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Matthaiou AM, Bizymi N, Pagonidis K, Manousaki E, Fragkoulakis M, Lambiri I, Mitrouska I, Vasarmidi E, Tzanakis N, Antoniou KM. Reversibility of the Enlargement of the Pulmonary Artery in COVID-19 Pneumonia as a Marker of Remission of the Disease. J Pers Med 2024; 14:161. [PMID: 38392595 PMCID: PMC10890114 DOI: 10.3390/jpm14020161] [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] [Received: 01/15/2024] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia is associated with extensive pulmonary microangiopathy and the enlargement of the pulmonary artery (PA), while its progression after the remission of the disease has not been investigated yet. The aim was to assess the diametral increase in the PA in COVID-19 pneumonia, as revealed on chest computed tomography (CT), and further investigate its progression. This was a retrospective cohort study of patients with COVID-19 pneumonia, without prior history of pulmonary hypertension, who underwent CT pulmonary angiography before, during, and after the infection. Pulmonary embolism was excluded in all cases. The main PA diameter (MPAD) was assessed in consecutive chest imaging. Statistical analysis was performed with the non-parametric Wilcoxon and Kruskal-Wallis tests, while correlations were performed with the non-parametric Spearman test. A mean ± SD MPAD of 3.1 ± 0.3 cm in COVID-19 pneumonia was significantly decreased to 2.8 ± 0.3 cm in the post-infectious state after 2-18 months in 31 patients (p-value: <0.0001). In a subgroup of six patients with more than one post-COVID-19 CT, a significant further decline in the diameter was observed (p-value: 0.0313). On the other hand, in accordance with the literature, a significant increase in the MPAD during COVID-19 pneumonia was noted in a group of 10 patients with a pre-COVID-19 CT (p-value: 0.0371). The enlargement of the PA is a common finding in COVID-19 pneumonia that regresses after the remission of the disease, indicating that this reversible cardiovascular event is a potential marker of disease activity, while its course in long COVID is yet to be determined.
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Affiliation(s)
- Andreas M Matthaiou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Nikoleta Bizymi
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Konstantinos Pagonidis
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Eirini Manousaki
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Michail Fragkoulakis
- Department of Medical Imaging, Knossos Medical Diagnosis Centre, 71409 Heraklion, Greece
| | - Irini Lambiri
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Ioanna Mitrouska
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71500 Heraklion, Greece
- Department of Respiratory Medicine, University Hospital of Heraklion, 71500 Heraklion, Greece
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2
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Margaritopoulos GA, Proklou A, Trachalaki A, Badenes Bonet D, Kokosi M, Kouranos V, Chua F, George P, Renzoni EA, Devaraj A, Desai S, Nicholson AG, Antoniou KM, Wells AU. Overnight desaturation in interstitial lung diseases: links to pulmonary vasculopathy and mortality. ERJ Open Res 2024; 10:00740-2023. [PMID: 38348245 PMCID: PMC10860199 DOI: 10.1183/23120541.00740-2023] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 11/21/2023] [Indexed: 02/15/2024] Open
Abstract
Background Overnight desaturation predicts poor prognosis across interstitial lung diseases (ILDs). The aim of the present study was to investigate whether nocturnal desaturation is associated with pulmonary vasculopathy and mortality. Methods A retrospective single centre study of 397 new ILD patients was carried out including patients with idiopathic pulmonary fibrosis (IPF) (n=107) and patients with non-IPF fibrotic ILD (n=290). This is the largest study to date of the effect of significant nocturnal desaturation (SND) (≥10% of total sleep time with oxygen saturation ≤90% measured by pulse oximetry). Results The prevalence of SND was 28/107 (26.2%) in IPF and 80/290 (27.6%) in non-IPF ILD. The prevalence of SND was higher in non-IPF ILDs than in IPF (p=0.025) in multivariate analysis. SND was associated with noninvasive markers of pulmonary hypertension (PH): tricuspid regurgitation velocity (TRV) (p<0.0001), brain natriuretic peptide (p<0.007), carbon monoxide transfer coefficient (p<0.0001), A-a gradient (p<0.0001), desaturation >4% in 6-min walking test (p<0.03) and pulmonary artery diameter (p<0.005). SND was independently associated with high echocardiographic PH probability in the entire cohort (OR 2.865, 95% CI 1.486-5.522, p<0.002) and in non-IPF fibrotic ILD (OR 3.492, 95% CI 1.597-7.636, p<0.002) in multivariate analysis. In multivariate analysis, SND was associated with mortality in the entire cohort (OR 1.734, 95% CI 1.202-2.499, p=0.003) and in IPF (OR 1.908, 95% CI 1.120-3.251, p=0.017) and non-IPF fibrotic ILD (OR 1.663, 95% CI 1.000-2.819, p=0.041). Separate models with exclusion of each one of the diagnostic subgroups showed that no subgroup was responsible for this finding in non-IPF ILDs. SND was a stronger marker of 5-year mortality than markers of PH. Conclusion SND was associated with high echocardiographic probability and mortality and was a stronger predictor of mortality in IPF and non-IPF ILDs grouped together to power the study.
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Affiliation(s)
- George A. Margaritopoulos
- Interstitial Lung Disease Unit, London North West University Hospital Healthcare Trust, London, UK
- National Heart and Lung Institute, Imperial College, London, UK
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athanasia Proklou
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Intensive Care Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athina Trachalaki
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
| | - Diana Badenes Bonet
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- Hospital del Mar, Parc de Salut Mar, Barcelona, Spain
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Vasilis Kouranos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Felix Chua
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Peter George
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | - Anand Devaraj
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Sujal Desai
- Radiology Department, Royal Brompton Hospital, London, UK
| | - Andrew G. Nicholson
- National Heart and Lung Institute, Imperial College, London, UK
- Department of Histopathology, Royal Brompton and Harefield Hospitals, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - Katerina M. Antoniou
- Interstitial Lung Disease Unit, University Hospital of Herakleio, Heraklion, Greece
- These authors contributed equally
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
- These authors contributed equally
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Barbayianni I, Kanellopoulou P, Fanidis D, Nastos D, Ntouskou ED, Galaris A, Harokopos V, Hatzis P, Tsitoura E, Homer R, Kaminski N, Antoniou KM, Crestani B, Tzouvelekis A, Aidinis V. SRC and TKS5 mediated podosome formation in fibroblasts promotes extracellular matrix invasion and pulmonary fibrosis. Nat Commun 2023; 14:5882. [PMID: 37735172 PMCID: PMC10514346 DOI: 10.1038/s41467-023-41614-x] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
The activation and accumulation of lung fibroblasts resulting in aberrant deposition of extracellular matrix components, is a pathogenic hallmark of Idiopathic Pulmonary Fibrosis, a lethal and incurable disease. In this report, increased expression of TKS5, a scaffold protein essential for the formation of podosomes, was detected in the lung tissue of Idiopathic Pulmonary Fibrosis patients and bleomycin-treated mice. Τhe profibrotic milieu is found to induce TKS5 expression and the formation of prominent podosome rosettes in lung fibroblasts, that are retained ex vivo, culminating in increased extracellular matrix invasion. Tks5+/- mice are found resistant to bleomycin-induced pulmonary fibrosis, largely attributed to diminished podosome formation in fibroblasts and decreased extracellular matrix invasion. As computationally predicted, inhibition of src kinase is shown to potently attenuate podosome formation in lung fibroblasts and extracellular matrix invasion, and bleomycin-induced pulmonary fibrosis, suggesting pharmacological targeting of podosomes as a very promising therapeutic option in pulmonary fibrosis.
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Affiliation(s)
- Ilianna Barbayianni
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Paraskevi Kanellopoulou
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Dionysios Fanidis
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Dimitris Nastos
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Eleftheria-Dimitra Ntouskou
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Apostolos Galaris
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Vaggelis Harokopos
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Pantelis Hatzis
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece
| | - Eliza Tsitoura
- Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Robert Homer
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - Naftali Kaminski
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Katerina M Antoniou
- Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Bruno Crestani
- Department of Pulmonology, Bichat-Claude Bernard Hospital, Paris, France
| | - Argyrios Tzouvelekis
- Department of Respiratory Medicine, School of Medicine, University of Patras, Patras, Greece
| | - Vassilis Aidinis
- Institute for Fundamental Biomedical Research, Biomedical Sciences Research Center Alexander Fleming, Athens, Greece.
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Spanakis M, Ioannou P, Tzalis S, Chouzouri F, Patelarou E, Kofteridis DP, Antoniou KM, Schiza SE, Patelarou A, Tzanakis N. Evaluation of Drug Interactions in Hospitalized Patients with Respiratory Disorders in Greece. Adv Respir Med 2023; 91:74-92. [PMID: 36825942 PMCID: PMC9952796 DOI: 10.3390/arm91010008] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/23/2023] [Accepted: 01/31/2023] [Indexed: 02/08/2023]
Abstract
Background: Patients with respiratory disorders often have additional diseases and are usually treated with more than one medication to manage their respiratory conditions as well as additional comorbidities. Thus, they are frequently exposed to polypharmacy (≥5 drugs), which raises the risk for drug-drug interactions (DDIs) and adverse drug reactions (ADRs). In this work, we present the results regarding the prevalence of DDIs in hospitalized patients with respiratory disorders in Greece. Methods: A 6-month descriptive single-center retrospective observational study enrolled 102 patients with acute or chronic respiratory disorders. Clinical characteristics and medication regimens were recorded upon admission, hospitalization, and discharge. The prevalence of DDIs and their clinical significance was recorded and analyzed. Results: Unspecified acute lower respiratory tract infection (25%), exacerbations of chronic obstructive pulmonary disease (12%) and pneumonia (8%) were the most frequent reasons for admission. Cardiovascular disorders (46%), co-existing respiratory disorders (32%), and diabetes (25%) were the most prevalent comorbidities. Polypharmacy was noted in 61% of patients upon admission, 98% during hospitalization, and 63% upon discharge. Associated DDIs were estimated to be 55% upon admission, 96% throughout hospitalization, and 63% on discharge. Pharmacodynamic (PD) DDIs were the most prevalent cases (81%) and referred mostly to potential risk for QT-prolongation (31.4% of PD-DDIs) or modulation of coagulation process as expressed through the international normalized ratio (INR) (29.0% of DDIs). Pharmacokinetic (PK) DDIs (19% of DDIs) were due to inhibition of Cytochrome P450 mediated metabolism that could lead to elevated systemic drug concentrations. Clinically significant DDIs characterized as "serious-use alternative" related to 7% of cases while 59% of DDIs referred to combinations that could be characterized as "use with caution-monitor". Clinically significant DDIs mostly referred to medication regimens upon admission and discharge and were associated with outpatient prescriptions. Conclusions: Hospitalized patients with respiratory disorders often experience multimorbidity and polypharmacy that raise the risk of DDIs. Clinicians should be conscious especially if any occurring arrhythmias, INR modulations, and prolonged or increased drug action is associated with DDIs.
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Affiliation(s)
- Marios Spanakis
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
- Computational Biomedicine Laboratory, Institute of Computer Science, Foundation for Research & Technology-Hellas (FORTH), GR-70013 Heraklion, Crete, Greece
- Correspondence:
| | - Petros Ioannou
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Sotiris Tzalis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Flora Chouzouri
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Evridiki Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Diamantis P. Kofteridis
- Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, 71110 Heraklion, Crete, Greece
| | - Katerina M. Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Sophia E. Schiza
- Sleep Disorders Unit, Department of Respiratory Medicine, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Athina Patelarou
- Department of Nursing, School of Health Sciences, Hellenic Mediterranean University, 71004 Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
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5
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Karampitsakos T, Phuong Diep P, Loth DW, Nadeem I, Khurtsidze E, Wijsenbeek MS, Wuyts WA, Bargagli E, Froidure A, Spagnolo P, Veltkamp M, Molina-Molina M, McCarthy C, Antoniou KM, Kreuter M, Moor CC. ERS International Congress 2022: highlights from the Interstitial Lung Diseases Assembly. ERJ Open Res 2023; 9:00584-2022. [PMID: 37077550 PMCID: PMC10107062 DOI: 10.1183/23120541.00584-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/01/2022] [Indexed: 01/07/2023] Open
Abstract
This article contains a selection of scientific highlights in the field of interstitial lung diseases (ILDs) presented at the hybrid European Respiratory Society (ERS) congress 2022. Early Career Members of Assembly 12 summarize recent advances in translational and clinical research in idiopathic interstitial pneumonias, ILDs of known origin, sarcoidosis and other granulomatous diseases, and rare ILDs. Many studies focused on evaluation of diagnostic and prognostic (bio)markers, and novel pharmacological and non-pharmacological treatment options for different ILDs. Besides, new insights in clinical, physiological, and radiological features of various rare ILDs were presented.
