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Grigoropoulos I, Tsioulos G, Kastrissianakis A, Shapira S, Green O, Rapti V, Tsakona M, Konstantinos T, Savva A, Kavatha D, Boumpas D, Syrigos K, Xynogalas I, Leontis K, Ntousopoulos V, Sakka V, Sardelis Z, Fotiadis A, Vlassi L, Kontogianni C, Levounets A, Poulakou G, Gaga M, MacLoughlin R, Stebbing J, Arber N, Antoniadou A, Tsiodras S. The safety and potential efficacy of exosomes overexpressing CD24 (EXO-CD24) in mild-moderate COVID-19 related ARDS. Respir Res 2024; 25:151. [PMID: 38561798 PMCID: PMC10983648 DOI: 10.1186/s12931-024-02759-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 03/06/2024] [Indexed: 04/04/2024] Open
Abstract
INTRODUCTION EXO-CD24 are exosomes genetically manipulated to over-express Cluster of Differentiation (CD) 24. It consists of two breakthrough technologies: CD24, the drug, as a novel immunomodulator that is smarter than steroids without any side effects, and exosomes as the ideal natural drug carrier. METHODS A randomized, single blind, dose-finding phase IIb trial in hospitalized patients with mild to moderate Coronavirus disease 2019 (COVID-19) related Acute Respiratory Distress Syndrome (ARDS) was carried out in two medical centers in Athens. Patients received either 109 or 1010 exosome particles of EXO-CD24, daily, for five consecutive days and monitored for 28 days. Efficacy was assessed at day 7 among 91 patients who underwent randomization. The outcome was also compared in a post-hoc analysis with an income control group (n = 202) that fit the inclusion and exclusion criteria. RESULTS The mean age was 49.4 (± 13.2) years and 74.4% were male. By day 7, 83.7% showed improved respiratory signs and 64% had better oxygen saturation (SpO2) (p < 0.05). There were significant reductions in all inflammatory markers, most notably in C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, fibrinogen and an array of cytokines. Conversely, levels of the anti-inflammatory cytokine Interleukin-10 (IL-10) were increased (p < 0.05). Of all the documented adverse events, none were considered treatment related. No drug-drug interactions were noted. Two patients succumbed to COVID-19. Post-hoc analysis revealed that EXO-CD24 patients exhibited greater improvements in clinical and laboratory outcomes compared to an observational income control group. CONCLUSIONS EXO-CD24 presents a promising therapeutic approach for hyper-inflammatory state and in particular ARDS. Its unique combination of exosomes, as a drug carrier, and CD24, as an immunomodulator, coupled with inhalation administration, warrants further investigation in a larger, international, randomized, quadri-blind trial against a placebo.
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Affiliation(s)
- Ioannis Grigoropoulos
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Georgios Tsioulos
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Artemis Kastrissianakis
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Shiran Shapira
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
- Department of Molecular Genetic and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Orr Green
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel
| | - Vasiliki Rapti
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Maria Tsakona
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Thomas Konstantinos
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Athina Savva
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Dimitra Kavatha
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Dimitrios Boumpas
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Konstantinos Syrigos
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Ioannis Xynogalas
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Konstantinos Leontis
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Vasileios Ntousopoulos
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Vissaria Sakka
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Zafeiris Sardelis
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Andreas Fotiadis
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Lamprini Vlassi
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Chrysoula Kontogianni
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Anastasia Levounets
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Garyfalia Poulakou
- 3, Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, "Sotiria" General Hospital, 11527, Athens, Greece
| | - Mina Gaga
- 7, Respiratory Medicine Department "Sotiria" General Hospital, 11527, Athens, Greece
| | - Ronan MacLoughlin
- R&D Science & Emerging Technologies, Aerogen Ltd., IDA Business Park, Dangan, Galway, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons, Dublin, Ireland
- School of Pharmacy and Pharmaceutical Sciences, Trinity College, Dublin, Ireland
| | - Justin Stebbing
- Department of Surgery and Cancer, Anglia Ruskin University, London, UK
- Department of Life Sciences, ARU, Cambridge, UK
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel-Aviv Sourasky Medical Center, 6 Weizmann St., 6423906, Tel Aviv, Israel.
- Department of Molecular Genetic and Biochemistry, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Anastasia Antoniadou
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
| | - Sotirios Tsiodras
- 4, Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462, Athens, Greece
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Grigoropoulos I, Tsioulos G, Kastrissianakis A, Shapira S, Arber N, Poulakou G, Syrigos K, Rapti V, Xynogalas I, Leontis K, Ntousopoulos V, Sakka V, Gaga M, Sardelis Z, Fotiadis A, Vlassi L, Kontogianni C, Levounets A, Tsakona M, Savva A, Kavatha D, Boumpas D, Antoniadou A, Tsiodras S. 1153. Safety and Potential Efficacy of Exosomes Overexpressing CD24 (EXO-CD24) for the Prevention of Clinical Deterioration in Patients with Moderate or Severe COVID-19: A Phase II, Randomized, Single-blinded Study. Open Forum Infect Dis 2022. [PMCID: PMC9752112 DOI: 10.1093/ofid/ofac492.991] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background EXO-CD24 is a novel inhaled drug of exosomes displaying CD24, a protein with anti-inflammatory properties. We evaluated the safety and potential efficacy of EXO-CD24, in a phase II, randomized, single-blinded clinical trial of EXO-CD24 in hospitalized patients with moderate or severe COVID-19, following the preliminary safety and efficacy results of a phase 1 study (ClinicalTrials.gov: NCT04747574). Methods Two tertiary care hospitals in Athens, Greece participated. Patients received either 109 or 1010 exosome particles per dose, once per day for 5 days and were followed for 28 days. Safety and efficacy measures (including respiratory rate < 23 b/min and pulse oximetry SpO2≥ 94% on room air, oxygen need and levels of inflammatory biomarkers i.e. CRP, LDH, ferritin, fibrinogen and d-dimers) were compared between groups at days 3, 5 and 7. A separate analysis was conducted comparing the clinical course of treated patients with that of a control cohort (n=70 patients) matched by propensity scoring out of a similar period hospitalized cohort (n=202) that did not participate in the study. Results Between June 9th and August 3rd 2021, 91 patients underwent randomization: 45 in group A and 46 in group B (109vs. 1010 exosome particles per dose). Mean age was 49.4 (± 13.2) years and 74.4% were male. Mean time from symptom onset to randomization was 8 days. Improvement in respiratory rate and pulse oximetry was noted in 72 out of 86 (83.7%) and 55 out of 86 (64%) analyzed patients. Day 7 inflammatory indices levels dropped at least 50% from baseline admission values in 72 out of 86 (82.8%) analyzed patients (p< 0.001). No treatment-related adverse events were reported. Comparison with the propensity score matched group showed statistically significant differences in the same parameters (p≤ 0.01 for all comparisons). Conclusion Our results suggest safety and potential efficacy of EXO-CD24 on clinical and laboratory parameters of moderate or severe COVID-19, that deserve further investigation in a phase 3 study. (Funded by Athens Medical Society. ClinicalTrials.gov: NCT04902183, EU Clinical Trials Register EudraCT Number 2021-002184-22). Disclosures All Authors: No reported disclosures.
