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Kostara M, Serbis A, Pavlou M, Kotanidou E, Tsabouri S, Vlahos A, Makis A, Siomou E. Unusual Manifestations of Kawasaki Disease in the COVID Era: A Case Series and Review of the Literature. Cureus 2023; 15:e51104. [PMID: 38274908 PMCID: PMC10809307 DOI: 10.7759/cureus.51104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/25/2023] [Indexed: 01/27/2024] Open
Abstract
Kawasaki disease (KD) is an acute medium-vessel vasculitis, mainly affecting infants older than six months and children under five years. It predisposes to the development of coronary artery aneurysms and constitutes the leading cause of acquired heart disease in children. Its diagnosis is based on clinical criteria, namely, fever lasting for ≥ five days together with at least four of the five principal clinical features of the disease. Occasionally, children with KD present with fever, but they fulfill only some of the five principal criteria, and this is described as incomplete KD. Furthermore, "atypical" KD is a term that is usually used for cases that appear with rather unusual clinical manifestations, which complicate clinical judgment and may delay diagnosis and treatment. In this case series, we present four cases of KD with rather unusual clinical features: a five-year-old boy with lobar pneumonia, a six-year-old girl with orange-brown chromonychia appearing on the 10th day of the disease, a 2.5-month-old infant with prolonged fever and urinary tract infection, and an 18-month-old infant with refractory KD and high suspicion of multisystem inflammatory syndrome in children (MIS-C). A literature review on the unusual manifestations of atypical KD was performed to identify clinical findings that must alert the clinician to consider this clinical entity.
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Affiliation(s)
- Maria Kostara
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Anastasios Serbis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Maria Pavlou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Eleni Kotanidou
- Second Department of Pediatrics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA University General Hospital, Thessaloniki, GRC
| | - Sofia Tsabouri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Antonios Vlahos
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, GRC
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Vlahos A, Rallis D, Lianou A, Baltogianni M, Dermitzaki N, Maragoudaki E, Papastergiou E, Tzallas C, Tsabouri S, Makis A, Siomou E, Milionis H, Giapros V. Serum PCSK9 levels in infants with deviant birth weight: a biomarker of the lipoprotein metabolism. J Matern Fetal Neonatal Med 2023; 36:2188108. [PMID: 36906794 DOI: 10.1080/14767058.2023.2188108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Abstract
OBJECTIVE Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9), a modulator of low-density lipoprotein (LDL) cholesterol metabolism, has been reported to be a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. In the current study, we sought to investigate potential differences in serum PCSK9 levels between infants with deviant birth weight and controls. METHODS We enrolled 82 infants, classified into 33 small (SGA), 32 appropriate (AGA), and 17 large for gestation (LGA) infants. Serum PCSK9 was measured on routine blood analysis within the first postnatal 48 h. RESULTS PCSK9 was significantly higher in SGA as compared to AGA and LGA infants [322 (236-431) as compared to 263 (217-302) and 218 (194-291) ng/ml respectively, p = .011]. In comparison to term AGA infants, PCSK9 was significantly elevated in preterm AGA and SGA infants. We also found a significantly higher level of PCSK9 in term female SGA infants as compared to term male SGA infants [325 (293-377) as compared to 174 (163-216) ng/ml, p = .011]. PCSK9 was significantly correlated with gestational age (R = -0.404, p < .001), birth weight (R = -0.419, p < .001), total cholesterol (R = 0.248, p = .028) and LDL cholesterol (R = 0.370, p = .001). SGA status (OR 2.56, p = .004, 95% CI 1.83-4.28) and prematurity (OR 3.10, p = .001, 95% CI 1.39-4.82) were strongly related to serum PCSK9 levels. CONCLUSION PCSK9 levels were significantly associated with total and LDL cholesterol. Moreover, PCSK9 levels were higher in preterm and SGA infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk.HighlightsWhat's already known? Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9) is a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. Infants that were born with a deviant birth weight have a unique lipoprotein metabolism profile.What this study adds? Serum PCSK9 levels were significantly associated with total and LDL cholesterol. PCSK9 levels were higher in preterm and small for gestation infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk.
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Affiliation(s)
- Antonios Vlahos
- Department of Paediatrics, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Alexandra Lianou
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Niki Dermitzaki
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Eleni Maragoudaki
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Eleni Papastergiou
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Christos Tzallas
- Department of Clinical Chemistry, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Sophia Tsabouri
- Department of Paediatrics, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Alexandros Makis
- Department of Paediatrics, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Paediatrics, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Haralambos Milionis
- First Division of Internal medicine, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, University of Ioannina, School of Medicine, Ioannina, Greece
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3
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Pelagiadis I, Kyriakidis I, Katzilakis N, Kosmeri C, Veltra D, Sofocleous C, Glentis S, Kattamis A, Makis A, Stiakaki E. The Diverse Genomic Landscape of Diamond-Blackfan Anemia: Two Novel Variants and a Mini-Review. Children (Basel) 2023; 10:1812. [PMID: 38002903 PMCID: PMC10670567 DOI: 10.3390/children10111812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/11/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023]
Abstract
Diamond-Blackfan anemia (DBA) is a ribosomopathy characterized by bone marrow erythroid hypoplasia, which typically presents with severe anemia within the first months of life. DBA is typically attributed to a heterozygous mutation in a ribosomal protein (RP) gene along with a defect in the ribosomal RNA (rRNA) maturation or levels. Besides classic DBA, DBA-like disease has been described with variations in 16 genes (primarily in GATA1, followed by ADA2 alias CECR1, HEATR3, and TSR2). To date, more than a thousand variants have been reported in RP genes. Splice variants represent 6% of identifiable genetic defects in DBA, while their prevalence is 14.3% when focusing on pathogenic and likely pathogenic (P/LP) variants, thus highlighting the impact of such alterations in RP translation and, subsequently, in ribosome levels. We hereby present two cases with novel pathogenic splice variants in RPS17 and RPS26. Associations of DBA-related variants with specific phenotypic features and malignancies and the molecular consequences of pathogenic variations for each DBA-related gene are discussed. The determinants of the spontaneous remission, cancer development, variable expression of the same variants between families, and selectivity of RP defects towards the erythroid lineage remain to be elucidated.
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Affiliation(s)
- Iordanis Pelagiadis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.P.); (I.K.); (N.K.)
| | - Ioannis Kyriakidis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.P.); (I.K.); (N.K.)
| | - Nikolaos Katzilakis
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.P.); (I.K.); (N.K.)
| | - Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.K.); (A.M.)
| | - Danai Veltra
- Laboratory of Medical Genetics, “Aghia Sophia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.V.); (C.S.)
| | - Christalena Sofocleous
- Laboratory of Medical Genetics, “Aghia Sophia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (D.V.); (C.S.)
| | - Stavros Glentis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, “Aghia Sofia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.G.); (A.K.)
| | - Antonis Kattamis
- Division of Pediatric Hematology-Oncology, First Department of Pediatrics, “Aghia Sofia” Children’s Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (S.G.); (A.K.)
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece; (C.K.); (A.M.)
| | - Eftichia Stiakaki
- Department of Pediatric Hematology-Oncology, University Hospital of Heraklion, School of Medicine, University of Crete, 71003 Heraklion, Greece; (I.P.); (I.K.); (N.K.)
