Purpose The Novara Cohort Study (NCS) was established to investigate the biological, psychological and social factors that influence ageing in the general population. The study aims to identify early risk factors for frailty, allostatic load and cognitive decline, and to uncover molecular and functional markers of accelerated biological ageing. NCS addresses the need for detailed life-course data from Southern Europe to support personalised prevention and early diagnosis, and to promote healthy longevity.Participants NCS is a population-based, longitudinal cohort in the Novara province (Northern Italy), originally enrolling adults aged 35 and older. The inclusion criteria were later expanded to encompass all residents aged 18 and over, facilitating the study of ageing trajectories from early adulthood onward. As of mid-2025, about 1000 participants have been enrolled, and recruitment is ongoing. The cohort’s diversity in age, employment status and health conditions enhances its value for life-course analysis.Findings to date Following a pilot phase in 2022–2023, the whole study protocol now includes detailed demographic, clinical, behavioural, cognitive and psychosocial data, along with biological samples stored in the UPO Biobank. The protocol incorporates validated tools, comprehensive physical and cognitive assessments, and over 90 laboratory biomarkers covering inflammation, metabolism, hormonal function and coagulation. Additionally, a subset of participants underwent advanced inflammatory profiling by simultaneous measurement of 92 immune-related proteins and comprehensive genomic profiling using Illumina Single Nucleotide Polymorphism (SNP) arrays, capturing common genetic variation across multiple biological domains. Preliminary results demonstrate the feasibility of integrating deep phenotyping, reveal the roles of frailty in ageing and show initial evidence of age-related changes in inflammatory proteins.Future plans NCS plans to enrol at least 10 000 participants and will conduct long-term follow-up using both passive methods, such as linking with clinical records and administrative health databases, and active in-person reassessments. Future phases will integrate clinical, behavioural and cognitive data with large-scale omics analyses, including genomics, proteomics, metabolomics and transcriptomics. Machine learning techniques will be employed to model biological age, identify early signs of age-related decline and develop personalised prevention strategies. By combining high-resolution phenotyping with multidimensional data, NCS aims to find modifiable risk factors and molecular signatures of ageing, supporting national and European research efforts and encouraging collaborative studies through open data-sharing frameworks.

Research into effective predictive markers and therapeutic interventions for COVID-19 remains of considerable interest. Vitamin D may be relevant, especially in frail populations in whom deficiency is more prevalent. In this prospective observational cohort study, 139 patients with moderate-to-severe COVID-19 who were hospitalized during the third wave of the pandemic in Italy were enrolled. Plasma vitamin D concentrations (both 25-hydroxyvitamin D-25(OH)D and 1,25-dihydroxyvitamin D-1,25(OH)2D) together with parathyroid hormone levels were measured using a chemiluminescent assay validated for clinical use on automated laboratory platforms. Plasma vitamin D levels were below the sufficiency threshold. Notably, 25(OH)D concentrations were significantly lower in patients who experienced a negative outcome (11.10 [8.80-16.20] vs. 15.25 [9.90-24.80] ng/mL, p = 0.0450) and significantly higher in patients with rapid clinical recovery (15.25 [10.70-24.80] vs. 13.30 [7.47-19.60] ng/mL, p = 0.0446) compared with all other patients. Through multivariable logistic regression analysis, higher 25(OH)D levels at the time of hospitalization were confirmed as an independent predictor of favorable outcome. A plasma 25(OH)D concentration above 11.10 ng/mL predicted favorable disease resolution, with a positive likelihood ratio of 1.40 (IQR: 1.05-1.87). In conclusion, our findings support plasma vitamin D levels as an independent predictor of clinical outcomes in patients hospitalized with COVID-19 pneumonia.

BACKGROUND:Early prognostic stratification of septic patients at hospital admission is challenging, especially in the elderly. Considering the well-known immunomodulatory effects of vitamin D and its common deficiency among elderly, we aimed to evaluate if vitamin D plasma levels (25(OH)D) at hospital admission could be a prognostic biomarker in septic patients. METHODS:Secondary analysis of data and samples from the multicenter Need-Speed trial, a multicenter study involving the emergency and internal medicine wards of five Italian hospitals. 1132 consecutive patients admitted to hospital with suspected sepsis were enrolled. 859 were confirmed to have sepsis at the end of the diagnostic work-up and 829 patients were included in the analysis. 25(OH)D at admission was measured using an automated chemiluminescence assay. RESULTS:Among the 829 patients included (median age 81 years [IQR: 72-87]), severe hypovitaminosis D was observed (median 11.2 ng/mL [IQR: 8.0-19.4]). At univariate analysis, baseline 25(OH)D levels were significantly lower in patients who died at 30 and 90 days and higher among patients discharged alive within 15 days (p < 0.05). Multivariate models confirmed 25(OH)D as an independent predictor of 90-day mortality and of discharge alive at 15 days (p < 0.05). Moreover, a 25(OH)D threshold of 12 ng/mL independently predicted both survival at 90 days (OR: 0.5961 [0.4068-0.8735]) and discharge alive at 15 days (OR: 1.6055 [1.1738-2.1960]). CONCLUSIONS:Lower 25(OH)D levels were independently associated with poorer clinical outcomes in older patients with sepsis. Therefore, hypovitaminosis D assessment may provide prognostic value beyond validated risk stratification tools, warranting prospective validation.