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Affiliation(s)
- Ioannis Grigoropoulos
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Georgios Tsioulos
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Artemis Kastrissianakis
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Shiran Shapira
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel, Tel Aviv, Tel Aviv, Israel
| | - Nadir Arber
- Integrated Cancer Prevention Center, Tel Aviv Medical Center, Tel Aviv 6423906, Israel, Tel Aviv, Tel Aviv, Israel
| | - Garyfallia Poulakou
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Konstantinos Syrigos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Vasiliki Rapti
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Ioannis Xynogalas
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Konstantinos Leontis
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Vasileios Ntousopoulos
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Vissaria Sakka
- 3rd Department of Internal Medicine, National and Kapodistrian University of Athens, Medical School, Sotiria General Hospital, Athens, Attiki, Greece
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Zafeiris Sardelis
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Andreas Fotiadis
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Lamprini Vlassi
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Chrysoula Kontogianni
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Anastasia Levounets
- 7th Respiratory Medicine Dept, Athens Chest Hospital "Sotiria", Athens, Attiki, Greece
| | - Maria Tsakona
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Dimitra Kavatha
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Dimitrios Boumpas
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, University General Hospital Attikon, Medical School, National and Kapodistrian University of Athens, 12462 Athens, Greece, Athens, Attiki, Greece
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Tziolos N, Karofylakis E, Grigoropoulos I, Kazakou P, Koullias E, Savva A, Kranidioti H, Pelekanou A, Boulouta A, Pirounaki M, Tsiodras S, Georgiopoulos G, Boumpas DT, Kavatha D, Thomas K, Vassilopoulos D, Antoniadou A. Real-Life Effectiveness and Safety of Baricitinib as Adjunctive to Standard-of-Care Treatment in Hospitalized Patients With Severe Coronavirus Disease 2019. Open Forum Infect Dis 2022; 9:ofab588. [PMID: 34988257 PMCID: PMC8711791 DOI: 10.1093/ofid/ofab588] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background Therapeutic options for hospitalized patients with severe coronavirus disease 2019 (sCOVID-19) are limited. Preliminary data have shown promising results with baricitinib, but real-life experience is lacking. We assessed the safety and effectiveness of add-on baricitinib to standard-of-care (SOC) including dexamethasone in hospitalized patients with sCOVID-19. Methods This study is a 2-center, observational, retrospective cohort study of patients with sCOVID-19, comparing outcomes and serious events between patients treated with SOC versus those treated with SOC and baricitinib combination. Results We included 369 patients with sCOVID-19 (males 66.1%; mean age 65.2 years; median symptom duration 6 days). The SOC was administered in 47.7% and combination in 52.3%. Patients treated with the combination reached the composite outcome (intensive care unit [ICU] admission or death) less frequently compared with SOC (22.3% vs 36.9%, P = .002). Mortality rate was lower with the combination in the total cohort (14.7% vs 26.6%, P = .005), and ICU admission was lower in patients with severe acute respiratory distress syndrome (29.7% vs 44.8%, P = .03). By multivariable analysis, age (odds ratio [OR] = 1.82, 95% confidence interval [CI] = 1.36–2.44, per 10-year increase), partial pressure of oxygen/fraction of inspired oxygen ratio (OR = 0.60, 95% CI = .52–0.68, per 10 units increase), and use of high-flow nasal cannula (OR = 0.34; 95% CI, .16–0.74) were associated with the composite outcome, whereas baricitinib use was marginally not associated with the composite outcome (OR = 0.52; 95% CI, .26–1.03). However, baricitinib use was found to be significant after inverse-probability weighted regression (OR = 0.93; 95% CI, .87–0.99). No difference in serious events was noted between treatment groups. Conclusions In real-life settings, addition of baricitinib to SOC in patients hospitalized with sCOVID-19 is associated with decreased mortality without concerning safety signals.
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Affiliation(s)
- Nikolaos Tziolos
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Emmanouil Karofylakis
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Ioannis Grigoropoulos
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Pinelopi Kazakou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Emmanouil Koullias
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Hariklia Kranidioti
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Aimilia Pelekanou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Anna Boulouta
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Maria Pirounaki
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Georgios Georgiopoulos
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Dimitrios T Boumpas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Dimitra Kavatha
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Konstantinos Thomas
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, National and Kapodistrian University of Athens School of Medicine, Hippokration General Hospital, Athens, Greece
| | - Anastasia Antoniadou
- 4th Department of Internal Medicine, National and Kapodistrian University of Athens School of Medicine, Attikon University General Hospital, Chaidari, Greece
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Kyriazopoulou E, Leventogiannis K, Norrby-Teglund A, Dimopoulos G, Pantazi A, Orfanos SE, Rovina N, Tsangaris I, Gkavogianni T, Botsa E, Chassiou E, Kotanidou A, Kontouli C, Chaloulis P, Velissaris D, Savva A, Cullberg JS, Akinosoglou K, Gogos C, Armaganidis A, Giamarellos-Bourboulis EJ. Macrophage activation-like syndrome: an immunological entity associated with rapid progression to death in sepsis. BMC Med 2017; 15:172. [PMID: 28918754 PMCID: PMC5603161 DOI: 10.1186/s12916-017-0930-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 08/10/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A subanalysis of a randomized clinical trial indicated sepsis survival benefit from interleukin (IL)-1 blockade in patients with features of the macrophage activation-like syndrome (MALS). This study aimed to investigate the frequency of MALS and to develop a biomarker of diagnosis and prognosis. METHODS Patients with infections and systemic inflammatory response syndrome were assigned to one test cohort (n = 3417) and a validation cohort (n = 1704). MALS was diagnosed for patients scoring positive either for the hemophagocytic syndrome score and/or having both hepatobiliary dysfunction and disseminated intravascular coagulation. Logistic regression analysis was used to estimate the predictive value of MALS for 10-day mortality in both cohorts. Ferritin, sCD163, IL-6, IL-10, IL-18, interferon gamma (IFN-γ), and tumor necrosis factor alpha (TNF-α) were measured in the blood the first 24 h; ferritin measurements were repeated in 747 patients on day 3. RESULTS The frequency of MALS was 3.7% and 4.3% in the test and the validation cohort, respectively. In both cohorts, MALS was an independent risk factor for 10-day mortality. A ferritin level above 4420 ng/ml was accompanied by 66.7% and 66% mortality after 28 days, respectively. Ferritin levels above 4420 ng/ml were associated with an increase of IL-6, IL-18, INF-γ, and sCD163 and a decreased IL-10/TNF-α ratio, indicating predominance of pro-inflammatory phenomena. Any less than 15% decrease of ferritin on day 3 was associated with more than 90% sensitivity for unfavorable outcome after 10 days. This high mortality risk was also validated in an independent Swedish cohort (n = 109). CONCLUSIONS MALS is an independent life-threatening entity in sepsis. Ferritin measurements can provide early diagnosis of MALS and may allow for specific treatment.