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Kosmeri C, Giapros V, Gounaris A, Sokou R, Siomou E, Rallis D, Makis A, Baltogianni M. Are the current feeding volumes adequate for the growth of very preterm neonates? Br J Nutr 2023; 130:1338-1342. [PMID: 36756759 PMCID: PMC10511681 DOI: 10.1017/s0007114523000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/08/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
Postnatal growth failure, a common problem in very preterm neonates associated with adverse neurodevelopmental outcome, has recently been shown not to be inevitable. There is a wide discussion regarding feeding practices of very preterm neonates, specifically regarding feeding volumes and nutrients supply to avoid postnatal growth failure. Current guidelines recommend an energy intake of 115–140 kcal /kg per d with a considerably higher upper limit of 160 kcal/kg per d. The feeding volume corresponding to this energy supply is not higher than 200 ml/kg in most cases. From the other side, randomised and observational studies used higher feeding volumes, and these were associated with better weight gain and growth, while no complications were noted. Taking into account the above, nutritional practices should be individualised in each very and extremely preterm infant trying to reduce postnatal growth failure, pointing out that available data are inconclusive regarding the effect of high-volume feeds on growth. Large clinical trials are necessary to conclude in the best feeding practices of very preterm neonates.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Antonios Gounaris
- Neonatal Intensive Care Unit, School of Medicine, University of Larissa, Larissa, Greece
| | - Rozeta Sokou
- Neonatal Intensive Care Unit, Nikaia General Hospital ‘Aghios Panteleimon’, Athens, Greece
| | - Ekaterini Siomou
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
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5
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Georgoulis V, Papoudou-Bai A, Makis A, Kanavaros P, Hatzimichael E. Unraveling the Immune Microenvironment in Classic Hodgkin Lymphoma: Prognostic and Therapeutic Implications. Biology (Basel) 2023; 12:862. [PMID: 37372147 DOI: 10.3390/biology12060862] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023]
Abstract
Classic Hodgkin lymphoma (cHL) is a lymphoid neoplasm composed of rare neoplastic Hodgkin and Reed-Sternberg (HRS) cells surrounded by a reactive tumor microenvironment (TME) with suppressive properties against anti-tumor immunity. TME is mainly composed of T cells (CD4 helper, CD8 cytotoxic and regulatory) and tumor-associated macrophages (TAMs), but the impact of these cells on the natural course of the disease is not absolutely understood. TME contributes to the immune evasion of neoplastic HRS cells through the production of various cytokines and/or the aberrant expression of immune checkpoint molecules in ways that have not been fully understood yet. Herein, we present a comprehensive review of findings regarding the cellular components and the molecular features of the immune TME in cHL, its correlation with treatment response and prognosis, as well as the potential targeting of the TME with novel therapies. Among all cells, macrophages appear to be a most appealing target for immunomodulatory therapies, based on their functional plasticity and antitumor potency.
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Affiliation(s)
- Vasileios Georgoulis
- Department of Hematology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece
| | - Alexandra Papoudou-Bai
- Department of Pathology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece
| | - Alexandros Makis
- Department of Child Health, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece
| | - Panagiotis Kanavaros
- Department of Anatomy-Histology-Embryology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45 000 Ioannina, Greece
| | - Eleftheria Hatzimichael
- Department of Hematology, School of Health Sciences, Faculty of Medicine, University of Ioannina, 45 500 Ioannina, Greece
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6
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Michali M, Basiari L, Komnos I, Makis A, Psychogios G. Hemorrhage of Upper Digestive and Respiratory Tracts in a Child with Glanzmann Thrombasthenia. Maedica (Bucur) 2023; 18:363-367. [PMID: 37588843 PMCID: PMC10427102 DOI: 10.26574/maedica.2023.18.2.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
Glanzmann thrombasthenia (GT) is an autosomal recessive platelet disorder that could cause mild to severe bleeding episodes. The incidence is approximately 1 per 1,000,000 births. Patients with GT frequently have mucocutaneous bleeding with absent platelet aggregation in response to all physiologic stimuli, but a normal platelet count and morphology. Specifically, the glycoprotein IIb/IIIa (GP IIb/IIIa) complex is either inadequate or dysfunctional. This case reports a 3.5-year-old boy with Glanzmann thrombasthenia who had two episodes with uncontrolled hemorrhage from upper digestive and respiratory tracts, the first with the bleeding point found in the left tonsil and the second in the adenoids.
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Affiliation(s)
- Maria Michali
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Ioannina, Ioannina, Greece
| | - Lentiona Basiari
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Ioannina, Ioannina, Greece
| | - Ioannis Komnos
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Ioannina, Ioannina, Greece
| | - Alexandros Makis
- Pediatric Department, University General Hospital of Ioannina, Ioannina, Greece
| | - Georgios Psychogios
- Department of Otorhinolaryngology-Head and Neck Surgery, University General Hospital of Ioannina, Ioannina, Greece
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Catapano R, Sessa R, Trombetti S, Cesaro E, Russo F, Izzo P, Makis A, Grosso M. Identification and Functional Analysis of Known and New Mutations in the Transcription Factor KLF1 Linked with β-Thalassemia-like Phenotypes. Biology 2023; 12:biology12040510. [PMID: 37106711 PMCID: PMC10135830 DOI: 10.3390/biology12040510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/16/2023] [Accepted: 03/24/2023] [Indexed: 03/31/2023]
Abstract
The erythroid transcriptional factor Krüppel-like factor 1 (KLF1) is a master regulator of erythropoiesis. Mutations that cause KLF1 haploinsufficiency have been linked to increased fetal hemoglobin (HbF) and hemoglobin A2 (HbA2) levels with ameliorative effects on the severity of β-thalassemia. With the aim of determining if KLF1 gene variations might play a role in the modulation of β-thalassemia, in this study we screened 17 subjects showing a β-thalassemia-like phenotype with a slight or marked increase in HbA2 and HbF levels. Overall, seven KLF1 gene variants were identified, of which two were novel. Functional studies were performed in K562 cells to clarify the pathogenic significance of these mutations. Our study confirmed the ameliorative effect on the thalassemia phenotype for some of these variants but also raised the notion that certain mutations may have deteriorating effects by increasing KLF1 expression levels or enhancing its transcriptional activity. Our results indicate that functional studies are required to evaluate the possible effects of KLF1 mutations, particularly in the case of the co-existence of two or more mutations that could differently contribute to KLF1 expression or transcriptional activity and consequently to the thalassemia phenotype.
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Affiliation(s)
- Rosa Catapano
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Raffaele Sessa
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Silvia Trombetti
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Department of Veterinary Medicine and Animal Productions, University of Naples Federico II, 80137 Naples, Italy
| | - Elena Cesaro
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Filippo Russo
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Paola Izzo
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45110 Ioannina, Greece
| | - Michela Grosso
- Department of Molecular Medicine and Medical Biotechnology, School of Medicine, University of Naples Federico II, 80131 Naples, Italy
- Correspondence:
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Hatzimichael E, Timotheatou D, Koumpis E, Benetatos L, Makis A. Luspatercept: A New Tool for the Treatment of Anemia Related to β-Thalassemia, Myelodysplastic Syndromes and Primary Myelofibrosis. Diseases 2022; 10:diseases10040085. [PMID: 36278584 PMCID: PMC9624301 DOI: 10.3390/diseases10040085] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/20/2022] [Accepted: 09/29/2022] [Indexed: 11/16/2022] Open
Abstract
Anemia is a common feature of both benign and malignant hematologic diseases. Beta-thalassemia (β-thalassemia) syndromes are a group of hereditary disorders characterized by ineffective erythropoiesis, due to a genetic deficiency in the synthesis of the beta chains of hemoglobin, often accompanied by severe anemia and the need for red blood cell (RBC) transfusions. Myelodysplastic syndromes (MDS) are characterized by cytopenia(s) and ineffective hematopoiesis, despite a hypercellular bone marrow. Primary myelofibrosis (PMF) is a clonal myeloproliferative neoplasm characterized by reactive fibrosis of the bone marrow, accompanied by extramedullary hematopoiesis. Luspatercept, previously known as ACE-536, is a fusion protein that combines a modified activin receptor IIB (ActRIIB), a member of the transforming growth factor-β (TGF-β) superfamily, with the Fc domain of human immunoglobulin G (IgG1). It has shown efficacy in the treatment of anemia due to beta β-thalassemia, MDS and PMF and recently gained approval by the Federal Drug Agency (FDA) and the European Medicines Agency (EMA) for transfusion-dependent (TD) patients with β-thalassemia and very low to intermediate-risk patients with MDS with ringed sideroblasts who have failed to respond to, or are ineligible for, an erythropoiesis-stimulating agent. In this review, we describe the key pathways involved in normal hematopoiesis and the possible mechanism of action of luspatercept, present its development and data from the most recent clinical trials in β-thalassemia, MDS and PMF, and discuss its potential use in the treatment of these hematological disorders.