BACKGROUND:Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to widespread post-acute sequelae of COVID-19 (PASC), affecting multiple body systems. Despite its prevalence, PASC's pathogenesis remains unclear, with hypotheses suggesting viral persistence, immune activation, and autoimmune responses among the pathogenetic mechanism. This study aimed to evaluate T cell memory response in PASC patients, one year post-hospital discharge and correlate it with clinical parameters to identify a potential PASC-associated fingerprint. METHODS:Peripheral blood mononuclear cells (PBMCs) from PASC patients and healthy controls (HC) were stimulated with a pool of spike peptides. CD4+ and CD8+ T cell responses were evaluated by flow cytometry using the activation-induced markers assay (AIM). RESULTS:Findings showed significant activation of the CD4+ T cell compartment, with a higher proportion of responders among PASC patients. Central memory (CM) T cells expressing pro-inflammatory cytokines were more prevalent in responders. Clinical correlations revealed higher SARS-CoV-2-specific T cell responses in patients with reduced diffuse lung capacity for carbon monoxide (DLCO) and residual symptoms. CONCLUSION:These immune changes, especially in CM T cells, could play a pivotal role in PASC's development and persistence, impacting patients' daily lives.

INTRODUCTION:The use of artificial intelligence in hematology laboratories has improved the diagnostic evaluation of peripheral blood cells. The aim of this study is to compare the performance of two automated digital cell morphology analyzers, the Mindray MC-80 and the West Medical Vision Hema Pro, with manual microscopy, the gold standard, for leukocyte differentiation in patients with hematologic malignancies and infections. METHODS:Peripheral blood smears from 75 patients were analyzed, including cases of acute lymphoblastic leukemia (ALL, 4), chronic lymphocytic leukemia (CLL, 20), acute myeloid leukemia (AML, 20), chronic myeloid leukemia (CML, 5), other lymphoproliferative disorders (LPD, 20), and infections (6). The agreement between microscopy, Vision Hema, and MC-80 was assessed by Bland-Altman analysis for eight leukocyte populations (neutrophils, lymphocytes, monocytes, eosinophils, basophils, band cells, myelocytes, and metamyelocytes). RESULTS:Vision Hema demonstrated better agreement with manual microscopy for eight normally expected leukocyte populations (neutrophils, lymphocytes, monocytes, eosinophils, basophils, band cells, myelocytes, and metamyelocytes), whereas MC-80 exhibited greater biases, particularly in lymphocytes, basophils, and immature granulocytes. For pathologic cells, VH significantly overestimated blasts, while MC-80 classified them more accurately, showing better agreement with manual microscopy in acute leukemias. Additionally, MC-80 showed potential clinical value in detecting abnormal lymphocytes and promyelocytes, which may be relevant for hematologic malignancies. CONCLUSION:Vision Hema provides more reliable classification of normally expected leukocyte populations, while MC-80 shows advantages in detecting abnormal cells, particularly in hematologic malignancies.

Objectives: Personalized medicine emphasizes prevention and early diagnosis by developing genetic screening and biomarker assessment tools. Biobanks, including University of Piemonte Orientale (UPO) Biobank, support this effort by providing high-quality biological samples collected, processed, and stored using optimized standardized protocols. To determine the optimal long-term storage conditions for biospecimens used in biomedical research, we evaluated plasma and serum samples cryopreserved using two storage methods, cryovials and straws, across various analytical methodologies with differing sensitivity and robustness. Design and Methods: Plasma and serum samples cryopreserved in liquid nitrogen in vials and straw at the UPO Biobank were subjected to multiple analyses including standard biochemical laboratory analysis, targeted lipidomics, untargeted proteomics, and targeted metabolites quantification through mass spectrometry-based analytical techniques. Results: Our data demonstrate the robustness and applicability of both storage methods for standard laboratory analyses in evaluating clinically relevant markers in plasma and serum. Lipidomic analysis revealed slight disparities in lipid abundance, though these differences were mostly confined to specific lipid species, particularly fatty acids. Conversely, proteomic and metabolomic analyses uncovered variations in abundance in a significant, albeit limited, fraction of analytes between vials and straw-derived samples. Conclusions: By highlighting similarities and differences in samples stored in these conditions, this study provides significant insights into optimizing biobanking practices and understanding the factors that influence the integrity of cryopreserved biospecimens and the reliability of the data derived from them. Both straws and vials are convenient and efficient cryopreservation methods, essentially equivalent for samples dedicated to robust and relatively low-sensitive standardized analyses. However, our findings emphasize the need for caution when interpreting omics data from samples subjected to different cryopreservation methods, as subtle variations can arise even with different types of containers.