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6
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Hoffmann-Vold AM, Distler O, Crestani B, Antoniou KM. Recent advances in the management of systemic sclerosis-associated interstitial lung disease. Curr Opin Pulm Med 2022; 28:441-447. [PMID: 35855572 DOI: 10.1097/mcp.0000000000000901] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Interstitial lung disease associated with systemic sclerosis (SSc-ILD) is a frequent organ manifestation leading to high morbidity and mortality. In 2020, the European management recommendations for SSc-ILD were published. Despite being comprehensive, several questions could not be answered or no consensus was reached. RECENT FINDINGS We highlight recent advances in the screening and early diagnosis, including surveys emphasizing that still 30-40% of all experts do not order baseline HRCTs in their SSc patients. We discuss recent advances in the assessment of disease progression, risk prediction and monitoring of SSc-ILD including novel insights in the disease course of SSc-ILD, clinical predictive factors for disease progression, the role of increasing extent of ILD on serial HRCT and radiomics, PET/CT and home spirometry as sensitive future tools to monitor SSc-ILD patients. We describe recent advances in the treatment of SSc-ILD, including novel data and trials as well as post hoc analyses of clinical trials on mycophenolate, cyclophosmphamide, tocilizumab, rituximab, riociguat and nintedanib. Lastly, we elucidate on peripheral blood cell gene expression profiling as a novel way to identify patients with a better treatment response to mycophenolate. SUMMARY In this review, we highlight recent advances in the management of SSc-ILD.
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Affiliation(s)
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Bruno Crestani
- APHP, Service de Pneumologie A, Centre de référence constitutif des Maladies Pulmonaires Rares, FHU APOLLO, Hôpital Bichat
- Université Paris Cité, Inserm, Unité 1152, laboratoire d'excellence INFLAMEX, Paris, France
| | - Katerina M Antoniou
- Laboratory of Molecular & Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Andrea Kalokerinou 13, Heraklion, Greece
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7
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Cottin V, Selman M, Inoue Y, Wong AW, Corte TJ, Flaherty KR, Han MK, Jacob J, Johannson KA, Kitaichi M, Lee JS, Agusti A, Antoniou KM, Bianchi P, Caro F, Florenzano M, Galvin L, Iwasawa T, Martinez FJ, Morgan RL, Myers JL, Nicholson AG, Occhipinti M, Poletti V, Salisbury ML, Sin DD, Sverzellati N, Tonia T, Valenzuela C, Ryerson CJ, Wells AU. Syndrome of Combined Pulmonary Fibrosis and Emphysema: An Official ATS/ERS/JRS/ALAT Research Statement. Am J Respir Crit Care Med 2022; 206:e7-e41. [PMID: 35969190 PMCID: PMC7615200 DOI: 10.1164/rccm.202206-1041st] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [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] [Indexed: 11/16/2022] Open
Abstract
Background: The presence of emphysema is relatively common in patients with fibrotic interstitial lung disease. This has been designated combined pulmonary fibrosis and emphysema (CPFE). The lack of consensus over definitions and diagnostic criteria has limited CPFE research. Goals: The objectives of this task force were to review the terminology, definition, characteristics, pathophysiology, and research priorities of CPFE and to explore whether CPFE is a syndrome. Methods: This research statement was developed by a committee including 19 pulmonologists, 5 radiologists, 3 pathologists, 2 methodologists, and 2 patient representatives. The final document was supported by a focused systematic review that identified and summarized all recent publications related to CPFE. Results: This task force identified that patients with CPFE are predominantly male, with a history of smoking, severe dyspnea, relatively preserved airflow rates and lung volumes on spirometry, severely impaired DlCO, exertional hypoxemia, frequent pulmonary hypertension, and a dismal prognosis. The committee proposes to identify CPFE as a syndrome, given the clustering of pulmonary fibrosis and emphysema, shared pathogenetic pathways, unique considerations related to disease progression, increased risk of complications (pulmonary hypertension, lung cancer, and/or mortality), and implications for clinical trial design. There are varying features of interstitial lung disease and emphysema in CPFE. The committee offers a research definition and classification criteria and proposes that studies on CPFE include a comprehensive description of radiologic and, when available, pathological patterns, including some recently described patterns such as smoking-related interstitial fibrosis. Conclusions: This statement delineates the syndrome of CPFE and highlights research priorities.
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Affiliation(s)
- Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Hospices Civils de Lyon, University of Lyon, INRAE, Lyon, France
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosío Villegas”, Mexico City, Mexico
| | | | | | - Tamera J. Corte
- Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | | | - Joseph Jacob
- University College London, London, United Kingdom
| | - Kerri A. Johannson
- Department of Medicine and Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | | | - Joyce S. Lee
- University of Colorado Denver Anschutz Medical Campus, School of Medicine, Aurora, CO, USA
| | - Alvar Agusti
- Respiratory Institute, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERES, Barcelona, Spain
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | | | - Fabian Caro
- Hospital de Rehabilitación Respiratoria "María Ferrer", Buenos Aires, Argentina
| | | | - Liam Galvin
- European idiopathic pulmonary fibrosis and related disorders federation
| | - Tae Iwasawa
- Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | | | | | | | - Andrew G. Nicholson
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | | | | | | | - Don D. Sin
- University of British Columbia, Vancouver, Canada
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery, University of Parma, Italy
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Valenzuela
- Pulmonology Department, Hospital Universitario de la Princesa, Departamento Medicina, Universidad Autónoma de Madrid, 28049 Madrid, Spain
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8
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Roche N, Crichton ML, Goeminne PC, Cao B, Humbert M, Shteinberg M, Antoniou KM, Suppli Ulrik C, Parks H, Wang C, Vandendriessche T, Qu J, Stolz D, Brightling C, Welte T, Aliberti S, Simonds AK, Tonia T, Chalmers JD. Update March 2022: management of hospitalised adults with coronavirus disease-19 (COVID-19): a European Respiratory Society living guideline. Eur Respir J 2022; 60:13993003.00803-2022. [PMID: 35710264 PMCID: PMC9363848 DOI: 10.1183/13993003.00803-2022] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [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: 04/16/2022] [Accepted: 05/31/2022] [Indexed: 12/15/2022]
Abstract
Since the identification of SARS-CoV-2 at the end of 2019, the coronavirus disease 2019 (COVID-19) pandemic has affected more than 410 million people worldwide and killed almost 6 million [1, 2]. The predecessors of COVID-19, i.e. the SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) outbreaks, had been relatively self-limiting, preventing clinicians and researchers from establishing evidence-based specific therapeutic strategies [3]. Conversely, COVID-19 rapidly proved to be extremely fast spreading, which led stakeholders to encourage, guide, build or fund multidirectional therapeutic research strategies based on both repurposing and development of new agents [4–8]. In parallel, considerable efforts were directed at describing the disease and understanding the underlying mechanisms [9–13]. As a result, there has been a huge generation of evidence, as highlighted by the impressive number of COVID-19 publications (more than 200 000 since the end of 2019). As a consequence, it proved rapidly impossible for any clinician, researcher or decision-maker to gather and analyse all the corresponding literature to derive appropriate guidance [14]. The first step of such a process is to select the relevant high-quality research that can be used to answer the question(s) of interest [15]. Even if limiting the search to clinical trials, systematic reviews and meta-analyses, almost 4000 papers appear in the PubMed database, as of mid-February 2022. In June and July 2020, the European Respiratory Society (ERS) and the American Thoracic Society (ATS) released early guidance on several aspects of COVID-19 management (i.e. rehabilitation, palliative care and acute management); at that time, direct specific evidence was sparse or absent [16–18]. Simultaneously, the ERS launched a living guideline on the management of COVID-19. The format was that of a “short” guideline, as per ERS standards [19, 20], in that the purpose was to release the first iteration within 12 months. However, the number of PICO (Population, Intervention, Comparator, Outcomes) questions to be addressed (n=12) already exceeded markedly what the ERS considers as being feasible during such a short timeframe (i.e. n=1–2), which was a direct consequence of the high number of unanswered issues in the field of acute COVID-19 management, all corresponding to outstanding clinical needs. The first version of these guidelines was published in March 2021 and addressed the following potential therapeutic options: corticosteroids, interleukin (IL)-6 receptor antagonists, hydroxychloroquine, azithromycin and both combined, colchicine, lopinavir-ritonavir, remdesivir, interferon-β, anticoagulation and non-invasive ventilatory support [6, 21]. An update of the mortality meta-analyses for corticosteroids, hydroxychloroquine, azithromycin, remdesivir, anti-IL-6 monoclonal antibodies, colchicine, lopinavir/ritonavir and interferon-β was published in December 2021 [22]. The ERS COVID-19 guidelines make recommendations for corticosteroids, anti-IL-6 monoclonal antibodies, baricitinib, anticoagulation and non-invasive respiratory support for hospitalised patients with COVID-19 https://bit.ly/3QgHH7U
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Affiliation(s)
- Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
| | | | | | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Saclay; Inserm UMR_S 999, Le Kremlin Bicêtre, France
| | - Michal Shteinberg
- Pulmonology institute and CF Center, Carmel Medical Center and the Technion- Israel Institute of Technology, Haifa, Israel
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre Hospital, Hvidovre, Denmark
| | | | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | | | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai, China; Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
| | | | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | - Stefano Aliberti
- University of Milan, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Anita K Simonds
- Respiratory and Sleep Medicine, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
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9
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Pitsidianakis G, Vassalou EE, Vasarmidi E, Bolaki M, Klontzas ME, Xirouchaki N, Georgopoulos D, Karantanas AH, Tzanakis N, Antoniou KM. Performance of Lung Ultrasound for Monitoring Interstitial Lung Disease. J Ultrasound Med 2022; 41:1077-1084. [PMID: 34291845 DOI: 10.1002/jum.15790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES In this study, we sought to assess the validity of lung ultrasound (LUS) during the follow-up of patients with a wide spectrum of interstitial lung diseases (ILDs). METHODS Twenty-four patients (13 males, 11 females; mean age ± SD, 65.4 ± 14.3 years; age range, 40-84 years) with a diagnosis of ILDs who were admitted to the Interstitial Lung Disease Unit were prospectively enrolled. Patients were examined with a 56-lung intercostal space LUS protocol in lateral decubitus position, at baseline, 6-months, and 1-year. The LUS score was defined as the sum of B-lines counted in each intercostal space. All patients underwent complete pulmonary function tests at baseline and follow-up time-points. High-resolution computed tomography (HRCT) was performed at baseline and during follow-up, according to personalized patients' needs. All HRCT studies were graded according to the Warrick scoring system (WS). RESULTS Pooled data analysis showed a significant correlation between WS and LUS scores (P < .001). For separate time-point analysis, a significant correlation between LUS scores and WS was found at baseline (P < .001) and 1 year (P = .005). LUS scores negatively correlated with alveolar volume (VA) (P < .046) and diffusing capacity for carbon monoxide (DLCO) (P < .001) at 6 months and with transfer coefficient of the lung for carbon monoxide (KCO) (P < .031) and DLCO (P = .002) at 12-months. A multivariate regression model showed DLCO to be an independent predictor of LUS score at 1 year (P = .026). CONCLUSIONS Our results highlight the validity and potential applicability of LUS for disease monitoring in a wide spectrum of ILDs.
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Affiliation(s)
| | - Evangelia E Vassalou
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
- Department of Medical Imaging, Sitia General Hospital, Sitia, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Michail E Klontzas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
| | - Nektaria Xirouchaki
- Department of Intensive Care Medicine, Heraklion University Hospital, Heraklion, Greece
| | | | - Apostolos H Karantanas
- Department of Medical Imaging, Heraklion University Hospital, Heraklion, Greece
- Department of Radiology, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Heraklion University Hospital, Heraklion, Greece
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10
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Raghu G, Remy-Jardin M, Richeldi L, Thomson CC, Inoue Y, Johkoh T, Kreuter M, Lynch DA, Maher TM, Martinez FJ, Molina-Molina M, Myers JL, Nicholson AG, Ryerson CJ, Strek ME, Troy LK, Wijsenbeek M, Mammen MJ, Hossain T, Bissell BD, Herman DD, Hon SM, Kheir F, Khor YH, Macrea M, Antoniou KM, Bouros D, Buendia-Roldan I, Caro F, Crestani B, Ho L, Morisset J, Olson AL, Podolanczuk A, Poletti V, Selman M, Ewing T, Jones S, Knight SL, Ghazipura M, Wilson KC. Idiopathic Pulmonary Fibrosis (an Update) and Progressive Pulmonary Fibrosis in Adults: An Official ATS/ERS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2022; 205:e18-e47. [PMID: 35486072 PMCID: PMC9851481 DOI: 10.1164/rccm.202202-0399st] [Citation(s) in RCA: 683] [Impact Index Per Article: 341.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background: This American Thoracic Society, European Respiratory Society, Japanese Respiratory Society, and Asociación Latinoamericana de Tórax guideline updates prior idiopathic pulmonary fibrosis (IPF) guidelines and addresses the progression of pulmonary fibrosis in patients with interstitial lung diseases (ILDs) other than IPF. Methods: A committee was composed of multidisciplinary experts in ILD, methodologists, and patient representatives. 1) Update of IPF: Radiological and histopathological criteria for IPF were updated by consensus. Questions about transbronchial lung cryobiopsy, genomic classifier testing, antacid medication, and antireflux surgery were informed by systematic reviews and answered with evidence-based recommendations using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. 2) Progressive pulmonary fibrosis (PPF): PPF was defined, and then radiological and physiological criteria for PPF were determined by consensus. Questions about pirfenidone and nintedanib were informed by systematic reviews and answered with evidence-based recommendations using the GRADE approach. Results:1) Update of IPF: A conditional recommendation was made to regard transbronchial lung cryobiopsy as an acceptable alternative to surgical lung biopsy in centers with appropriate expertise. No recommendation was made for or against genomic classifier testing. Conditional recommendations were made against antacid medication and antireflux surgery for the treatment of IPF. 2) PPF: PPF was defined as at least two of three criteria (worsening symptoms, radiological progression, and physiological progression) occurring within the past year with no alternative explanation in a patient with an ILD other than IPF. A conditional recommendation was made for nintedanib, and additional research into pirfenidone was recommended. Conclusions: The conditional recommendations in this guideline are intended to provide the basis for rational, informed decisions by clinicians.