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Affiliation(s)
- Eleftheria Hatzimichael
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
- Correspondence:
| | | | - Epameinondas Koumpis
- Department of Haematology, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
| | | | - Alexandros Makis
- Department of Child Health, Faculty of Medicine, School of Health Sciences, University of Ioannina, 45500 Ioannina, Greece
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Rallis D, Baltogianni M, Dermitzaki N, Balomenou F, Papastergiou E, Maragoudaki E, Tsabouri S, Makis A, Giapros V. Club cell protein expression amongst infants with respiratory distress syndrome. Pediatr Pulmonol 2022; 57:1543-1546. [PMID: 35304828 DOI: 10.1002/ppul.25897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Dimitrios Rallis
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Maria Baltogianni
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Niki Dermitzaki
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Foteini Balomenou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Papastergiou
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Eleni Maragoudaki
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Sophia Tsabouri
- Department of Paediatrics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Alexandros Makis
- Department of Paediatrics, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, School of Medicine, University of Ioannina, Ioannina, Greece
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Gkoutsias A, Makis A. The role of epigenetics in childhood autoimmune diseases with hematological manifestations. Pediatr Investig 2022; 6:36-46. [PMID: 35382418 PMCID: PMC8960932 DOI: 10.1002/ped4.12309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/22/2021] [Indexed: 11/18/2022] Open
Abstract
Autoimmune diseases with hematological manifestations are often characterized by chronicity and relapses despite treatment, and the underlying pathogenetic mechanisms remain unknown. Epigenetic alterations play a vital role in the deregulation of immune tolerance and the development of autoimmune diseases. In recent years, study of epigenetic mechanisms in both adult and childhood autoimmune disorders has been seeking to explain the pathophysiology of these heterogeneous diseases and to elucidate the interaction between genetic and environmental factors. Various mechanisms, including DNA methylation, histone modifications (chromatin remodeling), and noncoding RNAs (ncRNAs), have been studied extensively in the context of autoimmune diseases. This paper summarizes the epigenetic patterns in some of the most common childhood autoimmune disorders with hematological manifestations, based on epigenetic studies in children with primary immune thrombocytopenia (ITP), systemic lupus erythematosus (SLE), and juvenile idiopathic arthritis (JIA). Research findings indicate that methylation changes in genes expressed on T cells, modifications at a variety of histone sites, and alterations in the expression of several ncRNAs are involved in the pathogenesis of these diseases. These mechanisms not only determine the development of these diseases but also affect the severity of the clinical presentation and biochemical markers. Further studies will provide new tools for the prevention and diagnosis of childhood autoimmune disorders, and possible novel treatment options.
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Affiliation(s)
- Athanasios Gkoutsias
- Department of Pediatrics Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
| | - Alexandros Makis
- Department of Pediatrics Faculty of Medicine School of Health Sciences University of Ioannina Ioannina Greece
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Makis A, Masina V, Spiteri EA, Aggeli I, Vartholomatos G, Chaliasos N, Pergantou H. A refugee child with multiple patterned ecchymoses: a diagnostic dilemma between nonaccidental injury and primary hemostatic defect. Blood Coagul Fibrinolysis 2021; 32:603-606. [PMID: 33973895 DOI: 10.1097/mbc.0000000000001047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 4-year-old girl from Syria presented to the hospital with multiple bruises on her body. Bruises were observed in protected areas in a shape of fingerprints and objects, while no other bruises occurred during hospitalization. The parents also reported a history of bleeding diathesis from infancy. Both the initial laboratory evaluation and the secondary tests done for possible thrombocytopenia and coagulation factors deficiencies were normal. Thus, the nonaccidental injury protocol of the Hospital was activated, and the possibility of abuse was not quite evident. Investigation for platelet disorders followed. Platelet aggregation test and flow cytometry were indicative of Glanzmann's thrombasthenia. It is of great importance in these cases, that the doctor eliminates any possibility of physical abuse and examines the patient for common and rare primary hemostatic defects, although both can co-exist.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Vasiliki Masina
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Evangelia-Anna Spiteri
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Ioanna Aggeli
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | | | - Nikolaos Chaliasos
- Department of Pediatrics, Faculty of Medicine, School of Health Sciences, University of Ioannina
| | - Helen Pergantou
- Haemophilia Centre- Haemostasis and Thrombosis Unit, 'Aghia Sophia' Children's Hospital, Athens, Greece
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12
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Pomoni A, Aggeli I, Loutsi E, Hatzimichael E, Chaliasos N, Makis A. Cyanosis Due to Methemoglobinemia as the Presenting Sign of Glucose-6-Phosphate Dehydrogenase Deficiency in a Child: Diagnostic and Clinical Implications. J Pediatr Hematol Oncol 2021; 43:e1140-e1144. [PMID: 33031164 DOI: 10.1097/mph.0000000000001967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
A previously healthy 3-year-old boy presented with pallor, jaundice, cyanosis, and a 24-hour history of vomiting and anorexia following fava bean ingestion. Clinical examination and laboratory findings were consistent with severe nonimmune hemolytic anemia with methemoglobinemia. Given the patient's history, a previously unrecognized glucose-6-phosphate dehydrogenase deficiency was suspected and diagnosed. The aim of this article is to delineate the possible coexistence of methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency in children presented with acute hemolysis and discuss its management while reviewing the existing literature.
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Affiliation(s)
| | - Ioanna Aggeli
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Loutsi
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
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13
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Baka M, Michos A, Alexopoulou A, Bouka P, Bouka E, Dana E, Dimitriou G, Doganis, Grivea I, Ioannidou M, Kourti M, Magkou E, Makis A, Malama A, Mantadakis E, Markozannes G, Mitsios A, Moschovi M, Papadakis V, Panagopoulou P, Papakonstantinou E, Papadopoulos S, Polychronopoulou S, Themistocleous M, Tzotzola V, Ntzani E, Petridou ET. COVID-19 among children with cancer in Greece (2020): Results from the Nationwide Registry of Childhood Hematological Malignancies and Solid Tumors (NARECHEM-ST). Pediatr Blood Cancer 2021; 68:e29079. [PMID: 33991383 PMCID: PMC8209897 DOI: 10.1002/pbc.29079] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/08/2021] [Accepted: 04/09/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Margarita Baka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - Athanasios Michos
- Division of Infectious Diseases, First Department of Pediatrics, “Aghia Sophia” Children's Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - A. Alexopoulou
- Children's & Adolescents’ Radiotherapy DepartmentP&A Kyriakou Children's Hospital AthensGreece
| | - P. Bouka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - E. Bouka
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - E. Dana
- Children and Adolescents’ Hematology‐Oncology Department‘Mitera’ Children's HospitalAthensGreece
| | - G. Dimitriou
- Department of Pediatrics, Medical SchoolUniversity of PatrasRio AchaiaGreece
| | - Doganis
- Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - I. Grivea
- Department of Pediatrics, University General HospitalMedical School University of ThessalyLarissaGreece
| | - M. Ioannidou
- Hematology‐Oncology Unit, 2nd Pediatric DepartmentAristotle University of Thessaloniki, AHEPA HospitalThessaloniki
| | - M. Kourti
- Department of Pediatric OncologyHippokration General HospitalThessalonikiGreece
| | - E. Magkou
- Department of Pediatric Hematology‐OncologyP&Α Kyriakou Children's HospitalΑthensGreece
| | - A. Makis
- Pediatric Hematology‐Thalassemia Unit, Department of Pediatrics, Faculty of Medicine, School of Health SciencesUniversity of IoanninaIoanninaGreece
| | - A. Malama
- Department of Imaging, A Sofia Children's HospitalNational and Kapodistrian University of AthensAthensGreece
| | - E. Mantadakis
- Hematology‐Oncology Unit, Department of PediatricsUniversity General Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Thrace, Greece