Sickle cell disease (SCD) is a severe hereditary hemoglobinopathy with the highest burden in sub-Saharan Africa. Timely diagnosis via newborn screening is critical to enabling low-cost, life-saving interventions, yet its implementation remains inconsistent worldwide. This study assessed the performance and analytical stability of dried blood spot (DBS) samples collected on Guthrie cards for quantifying hemoglobin S (Hb S), using three high-performance liquid chromatography (HPLC) platforms and one capillary electrophoresis system. Simulated neonatal samples at three Hb S concentrations (non-carrier, carrier, and affected) were analyzed at three timepoints (immediate, 1 week, and 2 weeks post-collection). Across all methods, Hb S quantification was highly reproducible, with inter-timepoint variation remaining within the predefined critical threshold for the vast majority of the measurements. While minor discrepancies were observed for fetal hemoglobin (Hb F), all methods correctly classified samples for SCD screening purposes. These findings confirm that Guthrie card-based DBS is a robust and practical matrix for Hb S detection, suitable for transport and delayed analysis-even across different analytical platforms. Limitations include the use of spiked rather than native SCD neonatal samples and ambient-temperature shipping. Nonetheless, the results support broader adoption of DBS in SCD screening programs, particularly in low-resource or decentralized settings, and highlight the need for further standardization of Hb F quantification.

The Novara Cohort Study (NCS) is the first multidisciplinary cohort study on aging in Northern Italy. It is designed to explore aging trajectories and health outcomes in the general population. This study involves the collection of biological samples and extensive data, including socioeconomics, medical history, lifestyle habits, quality of life, and physical function. This paper outlines the rationale, objectives, and preliminary findings of the NCS pilot phase. It discusses baseline characteristics, initial biological characterization, and identifies key areas for improvement to ensure the successful implementation of the full-scale study. The NCS pilot phase enrolled participants aged 35 and older residing in Novara, Italy. The study involved the collection of biological samples, medical examinations, questionnaires, and functional tests. Data collected included demographic information, physical activity, sleep quality, diet, quality of life, mental health, medical history, and medication use. Key blood parameters were analyzed alongside clinical data.The pilot phase enrolled 123 participants, 68 (55.3%) females and 55 (44.7%) males with a median age of 65 years old. The NCS pilot participants had higher education levels, lower smoking rates, and higher physical activity levels than the general population. Blood biomarker profiling revealed significant variability across participants, offering exploratory and preliminary findings to guide the design and implementation of the larger cohort phase aimed at studying aging trajectories. The NCS pilot provided valuable initial insights into participant characteristics and identified areas for study protocol enhancement. These findings will guide refinements to optimize future study processes and outcomes, ultimately aimed at investigating the biological, social, and environmental determinants of aging in the Northern Italy area population.

Drepanocytosis is a genetic disease relevant for its epidemiological, clinical and socio-economic aspects. In our country the prevalence is highly uneven with peaks in former malaria areas, but migration flows in recent years have led to significant changes. In this document we review the screening programs currently existing in Italy with particular emphasis on newborn screening, which in other countries around the world, including within Europe, is at most universal and mandatory. The essential laboratory issues are reviewed, from sampling aspects (cord blood or peripheral), to the analytical (analytical methods dedicated to neonatal screening and adult carrier detection) and post analytical (reporting, informative) ones. An economic analysis based on data collected in the province of Modena is also proposed, clearly showing that neonatal screening is also beneficial from an economic point of view.

Inducible T-cell costimulator (ICOS, CD278) is a costimulatory receptor primarily expressed by activated T cells. It binds to ICOS ligand (ICOSL, CD275), which is expressed by various immune and non-immune cell types, particularly in inflamed tissues. ICOSL can also bind to osteopontin (OPN), a protein that functions both as a component of the extracellular matrix and as a soluble pro-inflammatory cytokine. Previous studies, including ours, have shown that ICOS and ICOSL play a role in skin wound healing, as mice deficient in either ICOS or ICOSL exhibit delayed healing. The aim of this study was to investigate the involvement of the ICOS/ICOSL/OPN network in skin wound healing by analyzing mice that are single knockouts for ICOS, ICOSL, or OPN, or double knockouts for ICOS/OPN or ICOSL/OPN. Our results showed that wound healing is impaired in all single knockout strains, but not in the two double knockout strains. Cellular and molecular analyses of the wound healing sites revealed that the healing defect in the single knockout strains is associated with reduced neutrophil infiltration and decreased expression of α-SMA (a marker of myofibroblasts), IL-6, TNFα, and VEGF. In contrast, the normalization of wound closure observed in the double knockout strains was primarily linked to increased vessel formation. A local treatment with recombinant ICOS-Fc improved healing in all mouse strains expressing ICOSL, but not in those lacking ICOSL, and led to a local increase in vessel formation and macrophage recruitment, predominantly of the M2 type.