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11
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Antoniou KM, Vasarmidi E, Russell AM, Andrejak C, Crestani B, Delcroix M, Dinh-Xuan AT, Poletti V, Sverzellati N, Vitacca M, Witzenrath M, Tonia T, Spanevello A. European Respiratory Society Statement on Long COVID-19 Follow-Up. Eur Respir J 2022; 60:13993003.02174-2021. [PMID: 35144991 PMCID: PMC9349784 DOI: 10.1183/13993003.02174-2021] [Citation(s) in RCA: 68] [Impact Index Per Article: 34.0] [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: 08/09/2021] [Accepted: 12/28/2021] [Indexed: 12/11/2022]
Abstract
Patients diagnosed with coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection frequently experience symptom burden post-acute infection or post-hospitalisation. We aimed to identify optimal strategies for follow-up care that may positively impact the patient's quality of life (QoL). A European Respiratory Society (ERS) Task Force convened and prioritised eight clinical questions. A targeted search of the literature defined the timeline of “long COVID” as 1–6 months post-infection and identified clinical evidence in the follow-up of patients. Studies meeting the inclusion criteria report an association of characteristics of acute infection with persistent symptoms, thromboembolic events in the follow-up period, and evaluations of pulmonary physiology and imaging. Importantly, this statement reviews QoL consequences, symptom burden, disability and home care follow-up. Overall, the evidence for follow-up care for patients with long COVID is limited. Follow-up care of patients infected with SARS-CoV-2 is crucial and may improve their quality of life. More evidence and research is emerging to understand the causes, mechanisms and risks of long COVID consequences.https://bit.ly/3J1WMWy
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Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece.,Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Authors contributed equally
| | - Anne-Marie Russell
- College of Medicine and Health, University of Exeter, Exeter, UK.,Authors contributed equally
| | - Claire Andrejak
- Service de Pneumologie, CHU Amiens-Picardie, UR 4294 AGIR, université Picardie Jules-Verne, Amiens, France
| | - Bruno Crestani
- Université de Paris, Inserm U1152, Labex Inflamex, Paris, France.,Centre de Référence des Maladies Pulmonaires Rares (site Constitutif), AP-HP, Service de Pneumologie, Hôpital Bichat, Paris, France
| | - Marion Delcroix
- Department of Pneumonology, KU Leuven University Hospitals Leuven, Leuven, Belgium
| | - Anh Tuan Dinh-Xuan
- AP-HP Centre, Hôpital Cochin, Respiratory Physiology Unit, Thoracic Diseases Department, Université de Paris, Paris, France
| | - Venerino Poletti
- Pulmonology Unit, Thoracic Diseases Department, G.B. Morgagni Hospital, Forlì, Italy.,Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Nicola Sverzellati
- Division of Radiology, Department of Surgical Sciences, University Hospital of Parma, Parma, Italy
| | - Michele Vitacca
- Istituti Clinici Scientifici Maugeri IRCCS, Respiratory Rehabilitation of the Institute of Lumezzane, Brescia, Italy
| | - Martin Witzenrath
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Antonio Spanevello
- Department of Medicine and Surgery, University of Insubria, Varese.,Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS Tradate, Varese, Italy
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12
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Guler SA, Cuevas-Ocaña S, Nasser M, Wuyts WA, Wijsenbeek MS, Froidure A, Bargagli E, Renzoni EA, Veltkamp M, Spagnolo P, Nunes H, McCarthy C, Molina-Molina M, Bonella F, Poletti V, Kreuter M, Antoniou KM, Moor CC. ERS International Congress 2021: highlights from the Interstitial Lung Diseases Assembly. ERJ Open Res 2022; 8:00640-2021. [PMID: 35615418 PMCID: PMC9124869 DOI: 10.1183/23120541.00640-2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/04/2021] [Indexed: 11/05/2022] Open
Abstract
This article provides an overview of scientific highlights in the field of interstitial lung disease (ILD), presented at the virtual European Respiratory Society Congress 2021. A broad range of topics was discussed this year, ranging from translational and genetic aspects to novel innovations with the potential to improve the patient pathway. Early Career Members summarize a selection of interesting findings from different congress sessions, together with the leadership of Assembly 12 – Interstitial Lung Disease.
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13
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Hilberg O, Hoffmann-Vold AM, Smith V, Bouros D, Kilpeläinen M, Guiot J, Morais A, Clemente S, Daniil Z, Papakosta D, Fretheim H, Neves S, Alfaro TM, Antoniou KM, Valveny N, Asijee G, Soulard S, Wuyts W. Epidemiology of interstitial lung diseases and their progressive-fibrosing behaviour in six European countries. ERJ Open Res 2021; 8:00597-2021. [PMID: 35083316 PMCID: PMC8784757 DOI: 10.1183/23120541.00597-2021] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022] Open
Abstract
The PERSEIDS study aimed to estimate incidence/prevalence of interstitial lung diseases (ILDs), fibrosing interstitial lung diseases (F-ILDs), idiopathic pulmonary fibrosis (IPF), systemic sclerosis-associated ILD (SSc-ILD), other non-IPF F-ILDs and their progressive-fibrosing (PF) forms in six European countries, as current data are scarce. This retrospective, two-phase study used aggregate data (2014–2018). In Phase 1, incident/prevalent cases of ILDs above were identified from clinical databases through an algorithm based on codes/keywords, and incidence/prevalence was estimated. For non-IPF F-ILDs, the relative percentage of subtypes was also determined. In Phase 2, a subset of non-IPF F-ILD cases was manually reviewed to determine the percentage of PF behaviour and usual interstitial pneumonia-like (UIP-like) pattern. A weighted mean percentage of progression was calculated for each country and used to extrapolate incidence/prevalence of progressive-fibrosing ILDs (PF-ILDs). In 2018, incidence/105 person-years ranged between 9.4 and 83.6 (ILDs), 7.7 and 76.2 (F-ILDs), 0.4 and 10.3 (IPF), 6.6 and 71.7 (non-IPF F-ILDs), and 0.3 and 1.5 (SSc-ILD); and prevalence/105 persons ranged between 33.6 and 247.4 (ILDs), 26.7 and 236.8 (F-ILDs), 2.8 and 31.0 (IPF), 22.3 and 205.8 (non-IPF F-ILDs), and 1.4 and 10.1 (SSc-ILD). Among non-IPF F-ILDs, sarcoidosis was the most frequent subtype. PF behaviour and UIP-like pattern were present in a third of non-IPF F-ILD cases each and hypersensitivity pneumonitis showed the highest percentage of progressive behaviour. Incidence of PF-ILDs ranged between 2.1 and 14.5/105 person-years, and prevalence between 6.9 and 78.0/105 persons. To our knowledge, PERSEIDS is the first study assessing incidence, prevalence and rate of progression of ILDs across several European countries. Still below the threshold for orphan diseases, the estimates obtained were higher and more variable than reported in previous studies, but differences in study design/population must be considered. The PERSEIDS study provides updated and detailed epidemiological data for ILDs across six European countries. Prevalences ranged between 26.7–236.8 (F-ILDs), 2.8–31.0 (IPF), 22.3–205.8 (non-IPF F-ILDs). A third of non-IPF F-ILD cases showed PF behaviour.https://bit.ly/3wLH7pF
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14
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Tsitoura E, Trachalaki A, Vasarmidi E, Mastrodemou S, Margaritopoulos GA, Kokosi M, Fanidis D, Galaris A, Aidinis V, Renzoni E, Tzanakis N, Wells AU, Antoniou KM. Collagen 1a1 Expression by Airway Macrophages Increases In Fibrotic ILDs and Is Associated With FVC Decline and Increased Mortality. Front Immunol 2021; 12:645548. [PMID: 34867934 PMCID: PMC8635798 DOI: 10.3389/fimmu.2021.645548] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 12/23/2020] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Within the Interstitial Lung Diseases (ILD), patients with idiopathic pulmonary fibrosis (IPF) and a subset of those with non-IPF fibrotic ILD have a distinct clinical phenotype of progression despite management. This group of patients has been collectively termed the progressive fibrotic phenotype (PFP). Their early recognition may facilitate access to antifibrotic therapies to prevent or slow progression. Macrophages/monocytes within the lung orchestrate the progression and maintenance of fibrosis. A novel role for monocyte-derived macrophages during tissue damage and wound healing is the expression of collagens. We examined Collagen 1a1 expression in airway macrophages from ILD patients at diagnosis. COL1A1 mRNA levels from BAL cells were elevated in IPF and Non-IPF patients. The presence of a UIP pattern and a subsequent progressive phenotype were significantly associated with the higher BAL COL1A1 levels. In Non-IPF patients, higher COL1A1 levels were associated with a more than twofold increase in mortality. The intracellular localisation of COL1A1 in airway macrophages was demonstrated by confocal microscopy in CD45 and CD163 co-staining assays. Additionally, airway macrophages co-expressed COL1A1 with the profibrotic SPP1 gene product osteopontin. The levels of SPP1 mRNA and OPN in the BAL were significantly higher in IPF and Non-IPF patients relative to healthy. Our results suggest that profibrotic airway macrophages are increased in the BAL of patients with IPF and other ILDs and co-express COL1A1 and OPN. Importantly, COL1A1 expression by pro-fibrotic airway macrophages could be a marker of disease progression and poor survival in ILDs.
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Affiliation(s)
- Eliza Tsitoura
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athina Trachalaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Semeli Mastrodemou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - George A. Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Maria Kokosi
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Dionysios Fanidis
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Apostolos Galaris
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Vassilis Aidinis
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Centre, Athens, Greece
| | - Elizabeth Renzoni
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Nikos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Hospital National Health Service (NHS) Foundation Trust, Imperial College, London, United Kingdom
| | - Katerina M. Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
- *Correspondence: Katerina M. Antoniou,
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15
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Antoniou KM, Bolaki M, Karagiannis K, Trachalaki A, Ierodiakonou D, Stamatopoulou V, Chatzinikolaou C, Mastrodimou S, Stamataki E, Pitsidianakis G, Lambiri I, Mitrouska I, Spandidos DA, Tzanakis N. Real-life Cretan asthma registry focused on severe asthma: On behalf of 'The Cretan registry of the use of Biologics in Severe Asthma'. Exp Ther Med 2021; 22:1239. [PMID: 34539835 DOI: 10.3892/etm.2021.10674] [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] [Received: 07/02/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
Asthma diagnosis and management remains a challenging task for the medical community. The aim of the present study was to present the functional and inflammatory profiles of patients with difficult-to-treat asthma in a real-life clinical setting referred to the specialized asthma clinic at the University Hospital of Heraklion. The registry included a cohort of 267 patients who were referred to the severe asthma clinic. Patients were assessed with emphasis on the history of allergies, nasal polyposis or other comorbidities. Blood testing for eosinophils counts and total and specific IgE, and pulmonary function tests were performed at baseline. The median age of patients with asthma was 55 years old, 68.5% were women and 58.3% were never smokers. The vast majority presented with late onset asthma (75.7%), whereas eight (3%) patients were on oral corticosteroids. The median number of exacerbations during the last 12 months was 1 (0-3). Furthermore, 50.7% of patients had a positive serum allergy test, the median eosinophil count was 300 (188-508.5) cells/µl of blood and median total IgE level was 117.5 (29.4-360.5) IU/ml. Patients were retrospectively grouped in the following categories: Group 1, mild-moderate asthma; group 2, patients prescribed a step 4 or 5 asthma therapy according to Global Initiative for Asthma; and group 3, patients on biologic agents. Group 1 had significantly higher FEV1% than groups 2 and 3 (93.4 vs. 79.9 and 79.4%, respectively; P<0.001). Finally, the median Asthma Control Questionnaire 7 (ACQ7) score was 1.14, with patients from groups 2 and 3 presenting higher ACQ7 scores compared with group 1 patients as expected (1.1 and 2.1 vs. 0.7, respectively; P<0.001). To the best of our knowledge, this was the first real-life asthma study in Crete that demonstrated that severe asthmatics predominantly have late-onset asthma with airflow obstruction and uncontrolled symptoms.