| | - G. Markozannes
- Department of Hygiene and Epidemiology, School of MedicineUniversity of IoanninaIoanninaGreece
| | - A. Mitsios
- Department of NeurosurgeryA. Sofia Children's HospitalAthensGreece
| | - M. Moschovi
- Pediatric Hematology‐Oncology Unit, First Department of Pediatrics, A. Sofia Children's Hospital, Medical SchoolNational and Kapodistrian University of AthensAthensGreece
| | - V. Papadakis
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece
| | - P. Panagopoulou
- 4th Department of PediatricsAristotle University of ThessalonikiGreece
| | - E. Papakonstantinou
- Department of Pediatric OncologyHippokration General HospitalThessalonikiGreece
| | - S. Papadopoulos
- Department of Pathology“Hygeia” General Hospital of AthensAthensGreece
| | - S. Polychronopoulou
- Dept of Pediatric Hematology‐OncologyA. Sofia Children's HospitalAthensGreece
| | - M. Themistocleous
- Department of NeurosurgeryA. Sofia Children's HospitalAthensGreece,Secretary General, Primary Health CareMinistry of HealthAthensGreece
| | - V. Tzotzola
- Dept of Pediatric Hematology‐OncologyA. Sofia Children's HospitalAthensGreece
| | - Evangelia Ntzani
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Hygiene and Epidemiology, School of MedicineUniversity of IoanninaIoanninaGreece,Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, School of Public HealthBrown UniversityProvidenceRhode IslandUSA
| | - Eleni Th Petridou
- Hellenic Society for Social Pediatrics and Health PromotionAthensGreece,Department of Epidemiology, Hygiene and Medical StatisticsNational and Kapodistrian University of AthensAthensGreece
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Makis A, Voskaridou E, Papassotiriou I, Hatzimichael E. Novel Therapeutic Advances in β-Thalassemia. Biology (Basel) 2021; 10:biology10060546. [PMID: 34207028 PMCID: PMC8235056 DOI: 10.3390/biology10060546] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/15/2021] [Accepted: 06/15/2021] [Indexed: 01/19/2023]
Abstract
Simple Summary Beta-thalassemia (β-thalassemia) is an autosomal recessive inherited disorder that causes decreased production of hemoglobin. Ineffective erythropoiesis and excess iron deposition are the most significant pathophysiological problems. Chronic red blood cell transfusions along with control of iron overload are the main principles of treatment. Yet, the patients have a problematic quality of life. Recently, novel therapies have emerged based on better knowledge of the pathophysiology of the disease. Aiming at ineffective erythropoiesis through the TGF-β ligand traps, such as luspatercept, has been shown to reduce the transfusion burden. Therapeutic approaches aiming at the iron metabolism mechanisms as well as the pathway of the production of erythroid cyclic guanosine monophosphate are being used in clinical trials with encouraging results. Significant improvements in the technique of hemopoietic stem cell transplantation have been accomplished, with a focus on the improvement of the conditioning regimen and the donor selection. Gene therapy has exhibited remarkable advances using lentiviral β-globin gene insertion techniques or gene editing platforms that target the suppression of γ-globin repressors. All these approaches will have a positive result in the quality of life of thalassemia patients. Abstract The main characteristic of the pathophysiology of β-thalassemia is reduced β-globin chain production. The inevitable imbalance in the α/β-globin ratio and α-globin accumulation lead to oxidative stress in the erythroid lineage, apoptosis, and ineffective erythropoiesis. The result is compensatory hematopoietic expansion and impaired hepcidin production that causes increased intestinal iron absorption and progressive iron overload. Chronic hemolysis and red blood cell transfusions also contribute to iron tissue deposition. A better understanding of the underlying mechanisms led to the detection of new curative or “disease-modifying” therapeutic options. Substantial evolvement has been made in allogeneic hematopoietic stem cell transplantation with current clinical trials investigating new condition regimens as well as different donors and stem cell source options. Gene therapy has also moved forward, and phase 2 clinical trials with the use of β-globin insertion techniques have recently been successfully completed leading to approval for use in transfusion-dependent patients. Genetic and epigenetic manipulation of the γ- or β-globin gene have entered the clinical trial setting. Agents such as TGF-β ligand traps and pyruvate kinase activators, which reduce the ineffective erythropoiesis, have been tested in clinical trials with favorable results. One TGF-β ligand trap, luspatercept, has been approved for use in adults with transfusion-dependent β-thalassemia. The induction of HbF with the phosphodiesterase 9 inhibitor IMR-687, which increase cyclic guanosine monophosphate, is currently being tested. Another therapeutic approach is to target the dysregulation of iron homeostasis, using, for example, hepcidin agonists (inhibitors of TMPRSS6 and minihepcidins) or ferroportin inhibitors (VIT-2763). This review provides an update on the novel therapeutic options that are presently in development at the clinical level in β-thalassemia.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatrics, Faculty of Medicine, University of Ioannina, Stavros Niarchos Avenue, 45110 Ioannina, Greece
- Correspondence: ; Tel.: +30-2651099793
| | - Ersi Voskaridou
- Centre of Excellence in Rare Haematological Diseases-Haemoglobinopathies, “Laikon” General Hospital, 11527 Athens, Greece;
| | - Ioannis Papassotiriou
- Department of Clinical Biochemistry, “Aghia Sophia” Children’s Hospital, 11527 Athens, Greece;
| | - Eleftheria Hatzimichael
- Department of Hematology, Faculty of Medicine, University of Ioannina, Stavros Niarchos Avenue, 45110 Ioannina, Greece;
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Kelaidi C, Makis A, Tzotzola V, Antoniadi K, Petrikkos L, Tsitsikas K, Peristeri I, Kitra V, Stefanaki K, Polychronopoulou S. Severe aplastic anaemia in children: Impact of histopathology profile and treatment on very long-term outcomes. Acta Paediatr 2021; 110:1308-1314. [PMID: 32810910 DOI: 10.1111/apa.15546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 01/13/2023]
Abstract
AIM To assess very long-term outcomes of children with severe aplastic anaemia (SAA) and impact of histopathology and of different treatments over time. METHODS We conducted a retrospective study of 57 consecutive patients with SAA during 1973-2019. According to period, treatment consisted of androgens, immunosuppressive treatment (IST) and haematopoietic cell transplantation (HCT) in 14, 31 and 13 patients, respectively. Histopathology immune profiles were studied on bone marrow (BM). RESULTS Response rate (RR) to androgens was 35%, with long-term survivorship in 4 of 5 responders. RR and 10-year overall survival (OS) after IST was 65% and 80%, respectively. RR was higher in girls (92% vs 43% in boys, P = .02). Mean baseline BM values of CD34 + and of B-lymphocytes in responders vs non-responders were 1.3% vs 0 (P = .08) and 14.1% vs 9.7% (P = .07), respectively. After IST, BM cellularity gradually increased and cytotoxic T-lymphocytes decreased (time variation P = .003 and 0.07, respectively). Outcome did not differ between patients with IST or frontline HCT. Ten-year OS improved over time, increasing from 35.3% to 77.1% and 77% during 1973-1985, 1986-2003 and 2004-2019, respectively. CONCLUSION Histopathology may refine response prediction to IST. The course of SAA in children, a previously fatal disease, was altered in recent times.
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Affiliation(s)
- Charikleia Kelaidi
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
| | - Alexandros Makis
- Department of Pediatrics University Hospital of Ioannina Ioannina Greece
| | - Vasiliki Tzotzola
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
| | - Kondylia Antoniadi
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
| | - Loizos Petrikkos
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
| | - Konstantinos Tsitsikas
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
| | - Ioulia Peristeri
- Bone Marrow Transplantation Unit “Aghia Sophia” Children's Hospital Athens Greece
| | - Vasiliki Kitra
- Bone Marrow Transplantation Unit “Aghia Sophia” Children's Hospital Athens Greece
| | - Kalliopi Stefanaki
- Department of Pathology “Aghia Sophia” Children's Hospital Athens Greece
| | - Sophia Polychronopoulou
- Department of Pediatric Hematology‐Oncology “Aghia Sophia” Children's Hospital Athens Greece
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected hundreds of thousands of people. The authors performed a comprehensive literature review to identify the underlying mechanisms and risk factors for severe COVID-19 in children. Children have accounted for 1.7% to 2% of the diagnosed cases of COVID-19. They often have milder disease than adults, and child deaths have been rare. The documented risk factors for severe disease in children are young age and underlying comorbidities. It is unclear whether male gender and certain laboratory and imaging findings are also risk factors. Reports on other potential factors have not been published.
