Pacifico John F Osborn Valeria Tromba Sara Romaggioli Stefano Bascetta Claudio Chiesa Department of Pediatrics Sapienza University of Rome Department of Health Sciences and Infectious Diseases Sapienza University of Rome Institute of Translational Pharmacology National Research Council

Helicobacter pylori(H. pylori) is a highly prevalent, serious and chronic infection that has been associated causally with a diverse spectrum of extragastric disorders including iron deficiency anemia, chronic idiopathic thrombocytopenic purpura, growth retardation, and diabetes mellitus. The inverse relation of H. pylori prevalence and the increase in allergies, as reported from epidemiological studies, has stimulated research for elucidating potential underlying pathophysiological mechanisms. Although H. pylori is most frequently acquired during childhood in both developed and developing countries, clinicians are less familiar with the pediatric literature in the field. A better understanding of the H. pylori disease spectrum in childhood should lead to clearer recommendations about testing for and treating H. pylori infection in children who are more likely to develop clinical sequelae. A further clinical challenge is whether the progressive decrease of H. pylori in thelast decades, abetted by modern clinical practices, may have other health consequences.

关键词： Helicobacter pylori Children Iron defi-ciency anem

Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents

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World Journal of Gastroenterology 2016年第39期22卷 8812-8819页

作者： Michele Di Martino Lucia Pacifico Mario Bezzi Rossella Di Miscio Beatrice Sacconi Claudio Chiesa Carlo Catalano Department of Radiological Sciences Oncology and Anatomical Pathology "Sapienza" University of Rome Department of Pediatrics and Child Neuropsychiatry "Sapienza" University of Rome Institute of Translational Pharmacology National Research Council

AIM To establish a threshold value for liver fat content between healthy children and those with nonalcoholic fatty liver disease(NAFLD) by using magnetic resonance imaging(MRI), with liver biopsy serving as a reference standard. METHODS The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel pointresolved 1H MR-Spectroscopy(1H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cutoff value. Lin coefficient test was used to evaluate thecorrelation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables. RESULTS According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF.CONCLUSION MRS is an accurate and precise method for detecting NAFLD in children.

关键词：磁性的回声光谱学磁性的回声 imaging-PDFF 肥胖非酒精的脂肪肝疾病孩子