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Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Maria Bolaki
- Department of Intensive Care Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Konstantinos Karagiannis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Athina Trachalaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Despo Ierodiakonou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece.,Department of Primary Care and Population Health, University of Nicosia Medical School, 2408 Nicosia, Cyprus
| | - Vagia Stamatopoulou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Charito Chatzinikolaou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Semeli Mastrodimou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Evangelia Stamataki
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - George Pitsidianakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Irini Lambiri
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Ioanna Mitrouska
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University Hospital of Heraklion, University of Crete, 71003 Heraklion, Greece
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16
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Bizymi N, Pitsidianakis G, Ierodiakonou D, Stathakis G, Vasarmidi E, Hiraki S, Bolaki M, Karagiannis K, Fanaridis M, Liopyrakis K, Marinos L, Xilouri I, Antoniou KM, Tzanakis N. Case Report: Diagnosis of Myelodysplastic Syndrome in a 72-Year-Old Female With Interstitial Lung Disease. Front Med (Lausanne) 2021; 8:673573. [PMID: 34434942 PMCID: PMC8380831 DOI: 10.3389/fmed.2021.673573] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Acute fibrinous and organizing pneumonia (AFOP) is an entity that can be secondary to various conditions leading to lung injury, such as infections, malignancies, and various autoimmune conditions or idiopathic interstitial lung disease, when no obvious underlying cause is identified. Myelodysplastic syndromes (MDS), on the other hand, are a spectrum of clonal myeloid disorders, with a higher risk of acute leukemia, characterized by ineffective bone marrow (BM) hematopoiesis and, thus, peripheral blood (PB) cytopenias. Immune deregulation is thought to take part in the pathophysiology of the disease, including abnormal T and/or B cell responses, innate immunity, and cytokine expression. In the literature, there are a few case reports of patients with MDS that have presented pulmonary infiltrates and were diagnosed as having AFOP or organizing pneumonia (OP). It is rare, though, to have isolated pulmonary infiltrates without Sweet's syndrome or even the pulmonary infiltrates to precede the diagnosis and treatment of MDS, which was our case. We present a 72-year-old female developing new lung infiltrates refractory to antibiotic treatment that responded well to corticosteroids and was histologically described as having OP. The treatment was gradually successfully switched to mycophenolate mofetil (MMF). The patient was later diagnosed with MDS. This interesting case report suggests firstly that a diagnosis of AFOP or OP should alert the clinician to search for an underlying cause including MDS and vice versa, the use of systemic steroids should not be postponed, and, finally, that MMF can successfully be used in these patients.
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Affiliation(s)
- Nikoleta Bizymi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | | | - Despo Ierodiakonou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.,Department of Primary care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
| | - Georgios Stathakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Stavroti Hiraki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Bolaki
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | | | - Michail Fanaridis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Konstantinos Liopyrakis
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Leonidas Marinos
- Department of Hemopathology, Evangelismos General Hospital, Athens, Greece
| | - Irini Xilouri
- Hemopoiesis Research Laboratory, School of Medicine, University of Crete and Department of Hematology, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
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17
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Papadogiannis G, Bouloukaki I, Mermigkis C, Michelakis S, Ermidou C, Mauroudi E, Moniaki V, Tzanakis N, Antoniou KM, Schiza SE. Patients with idiopathic pulmonary fibrosis with and without obstructive sleep apnea: differences in clinical characteristics, clinical outcomes, and the effect of PAP treatment. J Clin Sleep Med 2021; 17:533-544. [PMID: 33108270 DOI: 10.5664/jcsm.8932] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 12/14/2022]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) in patients with idiopathic pulmonary fibrosis (IPF) is associated with worse mortality and clinical outcome. We aimed to assess differences between patients with IPF with and without OSA and the effect of positive airway pressure treatment on sleep and overall life quality, morbidity, and mortality in these patients. METHODS Forty-five patients with newly diagnosed IPF underwent polysomnography. Using an apnea-hypopnea index ≥ 15 events/h for OSA diagnosis resulted in 16 patients with IPF and 29 with IPF-OSA. The patients completed the Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index, Functional Outcomes in Sleep Questionnaire, Fatigue Severity Scale, Short Form-36 life questionnaire, and Beck Depression Inventory before and at the end of the follow-up period. RESULTS Patients with IPF-OSA showed the most severe functional impairments in questionnaires, especially for General Health component of the Short Form-36 life questionnaire (37 vs 58, P = .03). At the 7-year follow-up, 16 (36%) patients had died, 6 (38%) in the IPF group and 10 (35%) in IPF-OSA group. Patients with ≥6-hour positive airway pressure use had better survival compared with patients with <6-hour use (P = .04). Significant improvement was also observed in Epworth Sleepiness Scale (3 vs 6, P = .03), Pittsburgh Sleep Quality Index (5 vs 8, P = .01), and Fatigue Severity Scale (37 vs 48, P = .008) score in patients with ≥4-hour positive airway pressure use. CONCLUSIONS OSA plays a significant role on clinical features and quality of life in patients with IPF. Effective positive airway pressure treatment results in a significant improvement in sleepiness, fatigue, sleep quality, and mortality. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: CPAP Therapy in Patients With Idiopathic Pulmonary Fibrosis and Sleep Apnea; URL: https://clinicaltrials.gov/ct2/show/record/NCT01637831; Identifier: NCT01637831.
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Affiliation(s)
- George Papadogiannis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Stylianos Michelakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Christina Ermidou
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Eleni Mauroudi
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Violeta Moniaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Nikolaos Tzanakis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Interstitial Lung Disease Unit, Pneumonology Molecular & Cellular Lab, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
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18
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Bouloukaki I, Mermigkis C, Antoniou KM, Schiza SE. PAP therapy in patients with idiopathic pulmonary fibrosis and obstructive sleep apnea: multum non multa. J Clin Sleep Med 2021; 17:1327-1328. [PMID: 33682677 DOI: 10.5664/jcsm.9212] [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: 11/13/2022]
Affiliation(s)
- Izolde Bouloukaki
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Charalampos Mermigkis
- Sleep Disorders Center, Department of Respiratory Medicine, University of Crete, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Interstitial Lung Disease Unit, Pneumonology Molecular and Cellular Lab, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Sophia E Schiza
- Department of Respiratory Medicine, Interstitial Lung Disease Unit, Pneumonology Molecular and Cellular Lab, Faculty of Medicine, University of Crete, Heraklion, Greece
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19
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Chalmers JD, Crichton ML, Goeminne PC, Cao B, Humbert M, Shteinberg M, Antoniou KM, Ulrik CS, Parks H, Wang C, Vandendriessche T, Qu J, Stolz D, Brightling C, Welte T, Aliberti S, Simonds AK, Tonia T, Roche N. Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline. Eur Respir J 2021; 57:2100048. [PMID: 33692120 PMCID: PMC7947358 DOI: 10.1183/13993003.00048-2021] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require noninvasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes. METHODS A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this "living guideline" using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations. RESULTS Based on the available evidence at the time of guideline development (20 February, 2021), the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for interleukin (IL)-6 receptor antagonist monoclonal antibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made. CONCLUSION The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.
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Affiliation(s)
- James D Chalmers
- School of Medicine, University of Dundee, Dundee, UK
- J.D. Chalmers and N. Roche are task force co-chairs
| | | | - Pieter C Goeminne
- Department of Respiratory Medicine, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Bin Cao
- Department of Respiratory and Critical Care Medicine, Clinical Microbiology and Infectious Disease Lab, China-Japan Friendship Hospital, National Center for Respiratory Medicine, Institute of Respiratory Medicine, Chinese Academy of Medical Science, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris-Saclay; Inserm UMR_S 999, Le Kremlin Bicêtre, France
| | - Michal Shteinberg
- Pulmonology institute and CF Center, Carmel Medical Center and the Technion-Israel Institute of Technology, Haifa, Israel
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre Hospital, Hvidovre, Denmark
| | | | - Chen Wang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center of Respiratory Diseases, Beijing, China
| | | | - Jieming Qu
- Department of Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai, China
- Institute of Respiratory Diseases, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Daiana Stolz
- Clinic of Respiratory Medicine and Pulmonary Cell Research, University Hospital Basel, Basel, Switzerland
- Clinic of Respiratory Medicine, Medical Center - University of Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Tobias Welte
- Medizinische Hochschule Hannover, Direktor der Abteilung Pneumologie, Hannover, Germany
| | - Stefano Aliberti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Respiratory Unit, Rozzano, Italy
| | - Anita K Simonds
- Sleep and Ventilation Unit, Royal Brompton and Harefield Hospital, Guys and St Thomas NHS Foundation Trust, London, UK
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University Bern, Bern, Switzerland
| | - Nicolas Roche
- Respiratory Medicine, Cochin Hospital, APHP Centre-University of Paris, Cochin Institute (INSERM UMR1016), Paris, France
- J.D. Chalmers and N. Roche are task force co-chairs
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20
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Papiris SA, Bouros D, Markopoulou K, Kolilekas L, Papaioannou AI, Tzilas V, Tzouvelekis A, Fouka E, Papakosta D, Daniil Z, Steiropoulos P, Gogali A, Papanikolaou IC, Xyfteri A, Haritou A, Korbila I, Tomos IP, Loukides S, Bellelli R, Kounti G, Rampiadou C, Karampitsakos T, Dimeas I, Kirgou P, Bompoki A, Vasarmidi E, Loverdos K, Antonogiannaki EM, Blizou M, Bouros E, Kagouridis K, Maniati M, Karakatsani A, Antoniou KM, Manali ED. Early COVID-19 lockdown in Greece and idiopathic pulmonary fibrosis: a beneficial "impact" beyond any expectation. Eur Respir J 2021; 57:13993003.03111-2020. [PMID: 33334934 DOI: 10.1183/13993003.03111-2020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 11/08/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Spyros A Papiris
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- First Academic Dept of Pneumonology, Hospital for Diseases of the Chest "Sotiria", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Iatriko Medical Center, Athens, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Argyrios Tzouvelekis
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Eva Fouka
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Despoina Papakosta
- A Dept of Pulmonary Medicine, Aristotle University of Thessaloniki, "G. Papanikolaou" Hospital, Thessaloniki, Greece
| | - Zoe Daniil
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paschalis Steiropoulos
- Dept of Pneumonology, University Hospital of Alexandroupolis, Democritus University of Thrace, Komotini, Greece
| | - Athina Gogali
- Dept of Pneumonology, Medical School, University of Ioannina, Ioannina, Greece
| | | | | | | | - Ioanna Korbila
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis P Tomos
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stylianos Loukides
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Rita Bellelli
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgia Kounti
- Pulmonary Dept, "G Papanikolaou" General Hospital, Thessaloniki, Greece
| | | | - Theodoros Karampitsakos
- Dept of Respiratory Medicine, General Hospital of Patras, University of Patras, Patra, Greece
| | - Ilias Dimeas
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Paraskevi Kirgou
- Dept of Respiratory Medicine, Medical School, University of Thessaly, Larissa, Greece
| | - Andromachi Bompoki
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Elvira-Markela Antonogiannaki
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Myrto Blizou
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Konstantinos Kagouridis
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Maniati
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Anna Karakatsani
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Katerina M Antoniou
- Dept of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,These authors contributed equally to this work
| | - Effrosyni D Manali
- 2nd Pulmonary Medicine Dept, General University Hospital "Attikon", Medical School, National and Kapodistrian University of Athens, Athens, Greece.,These authors contributed equally to this work
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21
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Antoniou KM, Tsitoura E, Vasarmidi E, Symvoulakis EK, Aidinis V, Tzilas V, Tzouvelekis A, Bouros D. Precision medicine in idiopathic pulmonary fibrosis therapy: From translational research to patient-centered care. Curr Opin Pharmacol 2021; 57:71-80. [PMID: 33556824 DOI: 10.1016/j.coph.2020.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/04/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022]
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive, irreversible fibrotic chronic lung disease affecting predominantly older adults, with a history of smoking. The current model of disease natural course is that recurrent injury of the alveolar epithelium in the context of advanced aging/cellular senescence is followed by defective re-epithelialization and scar tissue formation. Currently, two drugs, nintedanib and pirfenidone, that modify disease progression have been approved worldwide for the treatment of IPF. However, despite treatment, patients with IPF are not cured, and eventually, disease advances in most treated patients. Enhancing biogenomic and metabolic research output, its translation into clinical precision and optimal service delivery through patient-centeredness are key elements to support effective IPF care. In this review, we summarize therapeutic options currently investigated for IPF based on the major pathogenetic pathways and molecular targets that drive pulmonary fibrosis.
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Affiliation(s)
- Katerina M Antoniou
- Molecular & Cellular Pneumonology Laboratory, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Greece.