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Affiliation(s)
- Sophia Tsabouri
- Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Stavros Niarchos Avenue 45500, Ioannina, Greece.
| | - Alexandros Makis
- Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Stavros Niarchos Avenue 45500, Ioannina, Greece
| | - Chrysoula Kosmeri
- Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Stavros Niarchos Avenue 45500, Ioannina, Greece
| | - Ekaterini Siomou
- Department of Paediatrics, Child Health Department, School of Medicine, University of Ioannina, Stavros Niarchos Avenue 45500, Ioannina, Greece
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Kosmeri C, Koumpis E, Tsabouri S, Siomou E, Makis A. Hematological manifestations of SARS-CoV-2 in children. Pediatr Blood Cancer 2020; 67:e28745. [PMID: 33009893 PMCID: PMC7646039 DOI: 10.1002/pbc.28745] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/11/2020] [Accepted: 09/18/2020] [Indexed: 12/18/2022]
Abstract
Infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID-19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS-CoV-2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID-19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS-CoV-2.
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Affiliation(s)
- Chrysoula Kosmeri
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Epameinondas Koumpis
- Department of Internal Medicine, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Sophia Tsabouri
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Ekaterini Siomou
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
| | - Alexandros Makis
- Department of Pediatrics, Faculty of MedicineUniversity of IoanninaIoanninaGreece
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Makis A, Georgiou I, Traeger-Synodinos J, Storino MR, Giuliano M, Andolfo I, Hatzimichael E, Chaliasos N, Giapros V, Izzo P, Iolascon A, Grosso M. A Novel εγδβ-Thalassemia Deletion Associated with Severe Anemia at Birth and a β-Thalassemia Intermedia Phenotype Later in Life in Three Generations of a Greek Family. Hemoglobin 2019; 45:351-354. [PMID: 31829079 DOI: 10.1080/03630269.2019.1699568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We describe a novel deletion causing heterozygous εγδβ-thalassemia (εγδβ-thal) across three generations of a Greek family. The Greek deletion is about 72 kb in length, spanning from the hypersensitive site 4 (HS4) in the locus control region (LCR) to the 3' end of the β-globin gene, thus encompassing the entire β-globin gene cluster. The deletion caused severe but transient neonatal anemia and a non transfusion-dependent chronic hemolytic anemia state later in life, resembling mild β-thalassemia intermedia (β-TI) rather than β-thalassemia (β-thal) trait, as had been previously reported. Apart from the presentation of clinical and laboratory characteristics, the challenges involving clinical management are also discussed.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatrics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Ioannis Georgiou
- Genetics and In Vitro Fertilization Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Jan Traeger-Synodinos
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Rosaria Storino
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Mariarosaria Giuliano
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Immacolata Andolfo
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | | | - Nikolaos Chaliasos
- Department of Pediatrics, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Vasileios Giapros
- Neonatal Intensive Care Unit, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Paola Izzo
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Achille Iolascon
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
| | - Michela Grosso
- Department of Molecular Medicine and Medical Biotechnology, CEINGE, Advanced Biotechnologies, University of Naples Federico II, Naples, Italy
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Zisi D, Challa A, Makis A. The association between vitamin D status and infectious diseases of the respiratory system in infancy and childhood. Hormones (Athens) 2019; 18:353-363. [PMID: 31768940 PMCID: PMC7092025 DOI: 10.1007/s42000-019-00155-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 10/29/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE Respiratory tract infections (RTIs) are a major cause of illness worldwide and the most common cause of hospitalization for pneumonia and bronchiolitis. These two diseases are the leading causes of morbidity and mortality among children under 5 years of age. Vitamin D is believed to have immunomodulatory effects on the innate and adaptive immune systems by modulating the expression of antimicrobial peptides, like cathelicidin, in response to both viral and bacterial stimuli. The aim of this review is to summarize the more recently published data with regard to potential associations of 25-hydroxyvitamin D [25(OH)D] with infectious respiratory tract diseases of childhood and the possible health benefits from vitamin D supplementation. METHODS The literature search was conducted by using the PubMed, Scopus, and Google Scholar databases, with the following keywords: vitamin D, respiratory tract infection, tuberculosis, influenza, infancy, and childhood. RESULTS Several studies have identified links between inadequate 25(OH)D concentrations and the development of upper or lower respiratory tract infections in infants and young children. Some of them also suggest that intervention with vitamin D supplements could decrease both child morbidity and mortality from such causes. CONCLUSIONS Most studies agree in that decreased vitamin D concentrations are prevalent among most infants and children with RTIs. Also, normal to high-serum 25(OH)D appears to have some beneficial influence on the incidence and severity of some, but not all, types of these infections. However, studies with vitamin D supplementation revealed conflicting results as to whether supplementation may be of benefit, and at what doses.
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Affiliation(s)
- Dimitra Zisi
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Anna Challa
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece
| | - Alexandros Makis
- Child Health Department, Faculty of Medicine, University of Ioannina, P.O. Box 1187, 451 10, Ioannina, Greece.
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20
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Zioga A, Thanopoulou E, Hatzi E, Chaliasos N, Georgiou I, Makis A. Rare Association of Hb D-Los Angeles (HBB: c.364G>C) with Hb H Disease: Diagnosis and Clinical Implications. Hemoglobin 2019; 42:336-338. [PMID: 30626242 DOI: 10.1080/03630269.2018.1558066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hb D-Los Angeles (or Hb D-Punjab) (HBB: c.364G > C) is found worldwide and is derived from a point mutation in the β-globin gene prevalent in the Punjab region of Northwestern India. Heterozygous or homozygous inheritance does not cause significant medical problems, whereas association with other hemoglobinopathies, especially β-thalassemia (β-thal) and sickle cell disease, changes the phenotype. Coinheritance of Hb D-Los Angeles with Hb H disease (α-/- -) has never been reported before. The presence of this rare combination in a family of Greek origin is herein described, and the challenges involving clinical management are discussed.
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Affiliation(s)
- Aikaterini Zioga
- a Child Health Department, Faculty of Medicine , University of Ioannina , Ioannina , Greece
| | - Eleni Thanopoulou
- b Genetics and IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine , University of Ioannina , Ioannina , Greece
| | - Elissavet Hatzi
- b Genetics and IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine , University of Ioannina , Ioannina , Greece
| | - Nikolaos Chaliasos
- a Child Health Department, Faculty of Medicine , University of Ioannina , Ioannina , Greece
| | - Ioannis Georgiou
- b Genetics and IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine , University of Ioannina , Ioannina , Greece
| | - Alexandros Makis
- a Child Health Department, Faculty of Medicine , University of Ioannina , Ioannina , Greece
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21
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Voskaridou E, Kattamis A, Fragodimitri C, Kourakli A, Chalkia P, Diamantidis M, Vlachaki E, Drosou M, Lafioniatis S, Maragkos K, Petropoulou F, Eftihiadis E, Economou M, Klironomos E, Koutsouka F, Nestora K, Tzoumari I, Papageorgiou O, Basileiadi A, Lafiatis I, Dimitriadou E, Kalpaka A, Kalkana C, Xanthopoulidis G, Adamopoulos I, Kaiafas P, Mpitzioni A, Goula A, Kontonis I, Alepi C, Anastasiadis A, Papadopoulou M, Maili P, Dionisopoulou D, Tsirka A, Makis A, Kostaridou S, Politou M, Papassotiriou I. National registry of hemoglobinopathies in Greece: updated demographics, current trends in affected births, and causes of mortality. Ann Hematol 2018; 98:55-66. [DOI: 10.1007/s00277-018-3493-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 08/31/2018] [Indexed: 12/11/2022]
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22
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Makis A, Tsabouri S, Chaliasos N. Cystic fibrosis-related eczematous dermatitis in an infant: another rare cause of hypereosinophilia. Hippokratia 2018; 22:93. [PMID: 31217684 PMCID: PMC6548528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- A Makis
- Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - S Tsabouri
- Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - N Chaliasos
- Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
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Tsabouri S, Gkoutsias A, Lolis C, Makis A, Chaliasos N, Bartzokas A. Impact of meteorological factors on the emergence of bronchiolitis in North-western Greece. Allergol Immunopathol (Madr) 2018; 46:24-30. [PMID: 28483338 DOI: 10.1016/j.aller.2017.01.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 01/24/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the relationship between meteorological factors in North-western Greece and the incidence of bronchiolitis. METHODS Meteorological data (air temperature and rainfall) for Ioannina city in North-western Greece and medical data from hospitalised patients at University Hospital of Ioannina were collected between January 2002 and December 2013. The association between meteorological factors and rate of hospitalisation due to bronchiolitis was investigated. The data processing was done using the Pearson product-moment correlation coefficient and applying the chi-square test at contingency tables of the parameters. RESULTS Of the 792 hospitalised cases, 670 related to infants (<1 year) and 122 concerned patients aged 1-2 years old. The disease is more common among boys (59.5%) than girls (40.5%). The disease course through the year has a double variation with a main maximum in March and a main minimum in August. The statistical study showed statistically significant correlation of bronchiolitis with: (a) the temperature parameters on an annual basis; (b) precipitation in autumn and dryness in spring; and (c) with sudden changes in diurnal temperature range on an annual basis. CONCLUSION A peak incidence of bronchiolitis was noticed in cold and wet seasons during the five days preceding hospitalisation.