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Affiliation(s)
- Evdoxia Kyriazopoulou
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Konstantinos Leventogiannis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Anna Norrby-Teglund
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Georgios Dimopoulos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Aikaterini Pantazi
- 2nd Department of Internal Medicine, Thriasion Elefsis General Hospital, Elefsina, Greece
| | - Stylianos E Orfanos
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikoletta Rovina
- 1st Department of Pulmonary Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Iraklis Tsangaris
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Theologia Gkavogianni
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Elektra Botsa
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | | | - Anastasia Kotanidou
- 1st Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kontouli
- Intensive Care Unit, "Agios Dimitrios" General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Velissaris
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece
| | - Jonas-Sundén Cullberg
- Department for Infectious Diseases and Center for Infectious Medicine, Karolinska Institute, Karolinska University Hospital, Huddinge, Stockholm, Sweden
| | - Karolina Akinosoglou
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Charalambos Gogos
- Department of Internal Medicine, University of Patras, Medical School, Patras, Greece
| | - Apostolos Armaganidis
- 2nd Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos J Giamarellos-Bourboulis
- 4th Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 1 Rimini Street, 124 62, Athens, Greece.
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Kanni T, Tzanetakou V, Savva A, Kersten B, Pistiki A, van de Veerdonk FL, Netea MG, van der Meer JW, Giamarellos-Bourboulis EJ. Compartmentalized Cytokine Responses in Hidradenitis Suppurativa. PLoS One 2015; 10:e0130522. [PMID: 26091259 PMCID: PMC4474720 DOI: 10.1371/journal.pone.0130522] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 05/22/2015] [Indexed: 01/13/2023] Open
Abstract
Background Favorable treatment outcomes with TNF blockade led us to explore cytokine responses in hidradenitis suppurativa (HS). Methods Blood monocytes of 120 patients and 24 healthy volunteers were subtyped by flow cytometry. Isolated blood mononuclear cells (PBMCs) were stimulated for cytokine production; this was repeated in 13 severe patients during treatment with etanercept. Cytokines in pus were measured. Results CD14brightCD16dim inflammatory monocytes and patrolling monocytes were increased in Hurley III patients. Cytokine production by stimulated PBMCs was low compared to controls but the cytokine gene copies did not differ, indicating post-translational inhibition. The low production of IL-17 was restored, when cells were incubated with adalimumab. In pus, high concentrations of pro-inflammatory cytokines were detected. Based on the patterns, six different cytokine profiles were discerned, which are potentially relevant for the choice of treatment. Clinical improvement with etanercept was predicted by increased production of IL-1β and IL-17 by PBMCs at week 8. Conclusions Findings indicate compartmentalized cytokine expression in HS; high in pus but suppressed in PBMCs. This is modulated through blockade of TNF.
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Affiliation(s)
- Theodora Kanni
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
| | - Vassiliki Tzanetakou
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
| | - Athina Savva
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
| | - Brigit Kersten
- Department of Internal Medicine, Radboud University Medical Center and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands
| | - Aikaterini Pistiki
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
| | - Frank L. van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands
| | - Mihai G. Netea
- Department of Internal Medicine, Radboud University Medical Center and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands
| | - Jos W. van der Meer
- Department of Internal Medicine, Radboud University Medical Center and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands
| | - Evangelos J. Giamarellos-Bourboulis
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece
- Department of Internal Medicine, Radboud University Medical Center and Nijmegen Institute for Infection, Inflammation and Immunity (N4i), Nijmegen, The Netherlands
- * E-mail:
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Savva A, Plantinga TS, Kotanidou A, Farcas M, Baziaka F, Raftogiannis M, Orfanos SE, Dimopoulos G, Netea MG, Giamarellos-Bourboulis EJ. Association of autophagy-related 16-like 1 (ATG16L1) gene polymorphism with sepsis severity in patients with sepsis and ventilator-associated pneumonia. Eur J Clin Microbiol Infect Dis 2014; 33:1609-14. [PMID: 24791954 DOI: 10.1007/s10096-014-2118-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [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: 02/12/2014] [Accepted: 04/08/2014] [Indexed: 01/14/2023]
Abstract
Autophagy is a highly conserved mechanism of eukaryotic cells implicated in cell homeostasis and elimination of intracellular pathogens. Functional polymorphisms in genes encoding for autophagy have been associated with susceptibility to inflammatory and infectious diseases, but data on severe infections are missing. The aim of the present study was to assess whether polymorphisms in genes encoding proteins involved in autophagy influence susceptibility to ventilator-associated pneumonia (VAP). Mechanically ventilated patients with VAP were studied. Genotyping for autophagy-related 16-like 1 (ATG16L1, rs2241880) functional polymorphism was performed using the TaqMan single-nucleotide assay. Monocytes were isolated from patients and stimulated with lipopolysaccharide (LPS). Tumor necrosis factor-α (TNF-α) was measured in the supernatants of monocytes using an enzyme-linked immunosorbent assay. Procalcitonin (PCT) was also measured in the serum of patients by an immuno-time-resolved amplified cryptate technology assay. A total of 155 patients with VAP were enrolled in the study. Carriage of the minor A allele of ATG16L1 was associated with septic shock with at least one organ failure (odds ratio (OR): 2.40, p: 0.036). TNF-α production was significantly greater among the carriers of the polymorphism presenting with at least one organ failure (p: 0.040). PCT was increased upon worsening to septic shock and organ failure only among carriers of the minor frequency A alleles. In a homogeneous cohort of septic patients with VAP, the carriage of autophagy polymorphisms predisposes to VAP severity and septic shock development. This may be related with predisposition to immunoparalysis.
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Affiliation(s)
- A Savva
- 4th Department of Internal Medicine, Attikon University Hospital, University of Athens, Medical School, 1 Rimini Str., 12462, Athens, Greece,
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Giamarellos-Bourboulis EJ, Spyridaki A, Savva A, Georgitsi M, Tsaganos T, Mouktaroudi M, Raftogiannis M, Antonopoulou A, Papaziogas V, Baziaka F, Sereti K, Christopoulos P, Marioli A, Kanni T, Maravitsa P, Pantelidou I, Leventogiannis K, Tsiaoussis P, Lymberopoulou K, Koutelidakis IM. Intravenous paracetamol as an antipyretic and analgesic medication: the significance of drug metabolism. J Pharmacol Sci 2014; 124:144-52. [PMID: 24553403 DOI: 10.1254/jphs.13133fp] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
One prospective, open-label, non-randomized study was conducted in 100 patients to define the antipyretic and analgesic effect of a new intravenous formulation of 1 g of paracetamol; 71 received paracetamol for the management of fever and 29 received paracetamol for pain relief after abdominal surgery or for neoplastic pain. Serial follow-up measurements of core temperature and of pain intensity were done for 6 h. Additional rescue medications were recorded for 5 days. Blood was sampled for the measurement of free paracetamol (APAP) and of glucuronide-APAP and N-sulfate-APAP by an HPLC assay. Defervescence, defined as core temperature below or equal to 37.1°C, was achieved in 52 patients (73.2%) within a median time of 3 h. Patients failing to become afebrile with the first dose of paracetamol became afebrile when administered other agents as rescue medications. Analgesia was achieved in 25 patients (86.4%) within a median time of 2 h. Serum levels of glucuronide-APAP were greater among non-responders to paracetamol. The presented results suggest that the intravenous formulation of paracetamol is clinically effective depending on drug metabolism.