| | - Eliza Tsitoura
- Molecular & Cellular Pneumonology Laboratory, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Greece
| | - Eirini Vasarmidi
- Molecular & Cellular Pneumonology Laboratory, Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Greece
| | | | - Vassilis Aidinis
- Division of Immunology, Alexander Fleming Biomedical Sciences Research Center, Athens, Greece
| | - Vassilis Tzilas
- Center for Diseases of the Chest, Athens Medical Center, Athens, Greece
| | | | - Demosthenes Bouros
- Center for Diseases of the Chest, Athens Medical Center, Athens, Greece; Medical School, National and Kapodistrian University of Athens, Greece
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22
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Vassalou EE, Karantanas AH, Antoniou KM. Proposed Lung Ultrasound Protocol During the COVID-19 Outbreak. J Ultrasound Med 2021; 40:397-399. [PMID: 32761838 PMCID: PMC7436364 DOI: 10.1002/jum.15402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 05/03/2023]
Affiliation(s)
- Evangelia E. Vassalou
- Department of Medical ImagingUniversity HospitalHeraklionCreteGreece
- Department of RadiologyGeneral Hospital of SitiaLasithiCreteGreece
| | - Apostolos H. Karantanas
- Department of Medical ImagingUniversity HospitalHeraklionCreteGreece
- Department of RadiologyUniversity of Crete Medical SchoolHeraklionCreteGreece
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23
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Antoniou KM, Raghu G, Tzilas V, Bouros D. Management of Patients with Interstitial Lung Disease in the Midst of the COVID-19 Pandemic. Respiration 2020; 99:625-627. [PMID: 32841954 PMCID: PMC7490496 DOI: 10.1159/000509523] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Respiratory Medicine, University General Hospital of Heraklion, Medical School, University of Crete, Heraklion, Greece
| | - Ganesh Raghu
- Division of Pulmonary, Sleep and Critical Care Medicine, University of Washington, Seattle, Washington, USA
| | - Vasilios Tzilas
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece
| | - Demosthenes Bouros
- Athens Medical Center and 1st Department of Respiratory Medicine, "Sotiria" Hospital for Diseases of the Chest, National and Kapodistrian University of Athens, Athens, Greece,
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24
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Sperelakis I, Tsitoura E, Koutoulaki C, Mastrodimou S, Tosounidis TH, Spandidos DA, Antoniou KM, Kontakis G. Influence of reaming intramedullary nailing on MSC population after surgical treatment of patients with long bone fracture. Mol Med Rep 2020; 22:2521-2527. [PMID: 32705190 PMCID: PMC7411410 DOI: 10.3892/mmr.2020.11320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/08/2020] [Accepted: 07/09/2020] [Indexed: 11/22/2022] Open
Abstract
Reamed intramedullary nailing (RIN) is a surgical method of choice for treatment of diaphyseal fractures. This procedure affects the biological environment of bone tissue locally and systemically. This study investigated the influence of RIN on mesenchymal stem cells (MSCs) in patients with long bone fractures. The axis of C-X-C motif chemokine receptor 4 (CXCR4)/stromal cell-derived factor 1 (SDF-1) was selected since it is considered as major pathway for MSC homing and migration. Iliac crest bone marrow (IC-BM) samples and blood samples were collected at two different time points. One sample was collected before the RIN (BN) and the other immediately after RIN (AN). BM-MSCs were cultured and RT-qPCR was performed for CXCR4 mRNA levels and ELISA for the SDF-1 sera levels. The experimental study revealed that there was a correlation between the increase of SDF-1 levels in peripheral blood and a decrease in the levels of CXCR4 in MSCs in the IC-BM following RIN. The levels of SDF-1 showed a significant increase in the sera of patients after RIN. In conclusion, the present study is the first providing evidence of the effects of RIN on MSC population via the CXCR4/SDF-1 axis. The levels of serum SDF-1 factor were elevated after RIN while increased levels of SDF-1 in peripheral blood were inversely correlated with the mRNA levels of CXCR4 on BM-MSCs after RIN. Therefore, this study contributes to enlighten the systematic effects of RIN on the population of MSCs at a cellular level.
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Affiliation(s)
- Ioannis Sperelakis
- Department of Orthopedics and Traumatology, University of Crete School of Medicine, 71003 Heraklion, Greece
| | - Eliza Tsitoura
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Chara Koutoulaki
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Semeli Mastrodimou
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Theodoros H Tosounidis
- Department of Orthopedics and Traumatology, University of Crete School of Medicine, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - George Kontakis
- Department of Orthopedics and Traumatology, University of Crete School of Medicine, 71003 Heraklion, Greece
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25
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Vasarmidi E, Tsitoura E, Spandidos DA, Tzanakis N, Antoniou KM. Pulmonary fibrosis in the aftermath of the COVID-19 era (Review). Exp Ther Med 2020; 20:2557-2560. [PMID: 32765748 PMCID: PMC7401793 DOI: 10.3892/etm.2020.8980] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 01/08/2023] Open
Abstract
The year 2020 is characterized by the COVID-19 pandemic that has resulted in more than half a million deaths in recent months. The high mortality is associated with acute severe respiratory failure that results in ICU admission and intubation. While facing this fatal disease, research and clinical observations need to be carried out in order to evaluate the long-term effects of the COVID-19 acute respiratory distress syndrome (ARDS). Potent clinical and laboratory biomarkers should be studied to be able to predict the subgroup of patients that are going to deteriorate or develop lung fibrosis. The opportunity of personalized medicine is a good way to consider for these patients.
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Affiliation(s)
- Eirini Vasarmidi
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Eliza Tsitoura
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Nikolaos Tzanakis
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71003 Heraklion, Greece
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26
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Kallieri M, Zervas E, Katsoulis K, Fouka E, Porpodis K, Samitas K, Papaioannou AI, Kipourou M, Gaki E, Vittorakis S, Markatos M, Dimakou K, Ampelioti S, Koukidou S, Makris M, Ntakoula M, Mitrova MH, Glynos K, Antoniou KM, Gaga M, Tzanakis N, Markopoulou K, Papakosta D, Bakakos P, Loukides S. Mepolizumab in Severe Eosinophilic Asthma: A 2-Year Follow-Up in Specialized Asthma Clinics in Greece: An Interim Analysis. Int Arch Allergy Immunol 2020; 181:613-617. [PMID: 32570256 DOI: 10.1159/000508559] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Mepolizumab is a monoclonal antibody against IL-5 for the treatment of severe eosinophilic asthma. The aim of the current study was to present a predesigned interim analysis of the data of patients who have completed 1 year of therapy with mepolizumab. METHODS This study is a prospective multicenter, noninterventional 2-year observational study and aims to describe the clinical benefit and safety profile of mepolizumab in patients with severe eosinophilic asthma. RESULTS Compared to the year preceding the initiation of treatment, the annual rate of exacerbations decreased significantly, from 4.3 ± 2.3 to 1.3 ± 1.8; p < 0.0001. Forty-two patients received maintenance dose of oral corticosteroids (OCS) at baseline. From these patients at the end of 1 year of therapy with mepolizumab, 17 patients (40%) had achieved OCS discontinuation. A reduction in the median dose of OCS was also achieved. After 1 year of treatment with mepolizumab, the asthma control test score significantly increased from 16.3 ± 3.7 to 21.2 ± 3.8 (p < 0.0001). This marked clinical improvement was paralleled by a significant reduction of blood eosinophil count. All patients showed a considerable improvement of airflow limitation. In respect to adverse events of treatment with mepolizumab, 19 patients (27%) were recorded to have at least one such occurrence during their 1-year treatment. CONCLUSIONS We have shown that in patients with severe eosinophilic asthma, 1 year of treatment with mepolizumab was safe, resulted in significant reduction of the annual exacerbation rate, reduction (or even discontinuation) of the needed dose of OCS, and improvements of asthma control and lung function.
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Affiliation(s)
- Maria Kallieri
- 2nd Respiratory Department, Attiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | | | | | - Eva Fouka
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | | | - Andriana I Papaioannou
- 2nd Respiratory Department, Attiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria Kipourou
- Respiratory Department, 424 Army General Hospital, Thessaloniki, Greece
| | | | | | | | - Katerina Dimakou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | | | - Sofia Koukidou
- 5th Respiratory Clinic, "Sotiria" Chest Hospital, Athens, Greece
| | - Michael Makris
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Maria Ntakoula
- Allergy Unit, 2nd Department of Dermatology and Venereology, Attikon University General Hospital, Athens, Greece
| | - Marija Hadji Mitrova
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Katerina M Antoniou
- Respiratory Medicine Department, University Hospital of Heraklion, Iraklio, Greece
| | - Mina Gaga
- Sotiria Sotiria 7th Department, Athens Chest Hospital, Athens, Greece
| | - Nikolaos Tzanakis
- Respiratory Medicine Department, University Hospital of Heraklion, Iraklio, Greece
| | - Katerina Markopoulou
- 1st Pulmonary Department, Papanikolaou General Hospital Thessaloniki, Thessaloniki, Greece
| | - Despoina Papakosta
- Pulmonary Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Bakakos
- 1st Respiratory Department, Sotiria Chest Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Department, Attiko University Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece,
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Bolaki M, Tsitoura E, Spandidos DA, Symvoulakis EK, Antoniou KM. [COMMENT] Respiratory diseases in the era of COVID-19: Pearls and pitfalls. Exp Ther Med 2020; 20:691-693. [PMID: 32742314 PMCID: PMC7388138 DOI: 10.3892/etm.2020.8776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/20/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease 2019, a respiratory tract infection that has evolved into a pandemic, is expected to affect patients with underlying respiratory disease in a greater number and greater severity than patients with other underlying disorders. Whether this is true is an interesting question. However, the challenge both for the doctors and patients is to keep the respiratory disease in remission and prevent any exacerbations. Proper recommendations have been proposed for a wide range of respiratory disorders including chronic obstructive pulmonary disease (COPD), asthma and interstitial lung diseases, regarding the continuation or not of the treatment during this period and ways to maintain stability.
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Affiliation(s)
- Maria Bolaki
- Department of Respiratory Medicine, Laboratory of Molecular and Clinical Pneumonology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Eliza Tsitoura
- Department of Respiratory Medicine, Laboratory of Molecular and Clinical Pneumonology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Greece
| | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Laboratory of Molecular and Clinical Pneumonology, Faculty of Medicine, University of Crete, 71003 Heraklion, Greece
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28
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Tsitoura E, Bibaki E, Bolaki M, Vasarmidi E, Trachalaki A, Symvoulakis EK, Spandidos DA, Antoniou KM. [Comment] Treatment strategies to fight the new coronavirus SARS-CoV-2: A challenge for a Rubik's Cube solver. Exp Ther Med 2020; 20:147-150. [PMID: 32536988 PMCID: PMC7282080 DOI: 10.3892/etm.2020.8692] [Citation(s) in RCA: 4] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
SARS-coronavirus-2 (SARS-CoV-2), the etiologic agent of the new lung disease COVID-19 is closely related to SARS-CoV, and together with MERS-CoV are three new human coronaviruses that emerged in the last 20 years. The COVID-19 outbreak is a rapidly evolving situation with higher transmissibility and infectivity compared with SARS and MERS. Clinical presentations range from asymptomatic or mild symptoms to severe illness. The prevalent cause of mortality is pneumonia that progresses to ARDS. The ongoing pandemic has already resulted in more than 135,000 deaths and an unprecedented burden on national health systems worldwide. Pending the availability of a vaccine, there is a critical need to identify effective treatments and a number of clinical trials have been implemented worldwide. Trials are based on repurposed drugs that are already approved for other infections, have acceptable safety profiles or have performed well in animal studies against the other two deadly coronaviruses. Supportive care remains the mainstay of therapy at present, as it is still unclear how well these data can be extrapolated to SARS-CoV-2. Most of those emerging re-introduced drugs are administered to patients in the context of clinical trials. In this review, we summarize the strategies currently employed in the treatment of COVID-19.
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Affiliation(s)
- Eliza Tsitoura
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eleni Bibaki
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Maria Bolaki
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - Emmanouil K Symvoulakis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion Crete, Greece
| | - Demetrios A Spandidos
- Laboratory of clinical Virology, Medical School, University of Crete, Heraklion Crete, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, University General Hospital of Heraklion, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
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Abstract
Combined pulmonary fibrosis and emphysema (CPFE) is a clinical entity characterized by the combination of upper lobe emphysema and lower lobe fibrosis, the latter owing to various interstitial lung diseases. These patients have a characteristic lung function profile, with relatively preserved dynamic and static lung volumes, contrasting with a significant reduction of carbon monoxide transfer. The pathogenic mechanisms leading to the coexistence of emphysema with fibrosis remain unclear and different theories have been proposed. CPFE is frequently complicated by pulmonary hypertension, acute exacerbations, and lung cancer leading to poor natural history and prognosis. The syndrome of CPFE represents a distinct pulmonary manifestation in the spectrum of lung diseases associated with connective tissue diseases. Currently, there are no established recommendations regarding the management of patients with CPFE. We provide a review on the existing knowledge of CPFE regarding the epidemiology, pathogenesis, clinical manifestations, radiologic appearance, complications, prognosis, and possible treatment options.
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Affiliation(s)
- Maria Bolaki
- Department of Respiratory Medicine, Heraklion University Hospital, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Heraklion University Hospital, University of Crete School of Medicine, Heraklion, Crete, Greece
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30
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Tsitoura E, Vasarmidi E, Bibaki E, Trachalaki A, Koutoulaki C, Papastratigakis G, Papadogiorgaki S, Chalepakis G, Tzanakis N, Antoniou KM. Accumulation of damaged mitochondria in alveolar macrophages with reduced OXPHOS related gene expression in IPF. Respir Res 2019; 20:264. [PMID: 31775876 PMCID: PMC6880424 DOI: 10.1186/s12931-019-1196-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [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: 05/15/2019] [Accepted: 09/23/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Impaired mitochondria homeostasis and function are established hallmarks of aging and increasing evidence suggests a link with lung fibrosis. Mitochondria homeostasis may be also affected in alveolar macrophages (AMs) in idiopathic pulmonary fibrosis (IPF). In this study, we used bronchoalveolar lavage (BAL), a tool for both clinical and research purposes, and a rich source of AMs. METHODS BAL samples were examined from 52 patients with IPF and 19 healthy individuals. Measurements of mitochondria reactive oxygen species (mtROS), mitochondria morphology and related gene expression were performed. Additionally, autophagy and mitophagy levels were analysed. RESULTS Mitochondria in AMs from IPF patients had prominent morphological defects and impaired transcription paralleled to a significant reduction of mitochondria homeostasis regulators PINK1, PARK2 and NRF1. mtROS, was significantly higher in IPF and associated with reduced expression of mitochondria-encoded oxidative phosphorylation (OXPHOS) genes. Age and decline in lung function correlated with higher mtROS levels. Augmentation of damaged, oxidised mitochondria in IPF AMs however was not coupled to increased macroautophagy and mitophagy, central processes in the maintenance of healthy mitochondria levels. CONCLUSION Our results suggest a perturbation of mitochondria homeostasis in alveolar macrophages in IPF.
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Affiliation(s)
- Eliza Tsitoura
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Eleni Bibaki
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Athina Trachalaki
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Chara Koutoulaki
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - George Papastratigakis
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | | | - George Chalepakis
- Electron Microscopy Laboratory, University of Crete, Heraklion, Greece
| | - Nikos Tzanakis
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M Antoniou
- Department of Respiratory Medicine, Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece. .,Department of Respiratory Medicine, University Hospital of Heraklion, Heraklion, Greece.