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Delaporta P, Sofocleous C, Economou M, Makis A, Kostaridou S, Kattamis A. The Greek Registry of Shwachman Diamond-Syndrome: Molecular and clinical data. Pediatr Blood Cancer 2017; 64. [PMID: 28509441 DOI: 10.1002/pbc.26630] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 04/06/2017] [Accepted: 04/10/2017] [Indexed: 01/14/2023]
Abstract
This study presents the clinical phenotype and molecular analysis findings from 11 patients recorded in the Greek Shwachman-Diamond syndrome (SDS) Registry. The most severely affected patient in our registry was diagnosed at birth and is the first patient reported to require bone marrow transplantation so early in life. Severe psoriasis, a feature not previously reported in SDS, was observed in one patient. Mutations in the Shwachman-Bodian-Diamond syndrome gene (SBDS) were found in all patients. Cytogenetic analyses revealed clonal abnormalities, one novel, in two patients.
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Affiliation(s)
- Polyxeni Delaporta
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Christalena Sofocleous
- Department of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece.,Research Institute for the Study of Genetic and Malignant Disorders in Childhood, "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Marina Economou
- First Department of Pediatrics, University of Thessaloniki, Greece
| | - Alexandros Makis
- Department of Pediatrics, University Hospital of Ioannina, Greece
| | - Stavroula Kostaridou
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
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Makis A, Georgiou I, Traeger-Synodinos J, Chaliasos N, Grosso M, Gambale A, Iolascon A. Diagnosis and molecular characterization of a novel α 0 -thalassemia deletion (-Kozani) found in a Greek child with unexplained microcytic hypochromic anemia. Int J Lab Hematol 2017; 39:e124-e126. [PMID: 28603861 DOI: 10.1111/ijlh.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 03/24/2017] [Indexed: 11/27/2022]
Affiliation(s)
- A Makis
- Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - I Georgiou
- Genetics and IVF Unit, Department of Obstetrics and Gynecology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - J Traeger-Synodinos
- Laboratory of Medical Genetics, National and Kapodistrian University of Athens, Athens, Greece
| | - N Chaliasos
- Child Health Department, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - M Grosso
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, CEINGE- Advanced Biotechnologies, Italy
| | - A Gambale
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, CEINGE- Advanced Biotechnologies, Italy
| | - A Iolascon
- Department of Molecular Medicine and Medical Biotechnology, University of Naples Federico II, CEINGE- Advanced Biotechnologies, Italy
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Makis A, Hatzimichael E, Papassotiriou I, Voskaridou E. 2017 Clinical trials update in new treatments of β-thalassemia. Am J Hematol 2016; 91:1135-1145. [PMID: 27502996 DOI: 10.1002/ajh.24530] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 07/28/2016] [Accepted: 08/05/2016] [Indexed: 01/01/2023]
Abstract
The underlying basis of β-thalassemia pathology is the diminished β-globin synthesis leading to α-globin accumulation and premature apoptotic destruction of erythroblasts, causing oxidative stress-induced ineffective erythropoiesis, bone marrow hyperplasia, splenomegaly, and increased intestinal iron absorption with progressive iron overload. Better understanding of the molecular mechanisms underlying this disease led to the recognition of new targets with potential therapeutic utility. Agents such as JAK2 inhibitors and TGF-β ligand traps that reduce the ineffective erythropoiesis process are already being tested in clinical trials with promising results. Other agents that aim to reduce oxidative stress (activators of Foxo3, HRI-eIF2aP, Prx2, Hsp70, and PK anti-oxidant systems and inhibitors of HO-1) and to decrease iron overload (hepcidin agonists, erythroferrone inhibitors and exogenous transferrin) are also under experimental investigation. Significant progress has also been made in the area of allogeneic hematopoietic stem cell transplantation with several ongoing clinical trials examining new condition regimens as well as different donor selection and stem cell source options. Gene therapy has reached a critical point and phase 1 clinical trials have recently been launched to examine the effectiveness and especially long term safety. Epigenetic manipulation and genomic editing of the γ- or β-globin gene are novel and promising experimental gene therapy approaches for β-thalassemia giving hope for cure for this chronic disease. This review outlines the key points of the molecular mechanisms underlying β-thalassemia in relation to the development of new therapies and an update is given both at the pre-clinical and clinical level. Am. J. Hematol. 91:1135-1145, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Alexandros Makis
- Child Health Department, Faculty of Medicine; University of Ioannina; Ioannina Greece
| | | | - Ioannis Papassotiriou
- Department of Clinical Biochemistry; “Aghia Sophia” Children's Hospital; Athens Greece
| | - Ersi Voskaridou
- Department of Clinical Biochemistry; “Aghia Sophia” Children's Hospital; Athens Greece
- “Laikon” General Hospital; Thalassemia Center; Athens Greece
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Koutelekos IG, Kyritsi H, Makis A, Vassalos CM, Ktenas E, Polikandrioti M, Tzoumaka-Bakoula C, Chaliasos N. Development and Validation of a Multidimensional Expectation Questionnaire for Thalassaemia Major Patients. Glob J Health Sci 2015; 8:77-87. [PMID: 26383219 PMCID: PMC4804067 DOI: 10.5539/gjhs.v8n2p77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 12/03/2022] Open
Abstract
Nowadays, thalassaemia major (TM) patients are surviving into mature young adulthood; however, no published instrument exists to measure the expectations' dimensionality among older TM patients in their thirties. This study seeks to validate a novel multidimensional expectation questionnaire suitable for TM patients (MEQ-TMP) reaching their fourth decade of life. In order to establish the psychometric properties of the instrument, data analysis was carried out. The principal component analysis revealed four components ('Supportive social network'; 'Raising one's own family'; 'Career advancement'; 'Ability of daily activities'). Their cumulative contribution rate was 66.32%. Cronbach's alpha for the total scale was 0.87. Each subscale had an alpha value above 0.70; three subscales were in the 0.80 range. MEQ-TMP reliability was proved to be good. The known-group method served as a strategy in examining the operationalisation of the questionnaire's constructs. The present MEQ-TMP, developed for the aged group of TM patients, would be a useful tool for clinical personnel providing care to TM patients in understanding their outlook on life as they are growing up, to have better psychosocial adjustment to illness chronicity, live life as normally as possible, and fulfill their ambitions; thus enhancing their life satisfaction and quality of life.
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Makis A, Challa A, Hatzimichael E, Briasoulis E, Siamopoulou A, Chaliasos N. Adipocytokines are related to haemolytic and inflammatory biomarkers in sickle cell beta thalassaemia. Br J Haematol 2013; 163:142-4. [PMID: 23834307 DOI: 10.1111/bjh.12464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Alexandros Makis
- Child Health Department, University of Ioannina Medical School, Ioannina, Greece.