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Giamarellos-Bourboulis EJ, Mylona V, Antonopoulou A, Tsangaris I, Koutelidakis I, Marioli A, Raftogiannis M, Kopterides P, Lymberopoulou K, Mouktaroudi M, Papageorgiou C, Papaziogas B, Georgopoulou AP, Tsaganos T, Papadomichelakis E, Gogos C, Ladas M, Savva A, Pelekanou A, Baziaka F, Koutoukas P, Kanni T, Spyridaki A, Maniatis N, Pelekanos N, Kotsaki A, Vaki I, Douzinas EE, Koratzanis G, Armaganidis A. Effect of clarithromycin in patients with suspected Gram-negative sepsis: results of a randomized controlled trial. J Antimicrob Chemother 2013; 69:1111-8. [DOI: 10.1093/jac/dkt475] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
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Savva A, Roger T. Targeting toll-like receptors: promising therapeutic strategies for the management of sepsis-associated pathology and infectious diseases. Front Immunol 2013; 4:387. [PMID: 24302927 PMCID: PMC3831162 DOI: 10.3389/fimmu.2013.00387] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2013] [Accepted: 11/05/2013] [Indexed: 01/04/2023] Open
Abstract
Toll-like receptors (TLRs) are pattern recognition receptors playing a fundamental role in sensing microbial invasion and initiating innate and adaptive immune responses. TLRs are also triggered by danger signals released by injured or stressed cells during sepsis. Here we focus on studies developing TLR agonists and antagonists for the treatment of infectious diseases and sepsis. Positioned at the cell surface, TLR4 is essential for sensing lipopolysaccharide of Gram-negative bacteria, TLR2 is involved in the recognition of a large panel of microbial ligands, while TLR5 recognizes flagellin. Endosomal TLR3, TLR7, TLR8, TLR9 are specialized in the sensing of nucleic acids produced notably during viral infections. TLR4 and TLR2 are favorite targets for developing anti-sepsis drugs, and antagonistic compounds have shown efficient protection from septic shock in pre-clinical models. Results from clinical trials evaluating anti-TLR4 and anti-TLR2 approaches are presented, discussing the challenges of study design in sepsis and future exploitation of these agents in infectious diseases. We also report results from studies suggesting that the TLR5 agonist flagellin may protect from infections of the gastrointestinal tract and that agonists of endosomal TLRs are very promising for treating chronic viral infections. Altogether, TLR-targeted therapies have a strong potential for prevention and intervention in infectious diseases, notably sepsis.
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Affiliation(s)
- Athina Savva
- Infectious Diseases Service, Department of Medicine, Centre Hospitalier Universitaire Vaudois, University of Lausanne , Lausanne , Switzerland
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Kontogiorgi M, Opsimoulis P, Kopterides P, Savva A, Kalodimou VE, Belesiotou E, Giamarellos-Bourboulis E. Pulmonary nocardiosis in an immunocompetent patient with COPD: the role of defective innate response. Heart Lung 2013; 42:247-50. [PMID: 23680413 DOI: 10.1016/j.hrtlng.2013.03.007] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 03/29/2013] [Accepted: 03/29/2013] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Pulmonary nocardiosis is an uncommon opportunistic infection affecting mainly immunocompromised patients. We herein present a case of nocardiosis without profound underlying immunodeficiency. BACKGROUND A female, 84-years' old patient with stage IV chronic obstructive pulmonary disease (COPD) is presented. No profound causes of immunodeficiency existed, such as HIV infection, diabetes mellitus, malignancy, alcoholism, chemotherapy or previous corticosteroid intake. The patient recovered after treatment with trimethoprim/sulfamethoxazole for 6 months. RESULTS One year after infection resolution, stimulation of the patient's blood monocytes with Nocardia antigens revealed defective production of tumor necrosis factor-alpha, interleukin (IL)-6 and IL-17. CONCLUSION We provide preliminary evidence for a link between defective innate immune responses and predisposition for Nocardia infections. Further studies must be conducted in order to fully investigate this mechanism of infection acquisition.
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Affiliation(s)
- Marina Kontogiorgi
- 2nd Department of Critical Care Medicine, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, 1 Rimini st., Haidari, Athens 12462, Greece.
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Ramakers B, Giamarellos-Bourboulis E, Coenen M, Kox M, Van der Hoeven J, Routsi C, Savva A, Perdios I, Diamantea F, Sinapidis D, Smits P, Riksen N, Pickkers P. Effects of the common 34C>T variant of the AMPD1 gene on immune function, multiorgan dysfunction and mortality in patients with sepsis. Crit Care 2013. [PMCID: PMC3642423 DOI: 10.1186/cc11955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Louis K, Netea MG, Carrer DP, Kotsaki A, Mylona V, Pistiki A, Savva A, Roditis K, Alexis A, Van der Meer JWM, Giamarellos-Bourboulis EJ. Bacterial translocation in an experimental model of multiple organ dysfunctions. J Surg Res 2013; 183:686-94. [PMID: 23481560 DOI: 10.1016/j.jss.2013.01.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 01/31/2013] [Accepted: 01/31/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND In order to investigate the hypothesis that bacterial translocation from the intestine contributes to death after multiple organ dysfunction syndrome (MODS), a sterile MODS model was studied. METHODS MODS was induced in 139 male C57BL/6 mice by lipopolysaccharide (LPS) (endotoxin) infusion followed by zymozan infusion in four groups: Α, sham-operation; Β, LPS; C, LPS + 0.8 g/kg zymozan; and D, LPS + 1.2 g/kg zymozan. Mice were sacrificed at 24 and 48 h for quantitative tissue cultures, isolation, and stimulation of splenocytes, measurement of apoptosis of lymphocytes and macrophages, and of serum LPS and survival. Some mice with MODS were treated with the antibiotic ertapenem. RESULTS Enterobacteriaceae and Enterococcus spp were isolated from tissues. Group D had the highest bacterial load and the shortest survival. Release of interleukin-10, of interleukin-17, and of intgerferon-γ by splenocytes and the rate of apoptosis did not concur with immune paralysis. Serum LPS concentrations were higher in mice with MODS versus controls. Ertapenem prolonged survival and decreased the bacterial load. CONCLUSIONS Bacterial translocation seems to be an important contributor leading from MODS to death and suggests a change in therapy towards adaptation of antimicrobial treatment upon early signs of MODS.
