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Editor-in-chief
Maria Stella Graziani

Deputy Director
Martina Zaninotto

Associate Editors
Ferruccio Ceriotti
Davide Giavarina
Bruna Lo Sasso
Giampaolo Merlini
Martina Montagnana
Andrea Mosca
Paola Pezzati
Rossella Tomaiuolo
Matteo Vidali

EIC Assistant
Francesco Busardò

International Advisory Board Khosrow Adeli Canada
Sergio Bernardini Italy
Marcello Ciaccio Italy
Eleftherios Diamandis Canada
Philippe Gillery France
Kjell Grankvist Sweden
Hans Jacobs The Netherlands
Eric Kilpatrick UK
Magdalena Krintus Poland
Giuseppe Lippi Italy
Mario Plebani Italy
Sverre Sandberg Norway
Ana-Maria Simundic Croatia
Tommaso Trenti Italy
Cas Weykamp The Netherlands
Maria Willrich USA
Paul Yip Canada


Publisher
Biomedia srl
Via L. Temolo 4, 20126 Milano

Responsible Editor
Giuseppe Agosta

Editorial Secretary
Chiara Riva
Biomedia srl
Via L. Temolo 4, 20126 Milano
Tel. 0245498282
email: biochimica.clinica@sibioc.it

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ISSN print: 0393 – 0564
ISSN digital: 0392- 7091



BC: Articoli scritti da E. De Santis

Il laboratorio di autoimmunità nella diagnosi di miopatia autoimmune necrotizzante indotta da statina
The autoimmunity laboratory in the diagnosis of necrotizing autoimmune myopathy induced by statins
<p>Statins have been recently associated with a necrotizing autoimmune myopathy (NAM) characterized by inflammation, myopathy and muscle necrosis and by the presence of anti 3-hydroxy-3-methylglutaryl-coenzim A reductase antibodies (anti-HMGCR). This case report describes a case of a man who was taking atorvastatin, complaining muscle weakness and creatine kinase (CK) very high levels. The main laboratory and autoimmunity tests (including the major myositis antibodies) were negative, despite a muscle biopsy showed a myopathic process. Because of these results the detection of anti-HMGCR antibody was activated and the positive result confirmed the diagnosis of NAM. The patient stopped the statin therapy and started a steroid therapy with improvement in muscle symptoms and mild decrease of CK. The role of the autoimmunity laboratory in the diagnostic path of this rare autoimmune disease is fundamental. Though statin-associated NAM is a rare entity, it should be considered in patients who continue to have CK elevation and muscle weakness during or after discontinuation of statin therapy.</p>
Biochimica Clinica ; 45(4) e27
Casi clinici - Case report
 
Confronto tra un metodo nefelometrico ed un metodo turbidimetrico per la determinazione delle catene leggere libere sieriche: punti di forza e criticità
Comparison between a turbidimetric and a nephelometric method for the measurement of serum free light chains: strengths and weaknesses
<p>Background: monoclonal gammopathies include a broad spectrum of pathologies, and free light chains (FLC) measurement is recommended by guidelines for the diagnosis, follow up and prognosis of plasma cell dyscrasia. The aim of the study is to compare the measurement of FLC performed with two different analytical platforms, a nephelometer and a turbidimeter, in order to assess the analytical and diagnostic agreement.<br />Methods: 87 consecutive samples received by the laboratory with a request of FLC measurement were analyzed on nephelometer Immage 800 (Beckman Coulter, USA) and turbidimeter Optilite (The Binding Site, UK), using the same antibodies (Freelite, The Binding Site, UK).<br />Results: by applying the Passing-Bablok regression and the Bland-Altman analysis, a proportional and constant systematic error but non-significant bias for FLC ratio (rFLC) has been observed. By applying the Weighted Cohen&rsquo;s Kappa (WK) test to the rFLC values, an excellent diagnostic agreement between the two instruments has been shown, considering both the normal range (0.26 &ndash; 1.65) (WK=0.87) and the diagnostic range for multiple myeloma (&lt;0.01 or &gt;100) (WK=0.84).<br />Conclusions: Although there are statistical differences between the measurements performed by the two instruments, these do not affect the diagnostic agreement, that is excellent. Nevertheless, the turbidimeter is provided with a software that can automatically detect the antigen excess; by diluting further the samples automatically, it performs fewer dilutions than the nephelometer and provides a wider range of measurement, especially for low concentrations. These characteristics assist the operator both during the analysis and the validation phases of the results, saving time and resources. On the basis of the results of the study, it can be concluded that the turbidimeter shows better performances compared to the nephelometer.</p>
Biochimica Clinica ; 44(2) 149-156
Contributi Scientifici - Scientific Papers
 