Thrombosis is a multifaceted process involving various molecular components, including the coagulation cascade, platelet activation, platelet–endothelial interaction, anticoagulant signaling pathways, inflammatory mediators, genetic factors and the involvement of various cells such as endothelial cells, platelets and leukocytes. A comprehensive understanding of the molecular signaling pathways and cell interactions that play a role in thrombosis is essential for the development of precise therapeutic strategies for the treatment and prevention of thrombotic diseases. Ongoing research in this field is constantly uncovering new molecular players and pathways that offer opportunities for more precise interventions in the clinical setting. These molecular insights into thrombosis form the basis for the development of targeted therapeutic approaches for the treatment and prevention of thrombotic disease. The aim of this review is to provide an overview of the pathogenesis of thrombosis and to explore new therapeutic options.

Background/Objectives: The latest WHO classification underscores the importance of the complete blood count (CBC) and cell morphology assessment in diagnosing lymphoid neoplasms. This study evaluated the diagnostic role of Research Use Only (RUO) parameters from the BC-6800 Plus Mindray analyzer in differentiating cell chronic lymphocytic leukemia (CLL), acute lymphoblastic leukemia (ALL), and other lymphoproliferative disorders. Methods: CBCs were performed on 90 patients (66% male, median age 67 years) with pathological blood counts (ALL, n=14; CLL, n=47; other lymphoproliferative disorders, n=29) at Novara’s University Hospital. Univariable and multivariable logistic regression assessed the association of basic (WBC, Hb, RDW, NE#, LY#, MO#, PLT) and research cell parameters (NLR, NMR, LMR, NeuX, NeuY, NeuZ, LymX, LymY, LymZ, MonX, MonY, MonZ). Results: In multivariable analysis, Hb (p=0.02), NeuY (p=0.04), and MonY (p=0.01) independently predicted CLL versus ALL, correctly classifying 93.4% of cases (AUC 0.91, 95% CI 0.81-1.0). MO# (p=0.003), LymY (p<0.0001), and MonY (p=0.004) were independent predictors of CLL versus other lymphoproliferative disorders, classifying 77.6% of cases (AUC 0.86, 95% CI 0.78-0.95). NeuZ (p=0.01) and NeuY (p=0.04) independently predicted ALL versus other lymphoproliferative disorders, classifying 93% of cases (AUC 0.98, 95% CI 0.95-1.0). Conclusions: The use of RUO parameters offers valuable, cost-effective support in the early diagnosis of ALL, CLL, and other lymphoproliferative disorders.

Background: Dabigatran etexilate is a pro-drug hydrolyzed into dabigatran by carboxylesterases (CES) and is a substrate of the P-Glycoprotein encoded by the adenosine-triphosphate-binding cassette sub-family B member (ABCB)1 genes. We evaluated the functional response to dabigatran according to different CES1 and ABCB1 single-nucleotide polymorphisms (SNPs) in patients with atrial fibrillation (AF). Methods: A total of 100 consecutive patients with AF taking dabigatran were enrolled by two Italian centers. A venous blood sample was drawn for genetic determinations, as well as a measurement of the diluted thrombin time (dTT) and drug plasma concentrations, at the trough and peak. The main objective was the relationship between the dTT values and CES1 rs2244613, CES1 rs8192935 and ABCB1 rs4148738 SNP while on two different dabigatran doses (110 and 150 mg BID). Results: A total of 43 patients were on a 110 mg dabigatran dose and 57 on 150 mg. The DTT values at the trough and at peak were not different among patients with different CES1 rs2244613 and CES1 rs8192935 genotypes, regardless of the dabigatran dose. In patients on 150 mg dabigatran, the dTT values at the trough were 77 (44-111) ng/mL in patients with the ABCB1 rs4148738 heterozygous CT genotype vs. 127 (85-147) ng/mL in the wild-type CC genotype vs. 110 (47-159) ng/mL in the mutant trait TT genotype (p = 0.048). In patients with the ABCB1 rs4148738 CT genotype, OR for having dTT values at a trough below the median was 3.21, 95% CI 1.04-9.88 (p = 0.042). Conclusions: ABCB1 rs4148738 CT heterozygous is associated with the reduced anticoagulant activity of dabigatran at the trough in patients receiving the higher dose regimen.