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31
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Walsh SLF, Lederer DJ, Ryerson CJ, Kolb M, Maher TM, Nusser R, Poletti V, Richeldi L, Vancheri C, Wilsher ML, Antoniou KM, Behr J, Bendstrup E, Brown KK, Corte TJ, Cottin V, Crestani B, Flaherty KR, Glaspole IN, Grutters J, Inoue Y, Kondoh Y, Kreuter M, Johannson KA, Ley B, Martinez FJ, Molina-Molina M, Morais A, Nunes H, Raghu G, Selman M, Spagnolo P, Taniguchi H, Tomassetti S, Valeyre D, Wijsenbeek M, Wuyts WA, Wells AU. Diagnostic Likelihood Thresholds That Define a Working Diagnosis of Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2019; 200:1146-1153. [DOI: 10.1164/rccm.201903-0493oc] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Simon L. F. Walsh
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - David J. Lederer
- Department of Medicine and
- Department of Epidemiology, Columbia University Medical Center, New York, New York
| | - Christopher J. Ryerson
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martin Kolb
- Department of Medicine and
- Department of Pathology and Molecular Medicine, Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
| | - Toby M. Maher
- National Heart and Lung Institute, Imperial College, London, United Kingdom
- National Institute of Health Research Respiratory Clinical Research Facility and
| | - Richard Nusser
- Department of Respiratory Medicine, Summit Hospital, Oakland, California
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale G. B. Morgagni, Forlì, Italy
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Luca Richeldi
- Fondazione Policlinico A. Gemelli, Istituto di Ricovero e Carattere Scientifico, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo Vancheri
- Department of Clinical and Experimental Medicine, Regional Referral Centre for Rare Lung Diseases, University-Hospital “Policlinico” Vittorio Emanuele, University of Catania, Catania, Italy
| | - Margaret L. Wilsher
- Auckland District Health Board, University of Auckland, Auckland, New Zealand
| | - Katerina M. Antoniou
- Department of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Juergen Behr
- Department of Medicine V, University of Munich and Asklepios Fachkliniken Gauting, Comprehensive Pneumology Center, member of the German Center for Lung Research [DZL], Munich, Germany
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Tamera J. Corte
- Department of Respiratory Medicine, Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - Vincent Cottin
- National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, UMR 754, Claude Bernard University Lyon 1, Lyon, France
| | - Bruno Crestani
- APHP, Hopital Bichat, Service de Pneumologie A, Université Paris Diderot, Paris, France
| | - Kevin R. Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Michigan
| | - Ian N. Glaspole
- Alfred Health–Allergy, Immunology, and Respiratory Medicine, the Alfred Hospital, Melbourne, Australia
| | - Jan Grutters
- Division of Heart and Lungs, ILD Center of Excellence, St. Antonius Hospital, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki–Chuo Chest Medical Center, Osaka, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Michael Kreuter
- Center for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg and Translational Lung Research Center Heidelberg, member of the DZL, Heidelberg, Germany
| | | | - Brett Ley
- Kaiser Permanente San Francisco, San Francisco, California
| | | | | | - Antonio Morais
- Pulmonology, Faculdade de Medicina do Porto, Centro Hospitalar São João, Oporto, Portugal
| | - Hilario Nunes
- INSERM UMR 1272, Paris 13 University, Sorbonne Paris Cité, Service de Pneumologie, Hopital Avicenne, Bobigny, France
| | - Ganesh Raghu
- Center for Interstitial Lung Disease, University of Washington, Seattle, Washington
| | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias “Ismael Cosio Villegas,” Mexico City, Mexico
| | - Paolo Spagnolo
- Respiratory Disease Unit, Department of Cardiac, Thoracic, and Vascular Sciences, University of Padova, Padova, Italy
| | - Hiroyuki Taniguchi
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, Seto, Japan
| | - Sara Tomassetti
- Department of Diseases of the Thorax, Ospedale G. B. Morgagni, Forlì, Italy
| | - Dominique Valeyre
- INSERM UMR 1272, Paris 13 University, Sorbonne Paris Cité, Service de Pneumologie, Hopital Avicenne, Bobigny, France
| | - Marlies Wijsenbeek
- Department of Pulmonary Diseases, Erasmus Medical Center, University Hospital Rotterdam, Rotterdam, the Netherlands; and
| | - Wim A. Wuyts
- Department of Pulmonary Medicine, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Athol U. Wells
- Interstitial Lung Disease Unit, Royal Brompton and Harefield Foundation Trust, London, United Kingdom
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32
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Antoniou KM, Trachalaki A, Tzouvelekis A, Poletti V, Vasarmidi E, Sfikakis P, Bouros D. A role of antifibrotics in the treatment of Scleroderma-ILD? Pulmonology 2019; 26:1-2. [PMID: 31653592 DOI: 10.1016/j.pulmoe.2019.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 07/25/2019] [Accepted: 08/20/2019] [Indexed: 11/30/2022] Open
Affiliation(s)
- Katerina M Antoniou
- Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece.
| | - Athina Trachalaki
- Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Argyris Tzouvelekis
- Medical School, National and Kapodistrian University of Athens, First Academic Department of Pneumonology, Interstitial Lung Disease Unit, Athens, Greece
| | - Venerino Poletti
- Department of Respiratory and Thoracic Diseases AUSL della Romagna, G.B. Morgagni - L. Pierantoni Hospital, Forli, Italy; Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Eirini Vasarmidi
- Department of Respiratory Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Petros Sfikakis
- First Department of Propaedeutic and Internal Medicine and Joined Rheumatology Program, Medical School, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece.
| | - Demosthenes Bouros
- Medical School, National and Kapodistrian University of Athens, First Academic Department of Pneumonology, Interstitial Lung Disease Unit, Athens, Greece
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33
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Tzouvelekis A, Tzilas V, Antoniou KM, Bouros D. Human pentraxin 2 protein treatment for IPF. The Lancet Respiratory Medicine 2019; 7:640-641. [DOI: 10.1016/s2213-2600(19)30173-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/27/2022]
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Antoniou KM, Tzilas V, Vasarmidi E, Symvoulakis EK, Tzouvelekis A, Bouros D. Interstitial lung abnormalities: ignotum per ignotius. Lancet Respir Med 2019; 7:376-378. [PMID: 30935882 DOI: 10.1016/s2213-2600(19)30052-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 01/31/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Katerina M Antoniou
- Department of Pneumonology, Medical School, University of Crete, Crete, Greece
| | - Vasilios Tzilas
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Eirini Vasarmidi
- Department of Pneumonology, Medical School, University of Crete, Crete, Greece
| | | | - Argyris Tzouvelekis
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece
| | - Demosthenes Bouros
- First Academic Department of Pneumonology, Interstitial Lung Diseases Unit, Hospital for Diseases of the Chest Sotiria, National and Kapodistrian University of Athens, Athens 11527, Greece.
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35
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Margaritopoulos GA, Trachalaki A, Wells AU, Vasarmidi E, Bibaki E, Papastratigakis G, Detorakis S, Tzanakis N, Antoniou KM. Pirfenidone improves survival in IPF: results from a real-life study. BMC Pulm Med 2018; 18:177. [PMID: 30470213 PMCID: PMC6251092 DOI: 10.1186/s12890-018-0736-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [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: 06/25/2018] [Accepted: 11/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pirfenidone is an antifibrotic compound approved for the treatment of idiopathic pulmonary fibrosis (IPF). We present our real-world experience in terms of Pirfenidone's effect on mortality and adverse events profile outside the restrictions of a clinical trial. METHODS This is a retrospective observational intention to treat study of 82 consecutive IPF patients (UHH cohort). RESULTS We observed a high 3-years survival rate of 73% without excluding patients who discontinued treatment for different reasons. The survival was compared to the survival of an IPF cohort from a tertiary referral center (RBH cohort). After exclusion of severe cases (DLco< 30%), in unadjusted analysis, the survival in the UHH cohort was better than in the RBH cohort (HR:0.32, 95% CI: 0.19-0.53, p < 0.0001). After adjustment for age, gender and FVC, the survival remained higher in the UHH cohort (HR:0.28, 95% CI: 0.16-0.48, p < 0.0001). We observed a similar safety profile compared to previously published data and a lower rate of drug discontinuation due to photosensitivity reactions. CONCLUSION Pirfenidone provides a survival benefit in a real-life IPF cohort compared to previously used medications. Counselling patients and proactively managing possible adverse effects can reduce the necessity to discontinue pirfenidone.
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Affiliation(s)
- George A Margaritopoulos
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece.,Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Athina Trachalaki
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Eirini Vasarmidi
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Eleni Bibaki
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | | | - Stathis Detorakis
- Radiology Department, University Hospital of Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece
| | - Katerina M Antoniou
- Respiratory Medicine Department, University Hospital of Heraklion, Crete, Greece.
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36
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Proklou A, Bolaki M, Vassalou EE, Bibaki E, Vasarmidi E, Margaritopoulos GA, Karantanas AH, Tzanakis N, Antoniou KM. Paroxysmal cough and left sacroiliac joint pain in a 50-year-old Caucasian man. Breathe (Sheff) 2018; 14:e59-e67. [PMID: 30131837 PMCID: PMC6095242 DOI: 10.1183/20734735.018818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
A 50-year-old Caucasian man who was a lifelong nonsmoker presented with a 3-year history of paroxysmal dry cough, fatigue, nonspecific myalgias, muscle weakness of the lower extremities and left sacroiliac joint pain. Initially, he was reviewed by a pulmonologist and subsequently he was referred to the Dept of Thoracic Medicine (Heraklion University Hospital, Heraklion, Greece) for further investigation. His medical history was remarkable for the presence of arterial hypertension on treatment with amlodipine and irbesartan. Can you diagnose this patient with pulmonary symptoms, thoracic and laboratory test abnormalities and sacroiliac joint pain?http://ow.ly/LPyy30kaViz
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37
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Bolaki M, Karagiannis K, Bertsias G, Mitrouska I, Tzanakis N, Antoniou KM. New respiratory symptoms and lung imaging findings in a woman with polymyositis. Breathe (Sheff) 2018; 14:e34-e39. [PMID: 30131832 PMCID: PMC6095235 DOI: 10.1183/20734735.000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
A 57-year-old Greek woman presented with a 5-day history of fever and progressively worse shortness of breath without any additional symptoms. Can you identify the cause of the acute respiratory failure in this patient with a history of polymyositis?http://ow.ly/jeDO30jLX5R
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38
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Bibaki E, Tsitoura E, Vasarmidi E, Margaritopoulos G, Trachalaki A, Koutoulaki C, Georgopoulou T, Spandidos DA, Tzanakis N, Antoniou KM. miR-185 and miR-29a are similarly expressed in the bronchoalveolar lavage cells in IPF and lung cancer but common targets DNMT1 and COL1A1 show disease specific patterns. Mol Med Rep 2018; 17:7105-7112. [PMID: 29568927 PMCID: PMC5928671 DOI: 10.3892/mmr.2018.8778] [Citation(s) in RCA: 15] [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: 02/01/2018] [Accepted: 03/19/2018] [Indexed: 12/20/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) and lung cancer (LC) constitute two progressively devastating lung diseases with common risk factors including aging and smoking. There is an increasing interest in the investigation of common pathogenic mechanisms between IPF and LC with therapeutic implications. Several oncomirs, microRNAs associated with malignancy, are also linked with IPF. miR-29a and miR-185 downregulation is probably involved both in carcinogenesis and fibrogenesis. We have previously observed miR-29a and miR-185 downregulation in IPF cells from bronchoalveolar lavage (BAL) and in this study we investigated their expression in LC BAL cells. Common targets of miR-29a and miR-185 such as DNA methyltransferase (DNMT)1, DNMT3b, COL1A1, AKT1 and AKT2 were measured. Potential correlations with pulmonary function tests, smoking status and endobronchial findings were investigated. Similar levels of miR-29a and miR-185 were detected in IPF and LC while their common targets AKT1 and DNMT3b were not found to differ, suggesting potential pathogenetic similarities at the level of key epigenetic regulators. By conrast, COL1A1 mRNA levels were increased in IPF suggesting a disease-specific mRNA signature. Notably, DNMT1 was downregulated in the LC group and its expression was further reduced in the presence of increasing malignant burden as it was implied by the endobronchial findings.
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Affiliation(s)
- Eleni Bibaki
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Eliza Tsitoura
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Eirini Vasarmidi
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - George Margaritopoulos
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Athina Trachalaki
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Chara Koutoulaki
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Theodora Georgopoulou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Nikos Tzanakis
- Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, 71110 Heraklion, Crete, Greece
| | - Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, 71110 Heraklion, Crete, Greece
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Bouros D, Daniil Z, Papakosta D, Antoniou KM, Markopoulou K, Kolilekas L, Konstantopoulos G, Papiris S. Design, Rationale, Methodology, and Aims of a Greek Prospective Idiopathic Pulmonary Fibrosis Registry: Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF). Respiration 2018; 96:41-47. [PMID: 29514162 DOI: 10.1159/000487244] [Citation(s) in RCA: 6] [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: 12/18/2017] [Accepted: 01/23/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Idiopathic pulmonary fibrosis (IPF) is a chronic, fibrosing interstitial pneumonia of unknown origin. Despite the fact that the guidelines on the diagnosis and management of the disease were updated in 2015, incorporating novel agents recently introduced in the therapeutic approach of IPF, there is a lack of data on the epidemiology, disease status, and treatment in clinical practice. Contemporary data provided by national registries in IPF provide valuable information to guide clinical management of the disease in the real-world setting, adjusted to the local needs. OBJECTIVE Investigating Idiopathic Pulmonary Fibrosis in Greece (INDULGE IPF) is a Greek observational registry aiming at gaining further knowledge on the characteristics, management, progression, and outcomes of patients with IPF treated under real-world, clinical practice conditions in Greece. METHODS Approximately 300 patients will be enrolled consecutively in seven reference centers, constituting the largest IPF registry ever established in Greece. CONCLUSION This registry is expected to provide data on the characteristics of IPF patients in Greece and the entire clinical management during the course of the disease.
