Cryopreservation of Hemopoietic Cells for Allotransplant: Altered Immune Cell Subsets and Clinical Implications Anna Maria Raiola, Paola Contini, Massimiliano Gambella, Luca Barabino, Stefania Bregante, et al. American Journal of Hematology, 2026 Cryopreservation of allogeneic peripheral blood stem cells was widely adopted during the SARS‐CoV‐2 pandemic. We evaluated transplant‐related complications and graft product composition in a retrospective ( n = 62) and prospective ( n = 47) series of patients transplanted from an HLA‐identical donor comparing cryopreserved ( n = 50) versus fresh ( n = 59) peripheral blood stem cell grafts. Primary endpoints were hematological reconstitution and cumulative incidence of grade II–IV acute graft versus host disease. Median times to neutrophil and platelet recovery were longer in the cryopreserved group compared with the fresh group: 18 vs. 16 days ( p < 0.001) and 20 vs. 14 days ( p < 0.001), respectively. The cumulative incidence of grade II–IV acute graft versus host disease at day 100 and of poor graft function at 1 year was significantly higher in the cryopreserved group: 34% vs. 10.1%, ( p = 0.0017) and 20% vs. 1.6% ( p < 0.001), respectively. To characterize immune cell profiles in fresh and cryopreserved samples, a representative subset was analyzed by mass cytometry, revealing a higher number of T‐cell populations known to modulate immune responses and promote graft engraftment in fresh samples. Thus, cryopreservation of allogeneic peripheral blood stem cells is associated with increased incidence of acute graft versus host disease and poor graft function.
Notch4 regulatory T cells and SARS-CoV-2 viremia shape COVID19 survival outcome Mehdi Benamar, Peggy S. Lai, Ching‐Ying Huang, Qian Chen, Fatma Betul Oktelik, et al. Allergy European Journal of Allergy and Clinical Immunology, 2025 BackgroundImmune dysregulation and SARS‐CoV‐2 plasma viremia have been implicated in fatal COVID‐19 disease. However, how these two factors interact to shape disease outcomes is unclear.MethodsWe carried out viral and immunological phenotyping on a prospective cohort of 280 patients with COVID‐19 presenting to acute care hospitals in Boston, Massachusetts and Genoa, Italy between June 1, 2020 and February 8, 2022. Disease severity, mortality, plasma viremia, and immune dysregulation were assessed. A mouse model of lethal H1N1 influenza infection was used to analyze the therapeutic potential of Notch4 and pyroptosis inhibition in disease outcome.ResultsStratifying patients based on %Notch4+ Treg cells and/or the presence of plasma viremia identified four subgroups with different clinical trajectories and immune phenotypes. Patients with both high %Notch4+ Treg cells and viremia suffered the most disease severity and 90‐day mortality compared to the other groups even after adjusting for baseline comorbidities. Increased Notch4 and plasma viremia impacted different arms of the immune response in SARS‐CoV‐2 infection. Increased Notch4 was associated with decreased Treg cell amphiregulin expression and suppressive function whereas plasma viremia was associated with increased monocyte cell pyroptosis. Combinatorial therapies using Notch4 blockade and pyroptosis inhibition induced stepwise protection against mortality in a mouse model of lethal H1N1 influenza infection.ConclusionsThe clinical trajectory and survival outcome in hospitalized patients with COVID‐19 is predicated on two cardinal factors in disease pathogenesis: viremia and Notch4+ Treg cells. Intervention strategies aimed at resetting the immune dysregulation in COVID‐19 by antagonizing Notch4 and pyroptosis may be effective in severe cases of viral lung infection.
Evaluation of Frequency of CMV Replication and Disease Complications Reveals New Cellular Defects and a Time Dependent Pattern in CVID Patients Luca Marri, Paola Contini, Federico Ivaldi, Chiara Schiavi, Ottavia Magnani, et al. Journal of Clinical Immunology, 2024 Purpose Common Variable Immunodeficiency (CVID) is characterized by hypogammaglobulinemia and failure of specific antibody production due to B-cell defects. However, studies have documented various T-cell abnormalities, potentially linked to viral complications. The frequency of Cytomegalovirus (CMV) replication in CVID cohorts is poorly studied. To address this gap in knowledge, we set up an observational study with the objectives of identifying CVID patients with active viraemia (CMV, Epstein-Barr virus (EBV)), evaluating potential correlations with immunophenotypic characteristics, clinical outcome, and the dynamic progression of clinical phenotypes over time. Methods 31 CVID patients were retrospectively analysed according to viraemia, clinical and immunologic characteristics. 21 patients with non CVID humoral immunodeficiency were also evaluated as control. Results Active viral replication of CMV and/or EBV was observed in 25% of all patients. CMV replication was detected only in CVID patients (16%). CVID patients with active viral replication showed reduced HLA-DR+ NK counts when compared with CMV-DNA negative CVID patients. Viraemic patients had lower counts of LIN−DNAMbright and LIN−CD16+ inflammatory lymphoid precursors which correlated with NK-cell subsets. Analysis of the dynamic progression of CVID clinical phenotypes over time, showed that the initial infectious phenotype progressed to complicated phenotypes with time. All CMV viraemic patients had complicated disease. Conclusion Taken together, an impaired production of inflammatory precursors and NK activation is present in CVID patients with active viraemia. Since “Complicated” CVID occurs as a function of disease duration, there is need for an accurate evaluation of this aspect to improve classification and clinical management of CVID patients.