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Vlahos AP, Koutsouka FP, Papamichael ND, Makis A, Baltogiannis GG, Athanasiou E, Chaliasos N, Bourantas KL, Kolettis TM. Determinants of pulmonary hypertension in patients with Beta-thalassemia major and normal ventricular function. Acta Haematol 2012; 128:124-9. [PMID: 22846514 DOI: 10.1159/000338825] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Accepted: 04/04/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND/AIMS We sought to define the incidence and predictive factors of pulmonary hypertension in β-thalassemia major. METHODS We studied 27 consecutive patients (19 male, 38 ± 9 years of age) with β-thalassemia major. All the patients had normal (left and right) ventricular (systolic and diastolic) function and underwent echocardiographic assessment of pulmonary artery systolic pressure. Univariate regression and discriminant function analyses were used to identify predictive factors of pulmonary hypertension. RESULTS Pulmonary hypertension was observed in 18.5% of the patients, but clinically significant disease was detected in only 3.7%. A total of 14 (51.8%) patients had been receiving a combined administration of deferoxamine and deferiprone for 7.0 ± 1.3 years. Amidst a large number of variables examined, ferritin levels and delayed onset of chelation therapy were the only predictors of pulmonary hypertension. CONCLUSION Pulmonary hypertension in β-thalassemia major is relatively infrequent and generally mild due to improved chelation therapy. The role of hemochromatosis in pulmonary hypertension development merits further study.
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Makis A, Avgerinou G, Papadhimitriou S, Rola K, Rigatou E, Polychronopoulou S. 278 Familial myelodysplastic syndromes (MDS) in children associated with non-bone marrow failure congenital syndromes. Leuk Res 2011. [DOI: 10.1016/s0145-2126(11)70280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tzoufi M, Makis A, Grammeniatis V, Nakou I, Exarchakos G, Asproudis I, Zikou A, Argyropoulou M, Siamopoulou-Mavridou A. Idiopathic intracranial hypertension and facial palsy: case report and review of the literature. J Child Neurol 2010; 25:1529-34. [PMID: 20921567 DOI: 10.1177/0883073810375849] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present the case of an 11-year-old obese girl who presented with idiopathic intracranial hypertension affecting first the lateral abducens nerve. She received acetazolamide, but 5 days later she developed lateral, peripheral facial palsy. Imaging evaluation was normal, which primarily excluded cerebral venous thrombosis and sustained the initial diagnosis. Despite some complicating factors (obesity, elevated intracranial pressure), prednisolone was administered for a short-term period to counteract the facial palsy. Ophthalmological residuals resolved within almost 1.5 months, while facial palsy receded after 4 months. Peripheral facial palsy is an extremely rare, but not unknown condition in idiopathic intracranial hypertension. As a symptom, it should be investigated thoroughly, primarily to exclude cerebral venous sinus thrombosis, before it can be attributed to idiopathic intracranial hypertension. As far as treatment is concerned, corticosteroids can be added to the initial treatment with acetazolamide, without worsening already elevated intracranial hypertension or ophthalmologic findings.
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Affiliation(s)
- Meropi Tzoufi
- Department of Child Health, the University of Ioannina Medical School, Ioannina, Greece.
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Chaliasos N, Challa A, Hatzimichael E, Koutsouka F, Bourantas DK, Vlahos AP, Siamopoulou A, Bourantas KL, Makis A. Serum adipocytokine and vascular inflammation marker levels in Beta-thalassaemia major patients. Acta Haematol 2010; 124:191-6. [PMID: 21042009 DOI: 10.1159/000320274] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Accepted: 08/03/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIM The adipocytokines leptin and adiponectin represent a critical link between metabolism, immunity and chronic inflammation. A chronic vascular inflammatory state plays an important role in the pathophysiology of thalassaemia. We aimed to analyze the levels of these adipocytokines and determine any possible correlations with disease severity or vascular inflammation markers in beta-thalassaemia. METHODS Serum leptin, adiponectin, high-sensitivity C-reactive protein, endothelins, vascular adhesion molecule-1, intracellular adhesion molecule-1 and L- and E-selectin were measured in 28 beta-thalassaemia patients and compared with levels in healthy controls. RESULTS Leptin was significantly lower in patients compared to controls (2.23 ± 1.8 vs. 10.24 ± 5.78 μg/l; p = 0.0018), whereas adiponectin was elevated (11.75 ± 5.67 vs. 6.83 ± 2.75 μg/l; p = 0.009). For both adipocytokines, no correlations were found with characteristics such as age, gender, type of chelation, body mass index z score or haemoglobin. Leptin, but not adiponectin, was negatively correlated with ferritin (p = 0.032, r = -0.61). No correlations were found between leptin and the inflammation markers. However, adiponectin was positively correlated with endothelin-1 (p = 0.022, r = 0.63). CONCLUSIONS Serum leptin is low in beta-thalassaemia, perhaps due to the toxic effect of iron overload on adipose tissue. Paradoxically, adiponectin levels are high and positively correlated with endothelin-1, raising questions about the pro- or anti-inflammatory role of this adipocytokine in beta-thalassaemia.
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Makis A, Shipway D, Hatzimichael E, Galanakis E, Pshezhetskiy D, Chaliasos N, Stebbing J, Siamopoulou A. Cytokine and Adhesion Molecule Expression Evolves Between the Neutrophilic and Lymphocytic Phases of Viral Meningitis. J Interferon Cytokine Res 2010; 30:661-5. [DOI: 10.1089/jir.2009.0113] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Alexandros Makis
- Child Health Department, University of Ioannina Medical School, Ioannina, Greece
| | - David Shipway
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
| | | | | | - Dmitry Pshezhetskiy
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Nikolaos Chaliasos
- Child Health Department, University of Ioannina Medical School, Ioannina, Greece
| | - Justin Stebbing
- Department of Medical Oncology, Imperial College School of Medicine, Charing Cross Hospital, London, United Kingdom
| | - Antigone Siamopoulou
- Child Health Department, University of Ioannina Medical School, Ioannina, Greece
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Contopoulos-Ioannidis D, Evangeliou A, ter Laak H, de Vries B, Pfundt R, Scheffer H, Smeitink J, Tzoufi M, Makis A, Marinos E, Hess R, Adams D, Huizing M, Morava E. Recurrent rhabdomyolysis in a patient with oculocutaneous albinism type 1 and platelet storage-pool deficiency. Am J Med Genet A 2008; 146A:3100-3. [PMID: 19006216 DOI: 10.1002/ajmg.a.32569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Hatzimichael E, Dasoula A, Benetatos L, Makis A, Stebbing J, Crook T, Syrrou M, Bourantas KL. The absence of CDKN1C (p57KIP2) promoter methylation in myeloid malignancies also characterizes plasma cell neoplasms. Br J Haematol 2008; 141:557-8. [DOI: 10.1111/j.1365-2141.2008.07034.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Makis A, Polychronopoulou S, Haidas S. Osteosarcoma as a second tumor after treatment for primary non-Hodgkin's lymphoma in a child with ataxia-telangiectasia: presentation of a case and review of possible pathogenetic mechanisms. J Pediatr Hematol Oncol 2004; 26:444-6. [PMID: 15218420 DOI: 10.1097/00043426-200407000-00009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Patients with ataxia-telangiectasia (A-T) and cancer are exposed to additional toxicity due to their underlying inability to repair chemotherapy-induced DNA damage. The authors report the development of osteosarcoma as a second neoplasia in a child with A-T who was treated, without being irradiated, for non-Hodgkin's lymphoma as a primary malignancy. This is the first report of osteosarcoma associated with A-T. The authors postulate that the mechanisms of carcinogenesis are common and independent of the different histopathology categories of these two neoplasias, and the underlying "canvas" of the A-T mutated gene was further triggered by chemotherapy, leading to the development of a second malignancy.
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Affiliation(s)
- Alexandros Makis
- Department of Pediatric Hematology/Oncology, Aghia Sophia Children's Hospital, Athens, Greece.