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Affiliation(s)
- Konstantinos Louis
- 4th Department of Internal Medicine, University of Athens Medical School, Athens, Greece
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Savva A, Kanni T, Damoraki G, Kotsaki A, Giatrakou S, Grech I, Katoulis A, Papadavid E, Giamarellos-Bourboulis E. Impact of Toll-like receptor-4 and tumour necrosis factor gene polymorphisms in patients with hidradenitis suppurativa. Br J Dermatol 2013; 168:311-7. [DOI: 10.1111/bjd.12105] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Giamarellos-Bourboulis EJ, Norrby-Teglund A, Mylona V, Savva A, Tsangaris I, Dimopoulou I, Mouktaroudi M, Raftogiannis M, Georgitsi M, Linnér A, Adamis G, Antonopoulou A, Apostolidou E, Chrisofos M, Katsenos C, Koutelidakis I, Kotzampassi K, Koratzanis G, Koupetori M, Kritselis I, Lymberopoulou K, Mandragos K, Marioli A, Sundén-Cullberg J, Mega A, Prekates A, Routsi C, Gogos C, Treutiger CJ, Armaganidis A, Dimopoulos G. Risk assessment in sepsis: a new prognostication rule by APACHE II score and serum soluble urokinase plasminogen activator receptor. Crit Care 2012; 16:R149. [PMID: 22873681 PMCID: PMC3580738 DOI: 10.1186/cc11463] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/08/2012] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Early risk assessment is the mainstay of management of patients with sepsis. APACHE II is the gold standard prognostic stratification system. A prediction rule that aimed to improve prognostication by APACHE II with the application of serum suPAR (soluble urokinase plasminogen activator receptor) is developed. METHODS A prospective study cohort enrolled 1914 patients with sepsis including 62.2% with sepsis and 37.8% with severe sepsis/septic shock. Serum suPAR was measured in samples drawn after diagnosis by an enzyme-immunoabsorbent assay; in 367 patients sequential measurements were performed. After ROC analysis and multivariate logistic regression analysis a prediction rule for risk was developed. The rule was validated in a double-blind fashion by an independent confirmation cohort of 196 sepsis patients, predominantly severe sepsis/septic shock patients, from Sweden. RESULTS Serum suPAR remained stable within survivors and non-survivors for 10 days. Regression analysis showed that APACHE II ≥ 17 and suPAR ≥ 12 ng/ml were independently associated with unfavorable outcome. Four strata of risk were identified: i) APACHE II <17 and suPAR <12 ng/ml with mortality 5.5%; ii) APACHE II < 17 and suPAR ≥ 12 ng/ml with mortality 17.4%; iii) APACHE II ≥ 17 and suPAR <12 ng/ml with mortality 37.4%; and iv) APACHE II ≥ 17 and suPAR ≥ 12 ng/ml with mortality 51.7%. This prediction rule was confirmed by the Swedish cohort. CONCLUSIONS A novel prediction rule with four levels of risk in sepsis based on APACHE II score and serum suPAR is proposed. Prognostication by this rule is confirmed by an independent cohort.
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Mylona EE, Mouktaroudi M, Crisan TO, Makri S, Pistiki A, Georgitsi M, Savva A, Netea MG, van der Meer JWM, Giamarellos-Bourboulis EJ, Joosten LAB. Enhanced interleukin-1β production of PBMCs from patients with gout after stimulation with Toll-like receptor-2 ligands and urate crystals. Arthritis Res Ther 2012; 14:R158. [PMID: 22762240 PMCID: PMC3580550 DOI: 10.1186/ar3898] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/04/2012] [Indexed: 11/10/2022] Open
Abstract
Introduction Monosodium urate monohydrate (MSU) crystals synergize with various toll-like receptor (TLR) ligands to induce cytokine production via activation of the NOD-like receptor (NLR) family, pyrin domain-containing 3 (NLPR3) inflammasome. This has been demonstrated in vitro using human cell lines or monocytes of healthy volunteers. In the present study, we have investigated the effect of MSU crystals and of their combination with TLR ligands in peripheral blood mononuclear cells (PBMC) of patients with gout. Methods PBMCs from 18 patients with primary gout and 12 healthy donors were exposed to MSU crystals in the presence or absence of saturated fatty acid C18:0 (free fatty acid, TLR2 ligand), palmitoyl-3-cystein (Pam3Cys, TLR1/2 ligand) and fibroblast stimulating factor-1 (FSL-1, TLR 2/6 ligand). Production of IL-1β, IL-6, IL-8, IL-17 and tumor necrosis factor alpha (TNFα) was determined by ELISA. mRNA transcripts of IL-1β were measured by real-time PCR. Results MSU crystals alone failed to induce IL-1β, IL-6 or TNFα in both patients and control groups, but a stronger synergy between MSU/Pam3Cys and MSU/C18:0 for the induction of IL-1β was found in patients with gout compared to healthy controls. IL-6, but not IL-8, followed the kinetics of IL-1β. No production of the neutrophil-recruiting IL-17 was detectable after stimulation of the patients' PBMCs with MSU in both the presence or absence of TLR ligands. No change of gene transcripts of IL-1β after stimulation with MSU and Pam3Cys or with MSU and C18:0 was found. A positive correlation was found between synergy in IL-1β production from PBMCs of patients between C18:0 and MSU crystals, as well as the annual number of attacks of acute gouty arthritis (rs: +0.649, P: 0.022). Conclusions The synergy between MSU crystals and TLR-2 ligands is more prominent in patients with gout than in controls. This is likely mediated by the enhanced maturation of pro-IL-1β into IL-1β.
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Antonopoulou A, Baziaka F, Tsaganos T, Raftogiannis M, Koutoukas P, Spyridaki A, Mouktaroudi M, Kotsaki A, Savva A, Georgitsi M, Giamarellos-Bourboulis EJ. Role of tumor necrosis factor gene single nucleotide polymorphisms in the natural course of 2009 influenza A H1N1 virus infection. Int J Infect Dis 2012; 16:e204-8. [DOI: 10.1016/j.ijid.2011.11.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 01/04/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022] Open
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Atmatzidis S, Koutelidakis IM, Chatzimavroudis G, Kotsaki A, Louis K, Pistiki A, Savva A, Antonopoulou A, Atmatzidis K, Giamarellos-Bourboulis EJ. Detrimental effect of apoptosis of lymphocytes at an early time point of experimental abdominal sepsis. BMC Infect Dis 2011; 11:321. [PMID: 22099496 PMCID: PMC3247197 DOI: 10.1186/1471-2334-11-321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [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: 06/30/2011] [Accepted: 11/20/2011] [Indexed: 12/25/2022] Open
Abstract
Background Apoptosis of lymphocytes is considered a late sequelum in the sepsis cascade. The role of apoptosis of lymphocytes as a driver of final outcome was investigated. Methods Abdominal sepsis was induced after cecal ligation and puncture (CLP) in 31 rabbits. Blood was sampled at serial time intervals and peripheral blood mononuclear cells (PBMCs) were isolated. Apoptosis of lymphocytes and monocytes was measured through flow cytometric analysis. PBMCs were stimulated with LPS and Pam3Cys for the release of tumor necrosis factor-alpha (TNFα). Tissue bacterial growth was quantitatively measured. In a second set of experiments, CLP was performed in another 40 rabbits; 20 received single intravenous infusions of ciprofloxacin and of metronidazole 4 hours after surgery. Results Animals were divided into two groups based on the percentage of lymphocyte apoptosis at 4 hours after surgery; less than or equal to 32% and more than 32%. Survival of the former was shorter than the latter (p: 0.017). Tissue growth was similar between groups. Apoptosis of lymphocytes and of monocytes was lower in the former group over follow-up. Release of ΤNFα did not differ. The above findings on survival were repeated in the second set of experiments. Administration of antimicrobials prolonged survival of the former group (p: 0.039) but not of the latter group (pNS). Conclusions Lymphocyte apoptosis at an early time point of experimental peritonitis is a major driver for death. A lower percentage of apoptosis leads earlier to death. Antimicrobials were beneficial even at that disease state.