Una malattia neurologica di difficile inquadramento
A neurological disease difficult to classify
<p>We describe a case of a 32 year old woman visiting to the NeurologyUnit with progressive bi-frontal headache and reduced visual acuity followed by disequilibrium and dysarthria.<br />Cerebrospinal fluid (CSF) analysis documented pleyocitosis with slight CSF-blood-barrier damage.<br />Routine laboratory tests that were all negative except for the presence of serum anti-myelin oligodendrocyteglycoprotein (MOG) antibody.<br />Thanks to the laboratory test results, neurologists could classified the patient as a case of encephalomyelitis anti-MOG antibody related and have treated her with methylprednisolone followed by Rituximab with clinical improvementand reduction of brain lesion.<br />Anti-MOG antibody associated to encephalomyelitis is currently considerated as a distinct nosologic entityimmunopathogenetically identifiable among the neuromyelitis spectrum disorders.<br />The case illustrated here underlines the central role of the clinical laboratory for the correct diagnosis of demyelinatingnervous system diseases.</p>
Biochimica Clinica ; 43(3) e28-e30
Casi Clinici - Case Report
 
Efficacia e utilità del monitoraggio terapeutico di autoanticorpi e farmaci inibitori del Tumor Necrosis Factor alpha in pazienti in trattamento per patologie autoimmuni
Therapeutic monitoring of autoantibodies Tumor Necrosis Factor α inhibitor drugs: efficacy and benefit for patients with autoimmune diseases
<p>Therapeutic monitoring of autoantibodies Tumor Necrosis Factor &alpha; inhibitor drugs: efficacy and benefit for patients with autoimmune diseases. Tumor necrosis factor alpha (TNF&alpha;) is a proinflammatory cytokine involved in the pathogenesis of chronic inflammatory disease, such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Chron&rsquo;s disease and ulcerative colitis. TNF&alpha; inhibitors (anti-TNF&alpha;) are monoclonal antibodies drugs directed against TNF&alpha; (i.e. adalimumab, infliximab, etarnecept, golimumab and certolizumab). Their effect consists in reducing the inflammatory response of autoimmune diseases. Several randomized controlled trials and observational studies evaluated the therapeutic efficacy of these drugs and reported a clear benefit for patients affected by chronic inflammatory disease treated with anti-TNF&alpha;, but also a high risk of reactions and infections in the injection site. These drugs are immunogenic, and consequent anti-drug antibodies (ADA) formation may decrease the functional drug concentration resulting in a loss of response. Therefore, we evaluated the impact of ADA on therapeutic response through meta-analyses, showing that detectable ADA significantly reduced TNF&alpha; inhibitors response. ADA could interfere with drugs and compromise their effects, so the determination of serum ADA levels could improve the patient&rsquo;s management. Even if the decrease of therapeutic response, due to ADA production, is well documented, the clinical benefit of serum ADA determination remains unclear. At the moment, there are many indications about the use of immunogenicity test to guide the therapy, but more information should be acquired before implementing this test in clinical practice.</p>
Biochimica Clinica ; 42(3) 266-273
Documenti SIBioC - SIBioC Documents
 
Interferenze da farmaci biologici: un caso di accumulo di Bevacizumab
Interference by biological anti-cancer drugs: the case of Bevacizumab
<p>We report a case of interference with electrophoretic (CZE) and immunofixation (IFE) techniques after repeated cycles of a biological anti-cancer drug. A man, with colon neoplasia, underwent a prolonged therapy with Bevacizumab and other chemoterapeutic agents from September 2013 until May 2015. Before therapy, the electrophoretic pattern was normal while, during treatment, it showed a modification suggestive of the presence of a monoclonal component (MC) that was possible to type (IgG <span style="font-family:symbol; font-size:11.0pt">k</span>) and to quantify (8 g/L) after 22 cycles of therapy. The cooperation with clinicians and our study about biological drugs, allowed us to recognize this MC as an interference due to the accumulation of Bevacizumab in the serum of the patient. The laboratory report of a MC would have involved the patient in further procedures that are invasive, cost and time expensive. This case emphasizes the importance of a strict collaboration between physicians and the clinical laboratory in the management of patients treated with biological drugs.</p>
Biochimica Clinica ; 42(1) e05-e07
Casi clinici - Case report
 
Determinazione e utilizzo clinico di autoanticorpi e/o di profili autoanticorpali nelle malattie epatiche autoimmuni – aggiornamento 2021
<p>Description and clinical use of autoantibody determination in autoimmune liver diseases &ndash; update 2021, on behalf of the Study Group &ldquo;Autoimmune Diseases&rdquo; of the Italian Society of Clinical Biochemistry. The autoantibody assessment in the field of autoimmune liver disease is crucial both for diagnosis and prognosis. Although these autoantibodies are sometime present even in the normal healthy individuals, their presence is a prerequisite to diagnose autoimmune hepatitis (AIH) and primary biliary cholangitis (PBC); some of these autoantibodies are included in the diagnostic scoring system for these diseases. The laboratory diagnostics of autoimmune liver diseases, traditionally carried out using indirect immunofluorescence testing (IFT) on rodent tissue slices, has achieved substantial improvements due to innovative analytical opportunities, such as ELISA-based diagnostic assay and Multiple Immunodot Liver profile test based on recombinant or purified antigens. The aim of this document is to highlight the crucial role of the new antigen specific tests for a better diagnostic strategy in the field of the three major autoimmune liver diseases AIH, PBC and Primary sclerosing cholangitis (PSC).</p>
Biochimica Clinica ; 17(1)
Documenti - Documents