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Chaidos A, Makis A, Hatzimichael E, Tsiara S, Gouva M, Tzouvara E, Bourantas KL. Treatment of beta-thalassemia patients with recombinant human erythropoietin: effect on transfusion requirements and soluble adhesion molecules. Acta Haematol 2004; 111:189-95. [PMID: 15153710 DOI: 10.1159/000077551] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Accepted: 01/01/2004] [Indexed: 11/19/2022]
Abstract
The most common single genetic disorder and a major public health issue in Greece and other Mediterranean countries is beta-thalassemia. Current therapeutic approaches for homozygous beta-thalassemia entail blood transfusions and iron chelation therapy with deferoxamine or deferiprone for preventing tissue hemosiderosis. Recently, much effort has focused on various inducers of fetal hemoglobin (HbF) such as recombinant human erythropoietin (rHuEPO), especially in beta-thalassemia intermedia. Ten adult patients, 5 with beta-thalassemia major and 5 with beta-thalassemia intermedia, received 150 IU/kg rHuEPO (epoetin-alpha) subcutaneously three times a week. Seven patients were transfused every 14-30 days and 3 with beta-thalassemia intermedia were only occasionally transfused. The minimum duration of treatment was 12 weeks in order to define if there was any response. Transfusion intervals were modified according to the rHuEPO response to maintain stable Hb values. Lower transfusion requirements were observed in 5 patients after rHuEPO treatment (p = 0.028). In the 3 non-transfused patients, Hb values increased, and the patients are still being treated and followed up for a period ranging from 14 weeks to 2 years. Two patients with thalassemia major discontinued treatment after 12 weeks, as they did not achieve any response regarding transfusion requirements or Hb values. Pretreatment serum transferrin receptor levels were higher than in controls (p < 0.001) and significantly increased following rHuEPO treatment (p = 0.027). Patients had higher serum endothelin-3, sICAM-1 and sE-selectin values before rHuEPO treatment compared to controls (p < 0.001, p < 0.001 and p = 0.016, respectively), but these values were not altered during treatment. HbF values presented a slight, non-significant increase. rHuEPO treatment has a beneficial effect in transfusion-dependent beta-thalassemia patients. Although a slight increase in HbF levels was observed, other possible mechanisms are probably involved. None of our patients experienced thrombotic complications and a rise in blood pressure.
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Affiliation(s)
- Aristeidis Chaidos
- Department of Hematology, University of Ioannina Medical School, Ioannina, Greece
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Georgiou I, Makis A, Chaidos A, Bouba I, Hatzi E, Kranas V, Zilidis C, Bourantas KL. Distribution and frequency of beta-thalassemia mutations in northwestern and central Greece. Eur J Haematol 2003; 70:75-8. [PMID: 12581187 DOI: 10.1034/j.1600-0609.2003.00017.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Beta-Thalassemia is a common autosomal recessive disorder resulting from over 200 different mutations of the beta-globin genes. The spectrum of beta-thalassemia mutations in Greece has been previously described in the population of the capital city of Athens, or in beta-thalassemia patients having transfusion therapy. The aim of the present study was to identify the distribution of the most common beta-thalassemia mutations in the population of northwestern and central Greece. METHODS The data for this study were derived from a total of 1,130 unrelated subjects including 46 beta-thalassemia major, three beta -thalassemia intermedia and 1,081 carriers identified in our antenatal screening program. beta-Thalassemia mutations were identified by ARMS, DGGE and Reverse Dot Blot. RESULTS The most common mutation, IVS-I-110, is followed, in order of frequency, by the mutations Cd-39, IVS-I-1, IVS-II-1, Cd-6, IVS-I-6, IVS-I-5, IVS-II-745, Cd-5 and 44 bp del. IVS-I-110 and Cd-39 frequencies are similar with those found in other Balkan countries. Significant differences in regional distribution were observed. The results showed a clear drift of the distribution of the most frequent IVS-I-110 mutation in the south-north (29.4, 40.0, 44.6 and 61.7%) and the east-west axis (31.8 and 44.6%). CONCLUSIONS Population screening and prenatal diagnosis are significantly facilitated by these data. Furthermore, the detailed distribution tables of beta-thalassemia mutations are essential for counseling and extraction of genetic diversity estimates for population genetic studies in other inherited disorders.
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Affiliation(s)
- I Georgiou
- Genetics Unit, Department of Obstetrics and Gynecology, Medical School, University of Ioannina, Ioannina, Greece
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Abstract
BACKGROUND The Th1/Th2 cytokine balance seems to be involved in the susceptibility or resistance to Brucella infection, however the precise role of interleukins in human brucellosis has not been thoroughly explored. PATIENTS AND METHODS The serum levels of interleukin-3 (IL-3) and interleukin-4 (IL-4) were measured by enzyme-linked immunosorbent assay (Quantikines, R&D Systems) in five children hospitalized for brucellosis and in a control group comprising ten children who were residents of the same area. RESULT IL-4 levels were significantly increased during both the acute phase (p = 0.0036) and convalescence (p = 0.026) as compared to controls. IL-3 levels were mildly increased during the acute phase (p = 0.026) without any significant difference noted during convalescence (p = 0.271) as compared to controls. Both IL-3 and IL-4 levels were neither related to hemoglobin values, nor to red and white blood cell, neutrophil, lymphocyte and platelet counts. CONCLUSION Serum IL-4 levels are increased in hospitalized children with symptomatic brucellosis, a finding suggestive of a Th2 response leading to severe infection.
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Affiliation(s)
- E Galanakis
- Dept of Pediatrics, University Hospital of loannina, Greece.
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Mavridis AK, Tsiara S, Makis A, Chaidos A, Christou L, Seferiadis K, Bourantas KL. Interleukins, TNF-alpha and beta-2M in patients with B cell chronic lymphocytic leukemia. J Exp Clin Cancer Res 1998; 17:445-8. [PMID: 10089066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In order to investigate the possible existence of a prognostic factor for B cell chronic lymphocytic leukemia (B-CLL), we determined the serum levels of TNF-alpha, IL-1a, IL-1b, IL-2, sIL-2R, IL-6, IL-10 and beta-2M in 20 patients. We observed significant changes in sIL-2R and beta-2M levels, whereas in all stages of disease, TNF-alpha and other interleukins exhibited only mild changes. An excellent correlation between sIL-2R and beta-2M levels and disease activity wes reported. Patients with aggressive disease (Rai stages III and IV and Richter's syndrome) had increased levels. Patients who responded to therapy and with improved clinical status had decreased sIL-2R and beta-2M levels. However, patients with progressive disease and no response to therapy were associated with increased levels of sIL-2R and beta-2M. In conclusions, as serum levels of sIL-2R and beta-2M are increased in the aggressive stages of B-CLL, they may be used as reliable markers for monitoring B-CLL activity, showing response to treatment and early relapse and/or disease progression.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers, Tumor/blood
- Female
- Humans
- Interleukins/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/metabolism
- Male
- Middle Aged
- Prognosis
- Tumor Necrosis Factor-alpha/metabolism
- beta 2-Microglobulin/metabolism
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Affiliation(s)
- A K Mavridis
- Dept. of Microbiology, G. Hatzikosta General Hospital, Ioannina, Greece
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Abstract
To identify a possible acute phase response during the steady state of sickle cell disease, we estimated the serum alterations of acute phase proteins, beta2-microglobulin (beta2M), kappa and lambda light chains, interleukins (ILs) and tumor necrosis factor-alpha (TNFalpha) in 21 patients. Increased concentrations of C-reactive protein (CRP) were found in 5 patients, alpha-1-acid-glycoprotein (AGP) in 3, alpha-1-antitrypsin (AAT) in 8, ceruloplasmin (CER) in 2, alpha-2-macroglobulin (AMG) in 14 and decreased haptoglobin (HPT) and transferrin (TFR) in 11 and 9, respectively. Increased beta2M was found in 10 patients and kappa and lambda light chains in 11. IL-1beta, IL-2, IL-4, IL-10 and TNFalpha were not detected in any of the patients. However, significantly increased values of IL-6 and sIL-2r were found. This study has demonstrated increased serum levels of some of the acute phase proteins in patients during the steady state of sickle cell disease. This may be a result of a subclinical vaso-occlusion which in turn leads to a covert inflammatory response. Cytokines, and in particular IL-6, produced after this response, seem to be responsible for the high levels of acute phase proteins in the steady state of this disease.
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Affiliation(s)
- K L Bourantas
- Department of Internal Medicine, University of Ioannina Medical School, Greece
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Bourantas KL, Tsiara S, Makis A, Chaidos A, Christou L, Konstantinidou P, Kolios G, Seferiadis K. Recombinant human erythropoietin for the treatment of anemia in chronic myelogenous leukemia. Eur J Haematol 1997; 59:263-5. [PMID: 9338625 DOI: 10.1111/j.1600-0609.1997.tb00986.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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