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Affiliation(s)
- Stefanos Atmatzidis
- 2nd Department of Surgery, University of Thessaloniki, Medical School, Thessaloniki, Greece
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Savva A, Raftogiannis M, Baziaka F, Routsi C, Antonopoulou A, Koutoukas P, Tsaganos T, Kotanidou A, Apostolidou E, Giamarellos-Bourboulis EJ, Dimopoulos G. Soluble urokinase plasminogen activator receptor (suPAR) for assessment of disease severity in ventilator-associated pneumonia and sepsis. J Infect 2011; 63:344-50. [DOI: 10.1016/j.jinf.2011.07.016] [Citation(s) in RCA: 52] [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: 05/05/2011] [Revised: 07/28/2011] [Accepted: 07/29/2011] [Indexed: 11/29/2022]
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Dimopoulou I, Pelekanou A, Mavrou I, Savva A, Tzanela M, Kotsaki A, Kardara M, Orfanos SE, Kotanidou A, Giamarellos-Bourboulis EJ. Early serum levels of soluble triggering receptor expressed on myeloid cells-1 in septic patients: correlation with monocyte gene expression. J Crit Care 2011; 27:294-300. [PMID: 21855288 DOI: 10.1016/j.jcrc.2011.06.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [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: 01/26/2011] [Revised: 05/17/2011] [Accepted: 06/24/2011] [Indexed: 01/22/2023]
Abstract
PURPOSE To define early kinetics of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) and of TREM-1 monocyte gene expression in critically ill patients with sepsis. METHODS Blood was sampled at regular time intervals from 105 patients with sepsis. Concentrations of tumour necrosis factor α (TNFα), interleukin (IL)-6, IL-8 and IL-10 and IL-12p70 and sTREM-1 were measured by an enzyme immunoassay. Blood mononuclear cells were isolated on day 0 from 20 patients and 10 healthy volunteers; RNA was extracted and gene expression of TREM-1 and TNFα were assessed by reverse transcriptase polymerase chain reaction. RESULTS Early serum concentrations of sTREM-1 were greater among patients with severe sepsis/shock than among patients with sepsis; those of TNFα, IL-6, IL-8 and IL-10 were pronounced among patients with septic shock. Gene transcripts of TNFα were lower among patients with severe sepsis/shock than among patients with sepsis; that was not the case for TREM-1. Early serum levels of sTREM-1 greater than 180 pg/mL were predictors of shorter duration of mechanical ventilation. CONCLUSIONS Although serum levels of sTREM-1 are increased early upon advent of severe sepsis/shock, gene expression of TREM-1 on monocytes in severe sepsis/shock is not increased. These findings add considerably to our knowledge on the pathophysiology of sepsis.
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Affiliation(s)
- Ioanna Dimopoulou
- 2nd Department of Critical Care Medicine, University of Athens, Medical School, Greece
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Raftogiannis M, Antonopoulou A, Baziaka F, Spyridaki A, Koutoukas P, Tsaganos T, Savva A, Pistiki A, Georgitsi M, Giamarellos-Bourboulis EJ. Indication for a role of regulatory T cells for the advent of influenza A (H1N1)-related pneumonia. Clin Exp Immunol 2011; 161:576-83. [PMID: 20646008 DOI: 10.1111/j.1365-2249.2010.04208.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Regulatory T cells (T(regs) ) have an anti-inflammatory role. A former study in a limited number of patients found that absolute counts of T(regs) increase when infection by the new influenza H1N1 virus is complicated with pneumonia. These results generate the question if H1N1-related pneumonia is associated with a state of hypo-inflammation. A total of 135 patients were enrolled with blood sampling within less than 24 h from diagnosis; 23 with flu-like syndrome; 69 with uncomplicated H1N1-infection; seven with bacterial pneumonia; and 36 with H1N1-related pneumonia. T(regs) and CD14/HLA-DR co-expression were estimated by flow cytometry; concentrations of tumour necrosis factor-alpha (TNF-α), of interleukin (IL)-6 and of soluble triggering receptor expressed on myeloid cells-1 (sTREM-1) by an enzyme immunoassay; those of procalcitonin (PCT) by immuno-time-resolved amplified cryptate technology assay. Expression of human leucocyte antigen D-related (HLA-DR) on monocytes was similar between groups; absolute T(reg) counts were greater among patients with H1N1-related pneumonia than flu-like syndrome or H1N1-uncomplicated infection. Serum TNF-α of patients with bacterial pneumonia was greater than those of other groups, but IL-10 was similar between groups. Serum PCT was greater among patients with H1N1-related pneumonia and sTREM-1 among those with H1N1-related pneumonia. Regression analysis revealed that the most important factors related with the advent of pneumonia were the existence of underlying illnesses (P = 0·006) and of T(regs) equal to or above 16 mm(3) (P = 0·013). It is concluded that the advent of H1N1-related pneumonia is related to an early increase of the absolute T(reg) counts. This increase is probably not part of a hypo-inflammatory state of the host.
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Affiliation(s)
- M Raftogiannis
- 4th Department of Internal Medicine, University of Athens, Medical School, Athens, Greece.
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Katsenos C, Tsagkaris I, Antonopoulou A, Savva A, Michaloglou A, Giamarellos-Bourboulis E, Armaganidis A, Mandragos K. Early administration of hydrocortisone replacement after advent of septic shock is a major determinant of final outcome. Crit Care 2011. [PMCID: PMC3068341 DOI: 10.1186/cc9832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Giamarellos-Bourboulis EJ, van de Veerdonk FL, Mouktaroudi M, Raftogiannis M, Antonopoulou A, Joosten LAB, Pickkers P, Savva A, Georgitsi M, van der Meer JWM, Netea MG. Inhibition of caspase-1 activation in Gram-negative sepsis and experimental endotoxemia. Crit Care 2011; 15:R27. [PMID: 21244670 PMCID: PMC3222063 DOI: 10.1186/cc9974] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/19/2010] [Accepted: 01/18/2011] [Indexed: 12/17/2022]
Abstract
Introduction Down-regulation of ex-vivo cytokine production is a specific feature in patients with sepsis. Cytokine downregulation was studied focusing on caspase-1 activation and conversion of pro-interleukin-1β into interleukin-1β (IL-1β). Methods Peripheral blood mononuclear cells were isolated from a) 92 patients with sepsis mainly of Gram-negative etiology; b) 34 healthy volunteers; and c) 5 healthy individuals enrolled in an experimental endotoxemia study. Cytokine stimulation was assessed in vitro after stimulation with a variety of microbial stimuli. Results Inhibition of IL-1β in sepsis was more profound than tumour necrosis factor (TNF). Down-regulation of IL-1β response could not be entirely explained by the moderate inhibition of transcription. We investigated inflammasome activation and found that in patients with sepsis, both pro-caspase-1 and activated caspase-1 were markedly decreased. Blocking caspase-1 inhibited the release of IL-1β in healthy volunteers, an effect that was lost in septic patients. Finally, urate crystals, which specifically induce the NLPR3 inflammasome activation, induced significant IL-1β production in healthy controls but not in patients with sepsis. These findings were complemented by inhibition of caspase-1 autocleavage as early as two hours after lipopolysaccharide exposure in volunteers. Conclusions These data demonstrate that the inhibition of caspase-1 and defective IL-1 β production is an important immunological feature in sepsis.