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Affiliation(s)
- Demosthenes Bouros
- 1st Academic Department of Pneumonology, Hospital for Diseases of the Chest "Sotiria," Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Zoe Daniil
- Respiratory Medicine Department, University of Thessaly School of Medicine, University Hospital of Larissa, Larissa, Greece
| | - Despoina Papakosta
- Pulmonary Medicine Department, General Hospital of Thessaloniki "G. Papanikolaou," Aristotle University of Thessaloniki Medical School, Thessaloniki, Greece
| | - Katerina M Antoniou
- Thoracic Medicine Department, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina Markopoulou
- NHS Pulmonology Department, General Hospital of Thessaloniki "G. Papanikolaou,", Thessaloniki, Greece
| | - Likurgos Kolilekas
- NHS 7th Pulmonary Department and Asthma Center, Hospital for Diseases of the Chest "Sotiria,", Athens, Greece
| | | | - Spyros Papiris
- 2nd Respiratory Medicine Department, Medical School, National and Kapodistrian University of Athens, Attikon General Hospital, Athens, Greece
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Vassalou EE, Raissaki M, Magkanas E, Antoniou KM, Karantanas AH. Lung Ultrasonography in Patients With Idiopathic Pulmonary Fibrosis: Evaluation of a Simplified Protocol With High-Resolution Computed Tomographic Correlation. J Ultrasound Med 2018; 37:689-696. [PMID: 28877354 DOI: 10.1002/jum.14406] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare a simplified ultrasonographic (US) protocol in 2 patient positions with the same-positioned comprehensive US assessments and high-resolution computed tomographic (CT) findings in patients with idiopathic pulmonary fibrosis. METHODS Twenty-five consecutive patients with idiopathic pulmonary fibrosis were prospectively enrolled and examined in 2 sessions. During session 1, patients were examined with a US protocol including 56 lung intercostal spaces in supine/sitting (supine/sitting comprehensive protocol) and lateral decubitus (decubitus comprehensive protocol) positions. During session 2, patients were evaluated with a 16-intercostal space US protocol in sitting (sitting simplified protocol) and left/right decubitus (decubitus simplified protocol) positions. The 16 intercostal spaces were chosen according to the prevalence of idiopathic pulmonary fibrosis-related changes on high-resolution CT. The sum of B-lines counted in each intercostal space formed the US scores for all 4 US protocols: supine/sitting and decubitus comprehensive US scores and sitting and decubitus simplified US scores. High-resolution CT-related Warrick scores (J Rheumatol 1991; 18:1520-1528) were compared to US scores. The duration of each protocol was recorded. RESULTS A significant correlation was found between all US scores and Warrick scores and between simplified and corresponding comprehensive scores (P < .0001). Decubitus simplified US scores showed a slightly higher correlation with Warrick scores compared to sitting simplified US scores. Mean durations of decubitus and sitting simplified protocols were 4.76 and 6.20 minutes, respectively (P < .005). CONCLUSIONS Simplified 16-intercostal space protocols correlated with comprehensive protocols and high-resolution CT findings in patients with idiopathic pulmonary fibrosis. The 16-intercostal space simplified protocol in the lateral decubitus position correlated better with high-resolution CT findings and was less time-consuming compared to the sitting position.
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Affiliation(s)
- Evangelia E Vassalou
- Departments of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Maria Raissaki
- Departments of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Eleftherios Magkanas
- Department of Medical Imaging, Queen's Medical Center, Nottingham University Hospital, Nottingham, England
| | - Katerina M Antoniou
- Thoracic Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Departments of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
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Antoniou KM, Karagiannis K, Tsitoura E, Bibaki E, Lasithiotaki I, Proklou A, Spandidos DA, Tzanakis N. Clinical applications of mesenchymal stem cells in chronic lung diseases. Biomed Rep 2018; 8:314-318. [PMID: 29556380 PMCID: PMC5844081 DOI: 10.3892/br.2018.1067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Accepted: 02/12/2018] [Indexed: 12/18/2022] Open
Abstract
Mesenchymal stem (stromal) cells (MSCs) are multipotent stromal cells that have the ability to modulate immune response to tissue injury and promote repair in vivo. The therapeutic potential of ex vivo expanded MSCs are currently under investigation for a variety of chronic and acute lung diseases. This review summarizes the encouraging results regarding the safety of MSCs administration from recent and current clinical trials for idiopathic pulmonary fibrosis, acute respiratory distress syndrome, and chronic obstructive pulmonary disease. It also reviews the early preliminary data extracted by the same trials regarding the efficacy of MSCs in the aforementioned lung diseases.
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Affiliation(s)
- Katerina M Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece.,Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
| | - Konstantinos Karagiannis
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece.,Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
| | - Eliza Tsitoura
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece
| | - Eleni Bibaki
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece.,Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
| | - Ismini Lasithiotaki
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece.,Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
| | - Athanasia Proklou
- Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion 71110, Crete, Greece.,Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
| | - Demetrios A Spandidos
- Laboratory of Clinical Virology, Medical School, University of Crete, Voutes, Heraklion 71003, Crete, Greece
| | - Nikos Tzanakis
- Department of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital, University of Crete, Heraklion 71110, Crete, Greece
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42
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Samara KD, Trachalaki A, Tsitoura E, Koutsopoulos AV, Lagoudaki ED, Lasithiotaki I, Margaritopoulos G, Pantelidis P, Bibaki E, Siafakas NM, Tzanakis N, Wells AU, Antoniou KM. Upregulation of citrullination pathway: From Autoimmune to Idiopathic Lung Fibrosis. Respir Res 2017; 18:218. [PMID: 29287593 PMCID: PMC5747943 DOI: 10.1186/s12931-017-0692-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [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: 03/07/2017] [Accepted: 12/02/2017] [Indexed: 12/31/2022] Open
Abstract
Background Increased protein citrullination and peptidylarginine deiminases (PADIs), which catalyze the citrullination process, are central in Rheumatoid arthritis pathogenesis and probably involved in the initial steps towards autoimmunity. Approximately, 10% of RA patients develop clinically significantly ILD. A possible shared role of protein citrullination in rheumatoid arthritis associated interstitial lung disease (RA-ILD), and idiopathic pulmonary fibrosis (IPF) pathogenesis remains unclear. Methods We evaluated PADI2 and PADI4 mRNA expression in bronchoalveolar lavage fluid (BALF) cells of 59 patients with IPF, 27 patients RA-ILD and 10 healthy controls. PADI 2 and 4 expression was analyzed by western blot and immunohistochemistry. Citrullinated protein levels were also quantified. Results PADI4 mRNA and protein levels were higher in RA-ILD and IPF than controls. Furthermore, PADI4 mRNA levels showed an increase among smokers in RA-ILD. PADI4 expression was detected in granulocytes and macrophages in all groups, with the strongest cytoplasmic expression observed in granulocytes in RA-ILD and IPF. PADI2 mRNA and immunostaining of BAL cells, were similar in all groups among smokers. Overall, stronger staining was observed in current smokers. Citrullinated peptides were significantly increased in IPF compared to RA-ILD and controls. In RA-ILD, protein citrullination strongly correlated with PADI4 expression and anti-citrullinated protein antibodies (ACPAs). Conclusions These results suggest that the citrullination pathway is upregulated in IPF and in RA-ILD. Electronic supplementary material The online version of this article (10.1186/s12931-017-0692-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Katerina D Samara
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.,Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, SW3 6NP, UK
| | - Athina Trachalaki
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Eliza Tsitoura
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Anastasios V Koutsopoulos
- Department of Pathology, Medical School, University of Crete and Heraklion University Hospital, Heraklion, Crete, Greece
| | - Eleni D Lagoudaki
- Department of Pathology, Medical School, University of Crete and Heraklion University Hospital, Heraklion, Crete, Greece
| | - Ismini Lasithiotaki
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - George Margaritopoulos
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, SW3 6NP, UK
| | - Panagiotis Pantelidis
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, SW3 6NP, UK
| | - Eleni Bibaki
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos M Siafakas
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Nikolaos Tzanakis
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Athol U Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, Imperial College, London, SW3 6NP, UK
| | - Katerina M Antoniou
- Department of Thoracic Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Crete, Greece.
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Molina-Molina M, Agusti A, Crestani B, Schwartz DA, Königshoff M, Chambers RC, Maher TM, Faner R, Mora AL, Rojas M, Antoniou KM, Sellares J. Towards a global initiative for fibrosis treatment (GIFT). ERJ Open Res 2017; 3:00106-2017. [PMID: 29214157 PMCID: PMC5710382 DOI: 10.1183/23120541.00106-2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 08/25/2017] [Accepted: 10/06/2017] [Indexed: 12/13/2022] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is a progressive lung disease characterised by increased scarring of lung tissue. Despite the recent introduction of novel drugs that slow disease progression, IPF remains a deadly disease, and the benefits of these new drugs differ markedly between patients. Human diseases arise due to alterations in an almost limitless network of interconnected genes, proteins, metabolites, cells and tissues, in direct relationship with a continuously changing macro- or microenvironment. Systems biology is a novel research strategy that seeks to understand the structure and behaviour of the so-called “emergent properties” of complex systems, such as those involved in disease pathogenesis, which are most often overlooked when just one element of disease pathogenesis is observed in isolation. This article summarises the debate that took place during a European Respiratory Society research seminar in Barcelona, Spain on December 15–16, 2016, which focused on how systems biology could generate new data by integrating the different IPF pathogenic levels of complexity. The main conclusion of the seminar was to create a global initiative to improve IPF outcomes by integrating cutting-edge international research that leverages systems biology to develop a precision medicine approach to tackle this devastating disease. A novel call to action for implementing systems biology in IPF researchhttp://ow.ly/Is0A30gpnVb
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Affiliation(s)
- Maria Molina-Molina
- Servei de Pneumologia, Laboratori de Pneumologia Experimental, IDIBELL, Campus de Bellvitge, Universitat de Barcelona, Barcelona, Spain.,CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain
| | - Alvar Agusti
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Bruno Crestani
- Service de Pneumologie A, Hospital Bichat, University Paris Diderot, Paris, France
| | | | - Melanie Königshoff
- Division of Pulmonary Sciences and Critical Care Medicine, Dept of Medicine, University of Colorado, Aurora, CO, USA
| | - Rachel C Chambers
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, London, UK
| | - Toby M Maher
- Interstitial Lung Disease Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK.,Fibrosis Research Group, National Heart and Lung Institute, Imperial College, London, UK
| | - Rosa Faner
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - Ana Lucia Mora
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,Vascular Medicine Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Mauricio Rojas
- Division of Pulmonary, Allergy, and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.,The Dorothy P. and Richard P. Simmons Center for Interstitial Lung Disease, University of Pittsburgh, Pittsburgh, PA, USA
| | - Katerina M Antoniou
- Dept of Respiratory Medicine and Laboratory of Molecular and Cellular Pneumonology, Medical School, University of Crete, Heraklion, Greece
| | - Jacobo Sellares
- CIBER of Respiratory Diseases, ISCIII, Barcelona, Spain.,Servei de Pneumologia, Institut Respiratori, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
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Vassalou EE, Raissaki M, Magkanas E, Antoniou KM, Karantanas AH. Modified Lung Ultrasonographic Technique for Evaluation of Idiopathic Pulmonary Fibrosis: Lateral Decubitus Position. J Ultrasound Med 2017; 36:2525-2532. [PMID: 28656715 DOI: 10.1002/jum.14297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare lung ultrasonography (US) in the sitting or supine positions and the lateral decubitus position, with regard to the feasibility, duration, patient convenience, and assessment of B-lines, in patients with idiopathic pulmonary fibrosis. METHODS Twenty consecutive patients with idiopathic pulmonary fibrosis were prospectively enrolled. Lung US included scanning of 56 intercostal spaces. Each patient was examined twice by 2 protocols. During protocol 1, patients were examined in the supine and sitting positions for the anterior and dorsal chest, respectively. During protocol 2, patients were examined in the left lateral decubitus position for the evaluation of the right hemithorax and the reverse. Total, anterior, and posterior US scores resulted from the sum of B-lines at the whole, anterior, and posterior chest, respectively. High-resolution computed tomography (CT) was considered the reference standard. The duration of each protocol was recorded. Patients were questioned about which protocol they preferred. RESULTS There was no difference regarding feasibility between the protocols. A significant correlation was found between total US scores for both protocols and high-resolution CT findings (P < .0001), with protocol 2 showing a slightly higher correlation. A positive correlation was found between the protocols regarding total, anterior, and posterior US scores (P < .0001). The mean duration of protocol 2 was less than that of protocol 1 (P < .005). Nineteen patients (95%) reported a preference for protocol 2. CONCLUSIONS Lung US in the lateral decubitus position seems to be faster and more convenient. There appears to be no difference regarding feasibility and the number of B-lines, whereas it shows slightly higher correlation with high-resolution CT, compared with the sitting or supine positions in patients with idiopathic pulmonary fibrosis.