Clinical Characteristics of Systemic Lupus Erythematosus in Caucasians and Latin American Hispanics: Data from a Single Tertiary Center Luca Marri, Chiara Vassallo, Pasquale Esposito, Luca Bottaro, Raffaele De Palma, et al. Autoimmune Diseases, 2024 Background. Different studies report that systemic lupus erythematosus (SLE) tends to have a more aggressive course in Hispanic patients. In this study, we analysed epidemiologic, clinical, and laboratory characteristics in a cohort of Hispanic and Caucasian lupus patients in the context of Italian health service, which provides free access to care to all citizens, thus mitigating the impact of socioeconomic factors that negatively influence the course of the disease in ethnic minorities. Methods. This single‐center retrospective study was conducted at the San Martino Hospital “Lupus Clinic” in Genoa, Italy. Patients ≥18 years with a confirmed diagnosis of SLE and definite ethnicity (Hispanic or Caucasian) were recruited. Results. A total of 126 patients (90 Caucasians and 36 Hispanics) were enrolled. We compared epidemiologic characteristics, clinical features, autoantibodies profile, and treatment options without evidencing any statistically significant difference between the two groups, except for disease duration, which was higher in the Caucasian group (20.4 years versus 14.2 years in the Hispanic group, P = 0.002) and SLICC damage index, which was greater in Caucasian patients (2.11 versus 1.88 in Hispanics, P = 0.037), but this difference was no longer significant after correction for disease duration (P = 0.096). Conclusions. In our cohort, Hispanic ethnicity is not associated with worse disease features and outcomes. Therefore, we speculated that socioeconomic factors, in particular, free access to healthcare, might be more relevant in influencing the course of the disease than genetic background.
Arterial thrombosis triggered by methotrexate-induced hyperhomocysteinemia in a systemic lupus erythematosus patient with antiphospholipid antibodies Chiara Schiavi, Luca Marri, Simone Negrini Thrombosis Journal, 2023 Systemic lupus erythematosus (SLE) patients have an increased risk of cardiovascular disease and thrombotic events, and the presence of antiphospholipid antibodies further raises the risk of these complications. Here we report a case of a patient with SLE and triple positivity for antiphospholipid antibodies who developed a popliteal artery thrombosis in the context of a severe hyperhomocysteinemia after the introduction of methotrexate (MTX) treatment. MTX is one of the most prescribed medications for a wide spectrum of autoimmune diseases, including SLE. On the other hand, by interfering with folate metabolism, it may induce hyperhomocysteinemia, which, in turn, may increase the risk of vascular complications. Current recommendations suggest screening and, when possible, treating classical and disease-related cardiovascular risk factors in all lupus patients. Based on what observed in our case, we suggest a follow-up of homocysteine levels after the introduction of drugs capable of inducing hyperhomocysteinemia, such as MTX, in SLE patients at high cardiovascular risk.
Recurrence of COVID-19 related symptoms and viral detection in a patient discharged after complete recovery and test negativization Chiara Vassallo, Francesca Pupo, Luca Marri, Chiara Schiavi, Francesca Giusti, et al. Italian Journal of Medicine, 2021 Since the novel coronavirus disease 2019 (COVID-19) has been declared a pandemic, the possibility of recurrence of the disease after recovery has become a debated issue. We report a case of an 84-years-old male patient who was admitted to our hospital for dyspnea and fever. Lab and clinical workout showed that he had COVID-19. After a full recovery of symptoms and a double negative nasopharyngeal swab of severe acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) by realtime polymerase chain reaction assay, he was discharged from the hospital. One month later, he developed dyspnea and fever again with lung involvement. Surprisingly, the nasopharyngeal swab of SARS-CoV-2 was positive. Since he denied contacts with confirmed or suspected cases of COVID-19, he probably experienced a reactivation of a persistent infection. The failed eradication of the virus could depend on both virus’ escape mechanisms and dysfunctional immune response. Further studies are needed to confirm the hypothesis of viral reactivation and identify signs of an incomplete clearance.