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Georgopoulou AP, Savva A, Giamarellos-Bourboulis EJ, Georgitsi M, Raftogiannis M, Antonakos N, Apostolidou E, Carrer DP, Dimopoulos G, Economou A, Efthymiou G, Galanakis N, Galani L, Gargalianos P, Karaiskos I, Katsenos C, Kavatha D, Koratzanis E, Labropoulos P, Lada M, Nakos G, Paggalou E, Panoutsopoulos G, Paraschos M, Pavleas I, Pontikis K, Poulakou G, Prekates A, Sybardi S, Theodorakopoulou M, Trakatelli C, Tsiaoussis P, Gogos C, Giamarellou H, Armaganidis A, Meisner M. Early changes of procalcitonin may advise about prognosis and appropriateness of antimicrobial therapy in sepsis. J Crit Care 2010; 26:331.e1-7. [PMID: 20869839 DOI: 10.1016/j.jcrc.2010.07.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 07/20/2010] [Accepted: 07/21/2010] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study is to define if early changes of procalcitonin (PCT) may inform about prognosis and appropriateness of administered therapy in sepsis. METHODS A prospective multicenter observational study was conducted in 289 patients. Blood samples were drawn on day 1, that is, within less than 24 hours from advent of signs of sepsis, and on days 3, 7, and 10. Procalcitonin was estimated in serum by the ultrasensitive Kryptor assay (BRAHMS GmbH, Hennigsdorf, Germany). Patients were divided into the following 2 groups according to the type of change of PCT: group 1, where PCT on day 3 was decreased by more than 30% or was below 0.25 ng/mL, and group 2, where PCT on day 3 was either increased above 0.25 ng/mL or decreased less than 30%. RESULTS Death occurred in 12.3% of patients of group 1 and in 29.9% of those of group 2 (P < .0001). Odds ratio for death of patients of group 1 was 0.328. Odds ratio for the administration of inappropriate antimicrobials of patients of group 2 was 2.519 (P = .003). CONCLUSIONS Changes of serum PCT within the first 48 hours reflect the benefit or not of the administered antimicrobial therapy. Serial PCT measurements should be used in clinical practice to guide administration of appropriate antimicrobials.
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Kelekis NL, Efstathopoulos E, Balanika A, Spyridopoulos TN, Pelekanou A, Kanni T, Savva A, Brountzos E, Giamarellos-Bourboulis EJ. Ultrasound aids in diagnosis and severity assessment of hidradenitis suppurativa. Br J Dermatol 2010; 162:1400-2. [PMID: 20184586 DOI: 10.1111/j.1365-2133.2010.09710.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Mouktaroudi M, Savva A, Pistiki A, Raftogiannis M, Antonopoulou A, Giamarellos-Bourboulis E. Interferon-gamma reverses sepsis-induced immunoparalysis of monocytes in vitro. Crit Care 2010. [PMCID: PMC2934417 DOI: 10.1186/cc8249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Giamarellos-Bourboulis EJ, Raftogiannis M, Antonopoulou A, Baziaka F, Koutoukas P, Savva A, Kanni T, Georgitsi M, Pistiki A, Tsaganos T, Pelekanos N, Athanassia S, Galani L, Giannitsioti E, Kavatha D, Kontopidou F, Mouktaroudi M, Poulakou G, Sakka V, Panagopoulos P, Papadopoulos A, Kanellakopoulou K, Giamarellou H. Effect of the novel influenza A (H1N1) virus in the human immune system. PLoS One 2009; 4:e8393. [PMID: 20037642 PMCID: PMC2792719 DOI: 10.1371/journal.pone.0008393] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/01/2009] [Indexed: 01/23/2023] Open
Abstract
Background The pandemic by the novel H1N1 virus has created the need to study any probable effects of that infection in the immune system of the host. Methodology/Principal Findings Blood was sampled within the first two days of the presentation of signs of infection from 10 healthy volunteers; from 18 cases of flu-like syndrome; and from 31 cases of infection by H1N1 confirmed by reverse RT-PCR. Absolute counts of subtypes of monocytes and of lymphocytes were determined after staining with monoclonal antibodies and analysis by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from patients and stimulated with various bacterial stimuli. Concentrations of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-18, interferon (FN)-alpha and of IFN-gamma were estimated in supernatants by an enzyme immunoassay. Infection by H1N1 was accompanied by an increase of monocytes. PBMCs of patients evoked strong cytokine production after stimulation with most of bacterial stimuli. Defective cytokine responses were shown in response to stimulation with phytohemagglutin and with heat-killed Streptococcus pneumoniae. Adaptive immune responses of H1N1-infected patients were characterized by decreases of CD4-lymphocytes and of B-lymphocytes and by increase of T-regulatory lymphocytes (Tregs). Conclusions/Significance Infection by the H1N1 virus is accompanied by a characteristic impairment of the innate immune responses characterized by defective cytokine responses to S.pneumoniae. Alterations of the adaptive immune responses are predominated by increase of Tregs. These findings signify a predisposition for pneumococcal infections after infection by H1N1 influenza.
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Pelekanou A, Kanni T, Savva A, Mouktaroudi M, Raftogiannis M, Kotsaki A, Giamarellos-Bourboulis EJ. Long-term efficacy of etanercept in hidradenitis suppurativa: results from an open-label phase II prospective trial. Exp Dermatol 2009; 19:538-40. [PMID: 19758320 DOI: 10.1111/j.1600-0625.2009.00967.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the long-term efficacy of etanercept for the management of hidradenitis suppurativa. METHODS Analysis was based on the long-term follow-up (weeks 24-144) of 10 patients enrolled in a prospective open-label phase II study; etanercept was initially administered subcutaneously 50 mg once weekly for 12 weeks in 10 patients. Disease recurrence and the need to restart etanercept were recorded. RESULTS Three patients did not report any disease recurrence. A second course of treatment with etanercept was needed in seven patients. Favourable responses were found in five; two patients failed treatment. CONCLUSIONS The first treatment course achieved long-term disease remission in almost one-third of patients. The remaining needed a second treatment course but even in that case, their disease severity at restart was significantly lower compared with baseline.
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Kranidioti H, Orfanos SE, Vaki I, Kotanidou A, Raftogiannis M, Dimopoulou I, Kotsaki A, Savva A, Papapetropoulos A, Armaganidis A, Giamarellos-Bourboulis EJ. Angiopoietin-2 is increased in septic shock: evidence for the existence of a circulating factor stimulating its release from human monocytes. Immunol Lett 2009; 125:65-71. [PMID: 19539650 DOI: 10.1016/j.imlet.2009.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2009] [Revised: 05/30/2009] [Accepted: 06/08/2009] [Indexed: 12/22/2022]
Abstract
We aimed to investigate if angiopoietin-2 (Ang-2) participates in the septic process and what may be the role of monocytes as a site of release of Ang-2 in sepsis. Concentrations of Ang-2 were estimated in sera and in supernatants of monocytes derived form one already described cohort of 90 patients with septic syndrome due to ventilator-associated pneumonia (VAP). Mononuclear cells of 17 healthy volunteers were stimulated by serum of patients in the presence or absence of various intracellular pathway inhibitors. Ang-2 gene expression after stimulation was also tested. Ang-2 was higher in patients with septic shock compared to patients with sepsis, severe sepsis and controls. Ang-2 was significantly increased in non-survivors compared with survivors. Serum levels greater than 9700 pg/ml were accompanied by a 3.254 odds ratio for death (p: 0.033). Ang-2 release from monocytes of septic patients was slightly decreased after stimulation with lipopolysaccharide (LPS) of Escherichia coli O55:B5. Release of Ang-2 from healthy mononuclear cells was stimulated by serum of patients with shock but not by serum of non-shocked patients (p: 0.016). Release was decreased by LPS; increased in the presence of a TLR4 antagonist; and decreased by anti-TNF antibody. RNA transcripts of PBMCs after stimulation with serum of patients with septic shock were higher than those after LPS stimulation. It is concluded that Ang-2 is increased in serum in the event of septic shock and that its increase is related to unfavorable outcome. It seems that a circulating factor may exist in the serum of patients with septic shock that stimulates gene expression and subsequent release of Ang-2 from monocytes. TLR4 and TNFalpha modulate release of Ang-2.