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Affiliation(s)
- Evangelia E Vassalou
- Department of Radiology, University of Crete, and Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Maria Raissaki
- Department of Radiology, University of Crete, and Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
| | - Eleftherios Magkanas
- Department of Medical Imaging, Queen's Medical Center, Nottingham University Hospital, Nottingham, England
| | - Katerina M Antoniou
- Department of Thoracic Medicine, University Hospital of Heraklion, Crete, Greece
| | - Apostolos H Karantanas
- Department of Radiology, University of Crete, and Department of Medical Imaging, University Hospital of Heraklion, Crete, Greece
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Cottin V, Hansell DM, Sverzellati N, Weycker D, Antoniou KM, Atwood M, Oster G, Kirchgaessler KU, Collard HR, Wells AU. Effect of Emphysema Extent on Serial Lung Function in Patients with Idiopathic Pulmonary Fibrosis. Am J Respir Crit Care Med 2017; 196:1162-1171. [PMID: 28657784 DOI: 10.1164/rccm.201612-2492oc] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [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: 01/21/2023] Open
Abstract
RATIONALE Patients with idiopathic pulmonary fibrosis and emphysema may have artificially preserved lung volumes. OBJECTIVES In this post hoc analysis, we investigated the relationship between baseline emphysema and fibrosis extents, as well as pulmonary function changes, over 48 weeks. METHODS Data were pooled from two phase III, randomized, double-blind, placebo-controlled trials of IFN-γ-1b in idiopathic pulmonary fibrosis (GIPF-001 [NCT00047645] and GIPF-007 [NCT00075998]). Patients with Week 48 data, baseline high-resolution computed tomographic images, and FEV1/FVC ratios less than 0.8 or greater than 0.9 (<0.7 or >0.9 in GIPF-007), as well as randomly selected patients with ratios of 0.8-0.9 and 0.7-0.8, were included. Changes from baseline in pulmonary function at Week 48 were analyzed by emphysema extent. The relationship between emphysema and fibrosis extents and change in pulmonary function was assessed using multivariate linear regression. MEASUREMENTS AND MAIN RESULTS Emphysema was identified in 38% of patients. A negative correlation was observed between fibrosis and emphysema extents (r = -0.232; P < 0.001). In quartile analysis, patients with the greatest emphysema extent (28 to 65%) showed the smallest FVC decline, with a difference of 3.32% at Week 48 versus patients with no emphysema (P = 0.047). In multivariate analyses, emphysema extent greater than or equal to 15% was associated with significantly reduced FVC decline over 48 weeks versus no emphysema or emphysema less than 15%. No such association was observed for diffusing capacity of the lung for carbon monoxide or composite physiologic index. CONCLUSIONS FVC measurements may not be appropriate for monitoring disease progression in patients with idiopathic pulmonary fibrosis and emphysema extent greater than or equal to 15%.
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Affiliation(s)
- Vincent Cottin
- 1 Department of Respiratory Medicine, National Reference Center for Rare Pulmonary Diseases, Louis Pradel Hospital, Lyon, France.,2 Université Claude Bernard, Lyon, France
| | - David M Hansell
- 3 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
| | - Nicola Sverzellati
- 4 Department of Surgical Sciences, Ospedale Maggiore di Parma, Parma, Italy
| | | | | | - Mark Atwood
- 5 Policy Analysis Inc., Brookline, Massachusetts
| | - Gerry Oster
- 5 Policy Analysis Inc., Brookline, Massachusetts
| | | | - Harold R Collard
- 8 Division of Pulmonary and Critical Care Medicine, University of California, San Francisco, San Francisco, California
| | - Athol U Wells
- 3 Interstitial Lung Disease Unit, Royal Brompton Hospital, London, United Kingdom
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Wells AU, Antoniou KM. Treatment doses in idiopathic pulmonary fibrosis: The devil is in the detail. Respirology 2017; 23:244-245. [DOI: 10.1111/resp.13182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Athol U. Wells
- Interstitial Lung Disease Unit; Royal Brompton Hospital; London UK
| | - Katerina M. Antoniou
- Department of Respiratory Medicine and Laboratory of Molecular and Cellular Pulmonology; University of Crete; Crete Greece
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Walsh SLF, Maher TM, Kolb M, Poletti V, Nusser R, Richeldi L, Vancheri C, Wilsher ML, Antoniou KM, Behr J, Bendstrup E, Brown K, Calandriello L, Corte TJ, Cottin V, Crestani B, Flaherty K, Glaspole I, Grutters J, Inoue Y, Kokosi M, Kondoh Y, Kouranos V, Kreuter M, Johannson K, Judge E, Ley B, Margaritopoulos G, Martinez FJ, Molina-Molina M, Morais A, Nunes H, Raghu G, Ryerson CJ, Selman M, Spagnolo P, Taniguchi H, Tomassetti S, Valeyre D, Wijsenbeek M, Wuyts W, Hansell D, Wells A. Diagnostic accuracy of a clinical diagnosis of idiopathic pulmonary fibrosis: an international case-cohort study. Eur Respir J 2017; 50:50/2/1700936. [PMID: 28860269 DOI: 10.1183/13993003.00936-2017] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 05/30/2017] [Indexed: 11/05/2022]
Abstract
We conducted an international study of idiopathic pulmonary fibrosis (IPF) diagnosis among a large group of physicians and compared their diagnostic performance to a panel of IPF experts.A total of 1141 respiratory physicians and 34 IPF experts participated. Participants evaluated 60 cases of interstitial lung disease (ILD) without interdisciplinary consultation. Diagnostic agreement was measured using the weighted kappa coefficient (κw). Prognostic discrimination between IPF and other ILDs was used to validate diagnostic accuracy for first-choice diagnoses of IPF and were compared using the C-index.A total of 404 physicians completed the study. Agreement for IPF diagnosis was higher among expert physicians (κw=0.65, IQR 0.53-0.72, p<0.0001) than academic physicians (κw=0.56, IQR 0.45-0.65, p<0.0001) or physicians with access to multidisciplinary team (MDT) meetings (κw=0.54, IQR 0.45-0.64, p<0.0001). The prognostic accuracy of academic physicians with >20 years of experience (C-index=0.72, IQR 0.0-0.73, p=0.229) and non-university hospital physicians with more than 20 years of experience, attending weekly MDT meetings (C-index=0.72, IQR 0.70-0.72, p=0.052), did not differ significantly (p=0.229 and p=0.052 respectively) from the expert panel (C-index=0.74 IQR 0.72-0.75).Experienced respiratory physicians at university-based institutions diagnose IPF with similar prognostic accuracy to IPF experts. Regular MDT meeting attendance improves the prognostic accuracy of experienced non-university practitioners to levels achieved by IPF experts.
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Affiliation(s)
- Simon L F Walsh
- Dept of Radiology, King's College Hospital Foundation Trust, London, UK
| | - Toby M Maher
- Dept of Respiratory Medicine, Interstitial Lung Disease Unit, Royal Brompton Hospital and National Heart and Lung Institute, Imperial College, London, UK
| | - Martin Kolb
- Depts of Medicine and Pathology/Molecular Medicine, McMaster University, Firestone Institute for Respiratory Health, Hamilton, ON, Canada
| | - Venerino Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Nusser
- Dept of Respiratory Medicine, Summit Hospital, Oakland, CA, USA
| | - Luca Richeldi
- Unità Operativa Complessa di Pneumologia, Università Cattolica del Sacro Cuore, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Carlo Vancheri
- Dept of Clinical and Experimental Medicine, University of Catania, University - Hospital "Policlinico - Vitt. Emanuele", Catania, Italy
| | - Margaret L Wilsher
- Auckland District Health Board and the University of Auckland, Auckland, New Zealand
| | - Katerina M Antoniou
- Dept of Respiratory Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Jüergen Behr
- Dept of Medicine V, University of Munich and Asklepios Fachkliniken Gauting, Comprehensive Pneumology Center, member of the German Center for Lung Research, Munich, Germany
| | - Elisabeth Bendstrup
- Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lucio Calandriello
- Institute of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Tamera J Corte
- Dept of Respiratory Medicine, Royal Prince Alfred Hospital, and University of Sydney, Sydney, Australia
| | | | - Bruno Crestani
- APHP, Hopital Bichat, Service de Pneumologie A, Université Paris Diderot, Paris, France
| | - Kevin Flaherty
- University of Michigan, Division of Pulmonary and Critical Care Medicine, Ann Arbor, MI, USA
| | - Ian Glaspole
- Alfred Health - Allergy, Immunology and Respiratory Medicine, Melbourne, Australia
| | - Jan Grutters
- ILD Center of Excellence, St Antonius Hospital, Division Heart and Lungs, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - Maria Kokosi
- Dept of Respiratory Medicine, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Yasuhiro Kondoh
- Tosei General Hospital, Dept of Respiratory Medicine and Allergy, Seto, Japan
| | - Vasileios Kouranos
- Dept of Respiratory Medicine, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | - Michael Kreuter
- Center for interstitial and rare lung diseases, Pneumology and respiratory critical care medicine, Thoraxklinik, University of Heidelberg, and Translational Lung Research Center Heidelberg, Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | | | - Eoin Judge
- Respiratory Medicine and National Lung Transplantation Unit, Mater Misericordiae University Hospital, Dublin , Ireland
| | - Brett Ley
- Medicine, University of California San Francisco, San Francisco, CA, USA
| | - George Margaritopoulos
- Dept of Respiratory Medicine, Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
| | | | | | - António Morais
- Centro Hospitalar São João - Pulmonology, Faculdade de Medicina do Porto, Alameda Professor Hernâni Monteiro, Oporto, Portugal
| | - Hilario Nunes
- Paris 13 University, Sorbonne Paris Cité, Service de Pneumologie, Hopital Avicenne, Bobigny, France
| | - Ganesh Raghu
- University of Washington - Center for Interstitial Lung Disease, Seattle, WA, USA
| | | | - Moises Selman
- Instituto Nacional de Enfermedades Respiratorias "Ismael Cosio Villegas", Mexico City, Mexico
| | - Paolo Spagnolo
- Section of Respiratory Diseases, Dept of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Hiroyuki Taniguchi
- Tosei General Hospital, Dept of Respiratory Medicine and Allergy, Seto, Japan
| | - Sara Tomassetti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy
| | - Dominique Valeyre
- Paris 13 University, Sorbonne Paris Cité, Service de Pneumologie, Hopital Avicenne, Bobigny, France
| | - Marlies Wijsenbeek
- Dept of Pulmonary Diseases, Erasmus MC, University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Wim Wuyts
- Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - David Hansell
- Dept of Thoracic Imaging, Royal Brompton Hospital, London, UK
| | - Athol Wells
- Interstitial Lung Disease Unit, Royal Brompton Hospital, London, UK
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Antoniou KM, Bibaki E, Margaritopoulos GA. Controversies in Fibrosis and Emphysema. Arch Bronconeumol 2017; 53:231-232. [DOI: 10.1016/j.arbres.2017.02.003] [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] [Received: 11/04/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
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Kahn N, Fregonese L, Barrecheguren M, Franssen FM, Grgic A, Gompelmann D, Bibaki E, Antoniou KM, Kocks JW, Pinnock H, Herth F. Clinical highlights from the 2016 European Respiratory Society International Congress. ERJ Open Res 2017; 3:00147-2016. [PMID: 28462234 PMCID: PMC5406227 DOI: 10.1183/23120541.00147-2016] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 03/05/2017] [Indexed: 12/13/2022] Open
Abstract
This article contains highlights and a selection of the scientific advances from the European Respiratory Society (ERS) Clinical Assembly (Assembly 1) and its six respective groups (Groups 1.1-1.6) that were presented at the 2016 ERS International Congress in London, UK. The most relevant topics for clinicians will be discussed, covering a wide range of areas including clinical problems, rehabilitation and chronic care, thoracic imaging, interventional pulmonology, diffuse and parenchymal lung diseases, and general practice and primary care. In this comprehensive review, the newest research and actual data will be discussed and put into perspective.
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Affiliation(s)
- Nicolas Kahn
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Laura Fregonese
- Product Development Scientific Support Dept, European Medicines Agency, London, UK
| | | | | | - Aleksandar Grgic
- Dept of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany
| | - Daniela Gompelmann
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
| | - Eleni Bibaki
- Dept of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Katerina M. Antoniou
- Dept of Thoracic Medicine, Interstitial Lung Disease Unit, University Hospital of Heraklion, Heraklion, Greece
| | - Janwillem W.H. Kocks
- University of Groningen, University Medical Center Groningen, Dept of General Practice and Elderly Care Medicine, Groningen, The Netherlands
- University of Groningen, University Medical Center Groningen, GRIAC Research Institute, Groningen, The Netherlands
| | - Hillary Pinnock
- Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Felix Herth
- Pneumology and Critical Care Medicine, Thoraxklinik at University of Heidelberg, Heidelberg, Germany
- Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany
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50
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Margaritopoulos GA, Antoniou KM. Reply: Is a Trial of Vitamin K Antagonists and Bisphosphonates Possible in IPF? Am J Respir Crit Care Med 2017; 195:271-272. [DOI: 10.1164/rccm.201608-1636le] [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: 11/16/2022] Open
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