👤 Alessandro Ottaiano

Statins are crucial for both the prevention and management of atherosclerotic cardiovascular disease (ASCVD). However, even with optimized statin therapy, a significant residual risk of ASCVD remains, highlighting the need for innovative approaches to lipid-lowering therapies (LLT) that more effectively target low-density lipoprotein cholesterol (LDL-C) and other atherogenic lipoproteins. Recently, novel pharmacologic agents have been introduced for the management of dyslipidemia. Bempedoic acid, an inhibitor of ATP citrate lyase, has emerged as a promising alternative for patients who exhibit statin intolerance. Moreover, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have transformed the management of hypercholesterolemia by reducing LDL-C levels. PCSK9 is a protein that mediates LDL receptor degradation; its inhibition enhances LDL receptor recycling, facilitating increased LDL-C uptake. New antisense oligonucleotides targeting apolipoprotein C3 (apoC3), ANGPTL3, and lipoprotein(a) have demonstrated significant reductions in these molecules, offering potential therapeutic advantages for certain dyslipidemias. Ongoing research is also evaluating apolipoprotein A1 (apoA1) to leverage the protective effects of high-density lipoprotein cholesterol (HDL-C), though conclusive clinical evidence is still required. This review examines the mechanisms and clinical efficacy of emerging LLT other than statins, focusing on bempedoic acid and PCSK9 inhibitors. Bempedoic acid acts upstream in the cholesterol biosynthesis pathway, offering a potentially safer option for patients intolerant to statins. PCSK9 inhibitors enhance LDL receptor recycling, significantly lowering LDL-C levels and reducing cardiovascular risk. A deeper understanding of these mechanisms is essential for the advancement of therapeutic strategies in dyslipidemia and cardiovascular disease management. Show less

We introduce an innovative, non-invasive prenatal screening approach for detecting fetal monogenic alterations and copy number variations (CNVs) from maternal blood. Circulating free DNA (cfDNA) was extracted from maternal peripheral blood and processed using the VeriSeq NIPT Solution (Illumina, San Diego, CA, USA), with shallow whole-genome sequencing (sWGS) performed on a NextSeq550Dx (Illumina). A customized gene panel and bioinformatics tool, named the "VERA Revolution", were developed to detect variants and CNVs in cfDNA samples. Results were compared with genomic DNA (gDNA) extracted from fetal samples, including amniotic fluid and chorionic villus sampling and buccal swabs. The study included pregnant women with gestational ages from 10 + 3 to 15 + 2 weeks (mean: 12.1 weeks). The fetal fraction (FF), a crucial measure of cfDNA test reliability, ranged from 5% to 20%, ensuring adequate DNA amount for analysis. Among 36 families tested, 14 showed a wild-type genotype. Identified variants included two deletions (22q11.2, and 4p16.3), two duplications (16p13 and 5p15), and eighteen single-nucleotide variants (one in The "VERA Revolution" test highlights advancements in prenatal genomic screening, offering potential improvements in prenatal care. Show less

Cholangiocarcinoma (CCA) is a malignant neoplasm arising in the epithelium of the biliary tract. It represents the second most common primary liver cancer in the world, after hepatocellular carcinoma, and it constitutes 10-15% of hepatobiliary neoplasms and 3% of all gastrointestinal tumors. As in other types of cancers, recent studies have revealed genetic alterations underlying the establishment and progression of CCA. The most frequently involved genes are Show less