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Affiliation(s)
- Hariklia Kranidioti
- 4th Department of Internal Medicine, University of Athens, Medical School, Greece
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Antonopoulou A, Raftogiannis M, Baziaka F, Koutoukas P, Savva A, Kanni T, Georgitsi M, Pistiki A, Giamarellos-Bourboulis EJ. Effect of the novel influenza A (H1N1) virus in the human immune system. Crit Care 2009. [PMCID: PMC2776197 DOI: 10.1186/cc8080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Karayiannakis AJ, Syrigos KN, Savva A, Polychronidis A, Karatzas G, Simopoulos C. Serum E-cadherin concentrations and their response during laparoscopic and open cholecystectomy. Surg Endosc 2002; 16:1551-4. [PMID: 12072997 DOI: 10.1007/s00464-001-9221-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [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: 11/26/2001] [Accepted: 01/31/2002] [Indexed: 10/27/2022]
Abstract
BACKGROUND Elevated serum levels of the cell adhesion molecule E-cadherin have been associated with the presence of tissue injury and inflammation. We compared soluble E-cadherin response during laparoscopic and open cholecystectomy. METHODS The E-cadherin response to surgery was studied in 16 patients undergoing laparoscopic cholecystectomy and 12 patients undergoing open cholecystectomy. Serum E-cadherin levels were measured by an enzyme immunoassay (ELISA) preoperatively, 10 and 30 min after the commencement of surgery, and at 6 and 24 h following the operation. RESULTS Serum E-cadherin levels decreased progressively during laparoscopic cholecystectomy; their concentrations at 24 h after surgery were significantly lower when compared with preoperative values. In the open cholecystectomy group, serum E-cadherin levels did not differ from preoperative values at any time point. Serum E-cadherin concentrations at 24 h after surgery and the cumulative E-cadherin response were significantly higher in the open cholecystectomy group than in the laparoscopic group. CONCLUSION Compared with open cholecystectomy, the cumulative E-cadherin response is significantly reduced following laparoscopic cholecystectomy.
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Affiliation(s)
- A J Karayiannakis
- Second Department of Surgery, Democritus University of Thrace, Medical School, 6 I. Kaviri Street, 68 100 Alexandroupolis, Greece.
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Abstract
Epstein-Barr virus (EBV) is a known oncogenic virus associated with a wide variety of cancers, including nasopharyngeal carcinoma. Waldeyer's ring, a collection of lymphoid tissues, includes the nasopharynx, pharyngeal, and lingual tonsils. To determine if EBV plays a causative role in carcinomas arising from other tissues in Waldeyer's ring, we examined pharyngeal tonsillar carcinomas for evidence of EBV infection. As previously reported, DNA was extracted from 53 consecutive tonsil cancers, as well as from age- and gender-matched non-cancerous tonsillectomy specimens. Three different sets of primers for discrete exons of EBV were then used to determine if active or latent EBV infection was expressed in the extracted DNA using the polymerase chain reaction (PCR). All positive bands were then sequenced to confirm the presence of amplified EBV fragments. None of the samples showed evidence for active EBV infection. In primers demonstrating latent infection, 1 of 53 (1.9%) of tumors were positive, versus 6 of 53 (11.3%) of the controls. These results indicate that EBV expression is not increased in DNA from tonsil cancers and that EBV infection does not have a causal relationship with tonsil cancer.
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Affiliation(s)
- N Khabie
- Department of Otolaryngology, Mayo Clinic, Rochester, MN 55905, U.S.A
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Tsikas D, Sandmann J, Luessen P, Savva A, Rossa S, Stichtenoth DO, Frölich JC. S-Transnitrosylation of albumin in human plasma and blood in vitro and in vivo in the rat. Biochim Biophys Acta 2001; 1546:422-34. [PMID: 11295447 DOI: 10.1016/s0167-4838(01)00166-2] [Citation(s) in RCA: 34] [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] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
S-Nitrosoalbumin (SNOALB) is the most abundant physiological circulating nitric oxide (NO) carrier regulating NO-dependent biological actions in humans. The mechanisms of its formation and biological actions are still incompletely understood. Nitrosation by authentic NO and S-transnitrosylation of the single sulfhydryl group located at Cys-34 of human albumin by the physiological S-nitroso compounds S-nitrosocysteine (SNOC) and S-nitrosoglutathione (GSNO) are two possible mechanisms. On a quantitative basis, we investigated by gas chromatography-mass spectrometry the contribution of these two mechanisms to SNOALB formation in human plasma and blood in vitro. GSNO and SNOC (0-100 microM) rapidly and efficiently (recovery=35%) S-transnitrosylated albumin to form SNOALB. NO (100 microM) S-nitrosated albumin to SNOALB at a considerably lower extent (recovery=5%). The putative NO-donating drugs glyceryl trinitrate and sodium nitroprusside (each 100 microM) failed completely in S-nitrosating albumin. Bubbling NO into human plasma and blood resulted in formation of SNOALB that inhibited ADP-induced platelet aggregation. Infusion of GS(15)NO in the rat resulted in formation of S(15)NOALB, [(15)N]nitrate and [(15)N]nitrite. Our results suggest that S-transnitrosylation of albumin by SNOC and GSNO could be a more favored mechanism for the formation of SNOALB in the circulation in vivo than S-nitrosation of albumin by NO itself.
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Affiliation(s)
- D Tsikas
- Institute of Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Strasse 1, D-30625, Hannover, Germany
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Tsikas D, Sandmann J, Savva A, Luessen P, Böger RH, Gutzki FM, Mayer B, Frölich JC. Assessment of nitric oxide synthase activity in vitro and in vivo by gas chromatography-mass spectrometry. J Chromatogr B Biomed Sci Appl 2000; 742:143-53. [PMID: 10892593 DOI: 10.1016/s0378-4347(00)00142-0] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
A gas chromatographic-mass spectrometric method for the determination of nitric oxide synthase activity is described. The method is based on the gas chromatographic-mass spectrometric measurement of L-[15N2]arginine-derived [15N]nitrite as its pentafluorobenzyl derivative in the negative-ion chemical ionization mode. Application of the method to the analysis of [15N]nitrite formation by purified neuronal nitric oxide synthase revealed K(M) values of 3.1 microM by Hanes and 4.6 microM by Lineweaver-Burk for L-[15N2]arginine. The corresponding Vmax values were 0.204 and 0.228 micromol [15N]nitrite min(-1) mg(-1) NOS, respectively. N(G)-Nitro-L-arginine and N(G),N(G)-dimethylarginine (asymmetric dimethylarginine) were identified by this method as the most potent enzyme inhibitors. Nitric oxide synthase activity was also assessed in vivo by i.v. injection of L-[15N2]arginine in a rat and determination of plasma [15N]nitrite and [15N]nitrate. The assay described in this work allows for accurate, specific and highly sensitive determination of nitric oxide synthase activity in vitro and in vivo.
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Affiliation(s)
- D Tsikas
- Institute of Clinical Pharmacology, Hannover Medical School, Germany.
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