RECENT SCHOLAR PUBLICATIONS
Cryopreservation of Hemopoietic Cells for Allotransplant: Altered Immune Cell Subsets and Clinical Implications AM Raiola, P Contini, M Gambella, L Barabino, S Bregante, C Di Grazia, ... American Journal of Hematology 101 (5), 1036-1044 , 2026 2026
Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence … S Peruzzo, L Tagliafico, S Ottaviani, F Della Rovere, C Marani, M Mattioli, ... Maturitas, 108928 , 2026 2026
Splenomegaly in CVID patients associates with CMV replication and alterations of immune cells and functions L Marri, P Contini, F Ivaldi, C Schiavi, O Magnani, C Vassallo, A Guastalla, ... Immunology Letters 276, 107058 , 2025 2025
Notch4 regulatory T cells and SARS‐CoV‐2 viremia shape COVID19 survival outcome M Benamar, PS Lai, CY Huang, Q Chen, FB Oktelik, P Contini, M Wang, ... Allergy 80 (2), 557-569 , 2025 2025 Citations: 3
Evaluation of frequency of CMV replication and disease complications reveals new cellular defects and a time dependent pattern in CVID patients L Marri, P Contini, F Ivaldi, C Schiavi, O Magnani, C Vassallo, A Guastalla, ... Journal of Clinical Immunology 44 (6), 142 , 2024 2024 Citations: 4
Clinical Characteristics of Systemic Lupus Erythematosus in Caucasians and Latin American Hispanics: Data from a Single Tertiary Center L Marri, C Vassallo, P Esposito, L Bottaro, R De Palma, S Negrini Autoimmune Diseases 2024 (1), 5593302 , 2024 2024 Citations: 2
Analisi della replicazione virale di Citomegalovirus e del virus di Epstein-Barr su sangue periferico in una coorte di pazienti affetti da Immunodeficienza Comune Variabile … L Marri Università degli studi di Genova , 2023 2023
Arterial thrombosis triggered by methotrexate-induced hyperhomocysteinemia in a systemic lupus erythematosus patient with antiphospholipid antibodies C Schiavi, L Marri, S Negrini Thrombosis journal 21 (1), 113 , 2023 2023 Citations: 7
Notch4 signaling limits regulatory T-cell-mediated tissue repair and promotes severe lung inflammation in viral infections H Harb, M Benamar, PS Lai, P Contini, JW Griffith, E Crestani, ... Immunity 54 (6), 1186-1199. e7 , 2021 2021 Citations: 136
Recurrence of COVID-19 related symptoms and viral detection in a patient discharged after complete recovery and test negativization C Vassallo, F Pupo, L Marri, C Schiavi, F Giusti, M Greco, S Negrini, ... Italian Journal of Medicine 15, 67-70 , 2021 2021 Citations: 1
MOST CITED SCHOLAR PUBLICATIONS
Notch4 signaling limits regulatory T-cell-mediated tissue repair and promotes severe lung inflammation in viral infections H Harb, M Benamar, PS Lai, P Contini, JW Griffith, E Crestani, ... Immunity 54 (6), 1186-1199. e7 , 2021 2021 Citations: 136
Arterial thrombosis triggered by methotrexate-induced hyperhomocysteinemia in a systemic lupus erythematosus patient with antiphospholipid antibodies C Schiavi, L Marri, S Negrini Thrombosis journal 21 (1), 113 , 2023 2023 Citations: 7
Evaluation of frequency of CMV replication and disease complications reveals new cellular defects and a time dependent pattern in CVID patients L Marri, P Contini, F Ivaldi, C Schiavi, O Magnani, C Vassallo, A Guastalla, ... Journal of Clinical Immunology 44 (6), 142 , 2024 2024 Citations: 4
Notch4 regulatory T cells and SARS‐CoV‐2 viremia shape COVID19 survival outcome M Benamar, PS Lai, CY Huang, Q Chen, FB Oktelik, P Contini, M Wang, ... Allergy 80 (2), 557-569 , 2025 2025 Citations: 3
Clinical Characteristics of Systemic Lupus Erythematosus in Caucasians and Latin American Hispanics: Data from a Single Tertiary Center L Marri, C Vassallo, P Esposito, L Bottaro, R De Palma, S Negrini Autoimmune Diseases 2024 (1), 5593302 , 2024 2024 Citations: 2
Recurrence of COVID-19 related symptoms and viral detection in a patient discharged after complete recovery and test negativization C Vassallo, F Pupo, L Marri, C Schiavi, F Giusti, M Greco, S Negrini, ... Italian Journal of Medicine 15, 67-70 , 2021 2021 Citations: 1
Cryopreservation of Hemopoietic Cells for Allotransplant: Altered Immune Cell Subsets and Clinical Implications AM Raiola, P Contini, M Gambella, L Barabino, S Bregante, C Di Grazia, ... American Journal of Hematology 101 (5), 1036-1044 , 2026 2026
Polypharmacy and potentially inappropriate medications in patients requiring palliative care in hospitals and nursing homes: Evidence from a Ligurian point-prevalence … S Peruzzo, L Tagliafico, S Ottaviani, F Della Rovere, C Marani, M Mattioli, ... Maturitas, 108928 , 2026 2026
Splenomegaly in CVID patients associates with CMV replication and alterations of immune cells and functions L Marri, P Contini, F Ivaldi, C Schiavi, O Magnani, C Vassallo, A Guastalla, ... Immunology Letters 276, 107058 , 2025 2025
Analisi della replicazione virale di Citomegalovirus e del virus di Epstein-Barr su sangue periferico in una coorte di pazienti affetti da Immunodeficienza Comune Variabile … L Marri Università degli studi di Genova , 2023 2023